Archive for the ‘Sensory issues’ Category

A(nother) Laboratory Test(s) for Autism

Sunday, March 19th, 2017

A key piece of the autism puzzle appears to have been confirmed in an article published this week in the Public Library of Science Open Access Journal, Computational Biology. The title of the article is Classification and adaptive behavior prediction of children with autism spectrum disorder based upon multivariate data analysis of markers of oxidative stress and DNA methylation.

The news has already been reported in popular media as “A Blood Test for Autism“. Here is my clinical interpretation.

The Study
The data was collected from patients in previous studies, and included 83 children, aged 3-10 years, with ASD. Utilizing very dense, complicated statistics that were based on biochemical laboratory data, researchers identified neurotypical vs. autistic individuals, who already had the diagnosis, based on conventional developmental testing.

The chosen pathways evaluated abnormalities in methylation, an epigenetic function, and detoxification.

Specificity and sensitivity were very reliable, “96.1% of all neurotypical participants being correctly identified as such while still correctly identifying 97.6% of the ASD cohort.”

Discussion
Contrary to what the headlines proclaim, this is not a single test; it’s research material that is based on a number of not-yet-readily-available laboratory findings.

The biomarkers represent a final common pathway, not necessarily a cause. Although the data correlated with autism ‘scores’, it really wasn’t meant to discriminate for the various kinds of developmental challenges, such as those children who are mostly aggressive, immune, apraxic, or suffer gastrointestinal abnormalities.

Such an analysis begs the question, “Can it be used for prospective improvement – to follow course of the condition?”

Conclusion
The modern epidemic of childhood autism is extremely complicated and difficult to pin down for research purposes. This study renders a modern means to evaluate a myriad of variables. The metabolic pathways under scrutiny represent a confirmation of the roles of genes and toxins.

As with other ‘earliest diagnosis’ studies, this paper serves to solidify the concept that earlier diagnosis should lead to earlier interventions, with improved outcomes.

For those of us who are practicing ‘alternative’ medicine, it is comforting to rediscover that the treatments included in our modern arsenal of biomedical protocols are consistent with these findings.

Medical Academy of Pediatric Special Needs Spring 2017 Conference

Sunday, March 12th, 2017

At the conference with Yale prof Dr. Sid Baker – one of the originators of biomedical treatment

If practitioners wish to become more effective in the diagnosis and treatment of children who suffer developmental challenges, it will require a new paradigm. Therefore, attending conferences, such as the Simons Foundation for Autism Research, the Autism Research Institute, and the Medical Academy of Pediatric Special Needs, is essential to acquiring that knowledge.

This year’s advanced sessions introduced a completely new functional medicine topic – Hormones from Pregnancy to Teens. Dr. Cindy Schneider examined the differences between the brain anatomy, physiology, and chemistry that might explain how ASD affects males vs. females, and the consequences as we age. Additionally, there are the special complications incurred throughout puberty, with important implications regarding effective treatments.

Dr. Stephen Genuis‘ presentations, Hormone Disrupting Agents, provided a fascinating complement to that lecture. He highlighted the chronic nature of ASD, and the disrupting effects of toxic agents in our modern environment. A key component is the toxic load; if topical agents represent ounces, ingested compounds represent pounds, and the air that we breathe can be expressed in tons of potential poisonous compounds. And, it takes months or years to eliminate what takes days or weeks to ingest. He also pointed out that medical school curricula and training in toxicology is woefully inadequate.

Dr. Lynne Mielke rounded out the day by submitting actual case histories of young people with mysterious medical problems. Her background includes personal experience, extensive knowledge and patient care. This physician’s psychiatric/neurological point-of-view was especially insightful and provided valuable material that directly applied to the audience’s practice population.

Day 2
Another novel and exciting topic was Preconception Care: A New Standard of Care in Maternal-Fetal Medicine. Dr. Genuis discussed the increased risks of preterm birth, Caesarian section delivery, and chronic childhood illness, such as cancers, diabetes, autoimmune conditions, autism and  ADHD.
He presented the emerging research of toxicant exposures and nutritional deficiencies that continue to escalate. Metabolic disruptions may easily ensue, leading to many of the persistent disorders that are now experienced by an increasing number of children, although they may look perfectly normal at birth.

Such difficulties seem imminently preventable in the population, and there appears to be a lack of awareness in the majority of obstetricians. Even fathers who are exposed to toxic agents may become a vector for such later difficulties. Dr. Genuis then discussed the means to eliminate the myriad of  toxins – mostly by sweating, but some by other means, such as fasting or medication.

Dr. Elizabeth Mumper followed with an in-depth discussion about the lack of awareness of proper nutrition, environmental factors, the hazards of indiscriminate use of antibiotics, and poorly researched vaccinations, which appear to be significant factors leading to autism. She even offered another alternative schedule for high-risk infants and toddlers.

Nutritionist Robert Miller presented a very dense lecture, attempting to answer the complicated question, “What can be done about all of those new-fangled genetics tests?” Suffice it to say, that offering will take some time to digest.

Day 3
The lectures consisted of an assortment of the faculty’s most difficult cases. Experts included Drs. Baker, Frye, and Neuenschwander; and the audience wasn’t too shabby, either. Case histories were offered about families who experience unimaginable, incomprehensible challenges; from self-mutilation, to children attempting suicide (sometimes, successfully), to attacks on their caregivers.

The take-home items from such discussions are simply, “How can we prevent this, and successfully treat our population?”

Conclusion
It’s fortuitous that Dr. Ratajczek’s article, which examined the research about vaccine safety, was published at the time of this seminar. Participants have been wringing our hands about the ‘disconnect’ between what we (and many parents) experience every day, and conventional medicine’s dogma. The article might act as fuel-to-the-fire for some, be ignored by the majority, but represents some slight measure of vindication for our hard-working tribe.

We are getting only marginally closer to our understanding about the cause(s), treatment(s), and prevention(s) for autism. Much more research is needed. The Medical Academy of Pediatric Special Needs provides a valuable platform for presenting, evaluating, and disseminating such expertise.

Observations on an Autism Workshop

Sunday, March 5th, 2017

March 5, 2017.
Yesterday, I had the opportunity to be part of a panel for the South Florida Autism Charter Schools‘ medical workshop. In attendance were ~50 parents, and a group of 9 professionals; including dentists, a pediatric neurologist, an Ob-Gyn, a pediatrician, a psychologist and behavioral therapist.

My role was to answer questions regarding the biomedical approach to ASD.
Here are some of the things that I learned:

Parents are extremely frustrated by the lack of available services for special needs patients. “He’s too big for our MRI machine,” or “They do not know how to handle her aggression,” were common complaints. Frankly, the presenters had few useful suggestions that the families hadn’t already attempted.

Therapists and administrators wanted to be sure that parents take advantage of all available means for relief, such as following up with a medication schedule, and notifying appropriate personnel about serious issues in a timely manner.

There was a general dissatisfaction about the medical community’s lack of understanding regarding special needs families. Since the panel was composed of busy professionals willing to give up a Saturday morning, they were basically ‘preachin’ to the choir’.

Everyone agreed that the ideal situation would be a ‘one-stop shop’ for patients to get all necessary testing and treatment. Cancer Treatment Centers of America, for example, advertises that availability, and many facilities now afford such service. It may be some time before supply catches up to the demand, for special needs children, however.

I enjoyed an in-depth discussion with Dr. Jose Berthe about the proper time, types of evaluation, and medical interventions, as girls with developmental challenges get older.

Dr. Yadira Martinez-Fernandez contributed her comprehensive knowledge of autism and cardiac health. Affected children who suffer genetic or other complicated disorders, or who take certain medications, may be at an increased risk, which can be ascertained by appropriate evaluation, such as blood pressure monitoring, or an EKG.

The dental experts reviewed their approach to oral health; from how to get a successful visit, to evaluation and treatment of the common symptom of teeth grinding.

Dr. Carrie Landess provided her unique perspective and valuable insights, as a pediatric neurologist who is also the parent of a child with ASD.

My good friend and colleague, Dr. Linda Colon, offered several practical solutions for the challenged families’ concerns. The general pediatric community would find a great deal more cooperation from families, were they to adopt her thoughtful and empathetic point-of-view toward the autism epidemic.

Dr. Moodie, the Executive Director, is a fireball. Her experience, knowledge, insight, and dedication is leading to tangible changes in the care of children with developmental difficulties.

Conclusion
Parents want – and deserve – more answers, better service, and faster roads to improvement for their special needs children. The South Florida Autism Charter School is doing a great job in providing a tangible means toward those ends.

Recent Research about MRIs for Autism

Sunday, February 26th, 2017

Since the outbreak of autism, various attempts have been made to utilize modern imaging techniques to provide a more precise diagnosis. Here are two recent stories that warrant recognition and comment.

Relationship between brain stem volume and aggression in children diagnosed with autism spectrum disorder is not the first of its kind to describe an inverse correlation between the size of that part of the central nervous system and ASD. However, it is the first to possibly relate increased aggression with a measurable parameter.

One expert describes, “The brain stem serves as a bridge in the nervous system. All the fibers that go from the body to the brain and vice versa go through the brain stem. It sits at the top of the spinal column in the center of the brain… handles basic functions like breathing, swallowing, heart rate, blood pressure, sleeping and vomiting. The brain stem does not play a part in higher cognitive functions…”

The authors concluded, “Understanding brain differences in individuals with ASD who engage in aggressive behavior from those with ASD who do not can inform treatment approaches.” Indeed, disruptive behaviors describe a type of autism that is particularly difficult to address, and may even require potent medications.

The second article was Early brain development in infants at high risk for autism spectrum disorder, in Nature. The research revealed that surface area enlargement between 6 and 12 months precedes brain volume overgrowth observed between 12 and 24 months, which was linked to the emergence and severity of autistic social deficits. “These findings demonstrate that early brain changes occur during the period in which autistic behaviors are first emerging.”

The good
Both investigations serve to encourage the idea that timely detection leads to earlier intervention, which leads to improved outcomes. Even that obvious fact continues to be debated in some forums.

The bad
These studies are descriptive, and so they do not provide answers about cause and effect, form as relates to function, underlying genetic, nutritional or toxic states. There are many presentations of the condition, and research generally tries to get as homogeneous a group as possible – perhaps not representative of a larger group. More information is required to deduce practicality or therapeutic intervention.

The ugly
Emily Willingham, ‘science’ writer at Forbes.com, used the latter study to ‘prove’ and promote her vaccines-are-safe-for-all-kids campaign. Not a word about ‘shots’ was mentioned in the entire article, and this pro-inoculation zealot found a way to insert that thought into unsuspecting readers, in her piece entitled, “An Unexpected Takeaway From The Early Autism Diagnosis Study”. Yep, Em, that was unexpected!

Conclusion
One investigation delineated decreased brain size in one region, and the other demonstrated increased overall brain volume. A recent paper about neuro-imaging technology offered this advice: “… heterogeneous and definitive neural correlates in ASD have yet to be identified… findings from multiple independent neuroimaging meta-analyses in ASD appear discrepant…”

Such research represents further attempts to explain the medical issues. This should encourage other universities and research institutions to explore these topics, as well.

As is frequently the case, for now, the use of MRI technology to elucidate the pathophysiology and diagnosis of ASD deserves further study.

What to Expect from Biomedical Treatment for Autism and ADHD

Tuesday, February 21st, 2017

As in any medical condition, it is entirely fair for parents to inquire about the timing of improvements, after undertaking biomedical intervention to improve signs and symptoms in their children who are affected with ASD. “How will we know if it’s working? When will my child get better?”

Factors affecting speed of recovery
How severely the child scores, according a standardized test for autism, is a major factor in assessing the time it may take for reversal of symptoms. For those in denial, this can be a wake-up call. For the parent who ‘already knew’, it represents a starting point. The time that it will take to observe improvement is generally proportional; from mildly affected to very disturbed development, taking from 6 months to many years until improvement is noted.

Perhaps interestingly, children who score very ‘low’ (few autistic characteristics) may turn out to take more time than might be expected. That could be due to the mysterious nature of their particular developmental delay, and ‘putting our finger’ on how to address individual obstacles takes investigation and various trials.

The degree of a child’s inability to communicate – from the severity of speech apraxia to social isolation – is proportional to the time it will take for advancement. Whether due to biomedical intervention, or just maturation, it becomes extremely worrisome if this achievement takes more than 18 months. After initiating biomedical intervention, kids who simply begin to even copy the therapist will make faster gains.

Self-injurious behaviors and aggression greatly impede advancement in all domains. Such conduct is frequently gut-related, so a thorough workup and effective treatment should take precedence over any other interventions. The time it takes to get this system under control is predictive of speedier success.

Factors not necessarily related to timing of improvement
Intelligence is not in question for most patients. In fact, it seems that the brightest kids are the most likely to manipulate their family and therapists, sometimes slowing down their own improvement. Often, behavioral intervention (of some type) is key to achieving compliance and self-control.

Sensory issues may continue for many years, even after the children are mostly ‘better’. In fact, this may be the lingering issue for which parents seek treatment, and a major cause of inattention and social anxiety.

Immaturity is common, leading to tantrums and issues with self-control, and proceeds slower than neurotypical children. Peer pressure from role models and family members accelerates this troublesome problem.

Discussion
It is sometimes difficult to get our heads around the chronicity of this developmental condition. All children experience good days/ bad days; it appears exaggerated with ASD, and some medical problems recur (yeast, e.g.).

When first diagnosed, if a parent could be certain that their child may only experience leftover sensory, hyperactive, or focus issues, they would probably be okay with that future. Not all patients suffer even those lingering difficulties.

Many families have witnessed accelerated development resulting from biomedical intervention. Parents, teachers, and even doctors will avow visible progress.

Conclusion
Autism is a collection of conditions that emanate from a variety of sources. As the diagnosis becomes more precise, outcomes will be based on information, such as genetics, metabolism, and immune function, and expected outcomes will become more accurate, as well.

I advise parents to watch for little goals.  ‘Recovery’, ‘reversal’, ‘optimal outcome’, ‘normal’ are journeys that begin with small steps.

Frustrating as it may be, regardless of speed, it is the sustained, forward trajectory of development that appears to be of upmost importance as parents consider, “Will my child make it?”

Processing Disorders are Autism

Sunday, February 12th, 2017

With all of the professionals who care for individuals experiencing signs and symptoms that are presently classified as ASD, it isn’t surprising that the organization of problems reflects the point of view of each discipline.

To the extent that nomenclature describes identifiable, clearly understood pathways, it can improve our understanding of function (or the lack thereof), as it relates to structure (but not necessarily vise-versa). Often, however, researchers utilize long, complicated terms that merely restate the obvious. Such designations may not provide additional insight, which is sorely needed if we are to reverse the named condition.

Selective eating disorder = picky eater

Visual processing disorder = sees things differently

Auditory processing disorder = hears things differently

Sensory processing disorder = feels things differently

Oppositional defiance disorder = responds to everything the opposite way

Attention deficit disorder = won’t focus on non-preferred activities

Hyperactivity disorder = can’t sit still

ADHD = both of the above

Sleep disorder = takes longer to fall asleep, wakes up frequently, or both

Social anxiety disorder = uncomfortable around others

Obsessive compulsive disorder = repetitive behaviors and restricted interests

Cognitive processing disorder =?Executive functioning disorder = ?Motor planning disorder = ?expressive language deficiency = ?receptive language disruption = ?doesn’t (appear to) learn/listen/remember.

Discussion
Each of these labels accurately reflects some condition frequently experienced by individuals with ASD. Professionals may utilize such information to address a patient’s issues, but it can be quite confusing when complex jargon is invoked to explain an intervention to the family.

“Why is my child exhibiting this aberrant behavior?” Until much more research identifies actual, measurable, specific physiological states, my response is, “Signals sometimes go to the right place and can perform the appropriate function, the wrong place and lead to an incorrect response, or just bounce around and diminish.”

At least, an understanding about, and explanation of, similar terms utilized by other disciplines would ease parents’ concerns that, “Somebody missed something,” about their child.

Conclusion
I recently spoke with a mom who was told about a feedback loop issue in her child with motor planning deficiencies and sensory processing difficulties. Each therapist provided a valid diagnostic label. I suggested that she focus on the skills required in order for her 4 year-old to play with other children.

Rather than invoking esoteric, complicated language as to theoretical cause, the focus should be on assisting patients’ ability to achieve required skills, such as spontaneous speech, self-control, eye contact, motor proficiency and socialization.

Smooth, efficient processing between our body and brain is the goal. In human development, when systems fail to mesh in the correct fashion, what we observe is called autism.

Fecal Transplants and Autism Therapies

Sunday, January 29th, 2017

Recent media attention about a study involving a small group of children with ASD, who were treated with a specific protocol that included fecal transplantation, has spawned a slew of questions about this complicated protocol.
TheAutismDoctor response (so far):

What do these other autism therapies have in common?

•Probiotics – healthy bacteria (and, sometimes yeast).
•Prebiotics – food that fosters better bacteria.
•Special diets- nourishment that helps to reduce toxins, bad bacteria, or yeast.
Helminth therapy – administering live intestinal parasites into a patient’s stomach to reset the micro-biome.
Digestive enzymes – fostering more complete breakdown of foodstuff. This includes CM-AT powder; an experimental protocol utilizing “… a proprietary enzyme that is designed as a granulated powder taken three times daily.”
Turmeric, resveratrol, acai, and other antioxidants.
•Anti-fungal and antibacterial medications and supplements.

RIGHT! They all contribute to improved gastrointestinal health.

What else do they have in common?

•Physicians who explore and treat the enteric system to reduce negative behaviors know the success of such a protocol. However, this view is not a popular subject in the scientific literature, nor commonly accepted by the conventional medical community.
•Such interventions are generally short lived, with frequent recurrences.
•Improvements may seem to diminish with subsequent treatment.

Even hyperbaric oxygen therapy, stem cell therapy, chlorine dioxide, and chemical chelation may achieve their gains through this pathway.

How do they differ?

•Some protocols make some patients better, some have no effect, some produce adverse effects.
•Some are relatively inexpensive, other may cost thousands of dollars.
•They achieve change by a variety of biome-altering methods.

What is a Fecal transplant?

•Simply put, this treatment involves taking fecal material from a healthy individual, and transferring it into another individual’s intestines, by a variety of means, including pills, naso-gastric tubes, and colonoscopy. The procedure was first documented more than 60 years ago.

•For severe gastrointestinal problems in adults, the procedure was reviewed earlier in this century in the journal Clinical Gastroenterology. “This form of therapy has now reached primetime and should be used in any patient that has been resistant to therapy of recurrent attacks.”

What was this research?

•18 children, aged 7-16 years, with ASD and moderate to severe GI problems, were subjected to a “… modified <fecal microbiota transfer> protocol… involved 14 days of oral <antibiotic> treatment followed by… fasting with bowel cleansing, then repopulating gut microbiota by administering a high initial dose of Standardized Human Gut Microbiota… either orally or rectally followed by daily, lower maintenance oral doses with <antacids> for 7–8 weeks… Participants were followed for an additional 8 weeks after treatment ended…”

•”Substantial changes in GI and ASD symptoms were observed…  and those improvements were maintained after 8 weeks of no treatment… Only two… were designated as non-responders…”

Discussion
The authors in this paper noted that, “… it appears likely that extended treatment… over many weeks, as done in this study, is necessary to observe these benefits.” They concluded that, “While this study was an open-label trial that is subject to placebo effects, these results are promising and provide a crucial step for understanding the connection between the microbiome and ASD. A randomized, double-blind, placebo-controlled study is the next step to investigate the value of Microbiota Transfer Therapy in treating children with ASD and GI problems.”

For the foreseeable future, Fecal Microbiota Transplantation (FMT) will not be covered under health insurance. Presently, the cost for eradication of Clostridia difficile (a common organism that causes severe bowel disease) exceeds $3000 for short term treatment.

Conclusions
FMT represents a promising remedy for many of the disruptive behaviors that patients may exhibit. At the very least, it assists in heightening the awareness of the gut-brain connection, especially in ASD.

While parents are all desperate for a cure, this may simply represent another link in the chain that points to gut health as a major contributor of signs and symptoms involved in one type of autism. More research about this therapy needs to be undertaken before safety and efficacy can be assured.

Because of the required resources and time, it will take a while for this treatment to take hold, even by doctors who specialize in this type of patient.

As an increasing number of parents wish to explore this option, with practitioners who are available to work with them, valuable information will be gained for the multitude of other families who seek relief from this modern developmental disorder.

Good Doctors for Autism and ADHD

Sunday, January 15th, 2017

The Best Autism Doctors has been a popular story on this website. My point was that patients need a competent clinician, and that ‘BEST’ is not necessarily relevant, necessary, or attainable for each child. Considering these issues will help a parent make a more informed decision.

All doctors
‘Good’ doctors thoroughly address your specific problems, so their knowledge and abilities are of upmost importance. Patients expect a clean, well-run office, with friendly, competent, respectful staff and up-to-date equipment.

We want caring clinicians who give us the time to explain our problems and really listen. Patience is key. We expect calls to be returned, especially regarding test results – with kind, compassionate responses. We want to be able to refer this professional to others.

Autism specialists
The qualities that make an effective doctor for patients with ASD and ADHD should also include the following:

Adequate observation by the treating physician. Remember, if you’ve seen one child with autism… Personnel trained to recognize ASD may not necessarily consider metabolic or gastrointestinal conditions, so collaboration with the doctor is paramount.

Up-to-date labs, individualized for each patient, with regular testing should be performed. A recent study demonstrated that traditional specialists  “… fail to order tests that should be routinely performed and often order tests that are not routinely indicated yet are neither benign nor inexpensive. Recommended molecular genetic tests are often not ordered.”

Doctors who successfully treat patients with ASD have an extensive education, experience, and devote the time to rigorous continuing education. For parents wishing to go to the ‘best’ autism doctors, membership in the Medical Academy of Pediatric Special Needs should be prerequisite, until some better medical society comes along.

Especially regarding the expenses associated with an autism diagnosis, supplements need to be made available at a fair price. There are thousands of products that claim better toleration, improved absorption, fewer side effects, etc. Your ‘good’ clinician is best suited to make the correct choice. Also, there should be a willingness to explore alternative preparations that make sense.

Interventions that are tailored, not only to a patient’s symptoms, but reflect underlying, treatable problems. As one protocol fails to demonstrate effectiveness, the approach should be altered – sometimes frequently. Professional explanations, appropriate literature, and use of web information goes a long way to reducing the confusion of this difficult developmental diagnosis.

Close follow-up of the clinical course, response to treatment, and childhood development can fashion an improved outcome. Therefore, some method of reasonable response time to emails, phone calls, etc. is an important feature.

‘Good’ doctors show a willingness to collaborate with the traditional therapies and therapists. An experienced staff, who frequently are well-versed in autism, can be a great resource regarding such advice. Parents frequently have questions about issues, from academic environments to alternative treatments.

Regarding the use of supplements and medications, “starting slow and going low,” offers the best opportunity for the parents – the patient’s expert – to report positive and negative results. Complex and/or confusing protocols may lead to more negative results than necessary. Parents should understand specific directions, with as few changes as possible prior to instituting another shift.

‘Good’ autism doctors advise about the efficient use of resources. There are a myriad of interventions, from affordable and readily available vitamins, to expensive hardware and complicated procedures. Due to a paucity of repeatable research, the doctor who studies all possibilities, and understands a family’s resources, can give the best advice. Also, referral and willingness to collaborate with appropriate medical sub-specialists will streamline the process of recovery.

Conclusion
Indeed, even the BEST autism doctor may not be able to assist a severely affected patient. Understanding and effectively treating speech apraxia, repetitive thoughts and behaviors (scripting and stimming), and aggression may be beyond our science, at this time.

This does not mean that parents should not continue to search for better treatments, but that a reasonable workup by a competent, caring clinician who persists in exploring ongoing problems may provide the most effective treatment available.

Becoming a good doctor for this mysterious diagnosis is not so much,
“Thinking outside the box.”
Successful results occur when professionals
Connect the dots • — • — •

ADHD Medication Guide

Sunday, January 8th, 2017

As the academic season becomes more challenging, The Child Development Center is often asked about the various pharmaceutical preparations that are suggested by doctors, behavioral and academic personnel. Specific medicines are frequently prescribed for symptoms that include poor focus and attention, hyperactivity, distractibility, fidgeting, not listening, a short fuse, and lack of self control.

As parents ponder this important decision, here is a useful list to improve understanding and address frequent concerns, in decreasing order of potency and side effects:

Prescription
Methamphetamines

Names: AdderallDesoxynAdzenysDianavelEvekeo, Dexedrine, ProCentra, Zenzeti
Plus Lisdexamphetamine (Vyvanse)

Class – Stimulant, Amphetamine
Comment: These were the first generation of stimulants. They are the most addictive, bring about appetite suppression (‘diet’ pills), create sleep disturbance and growth suppression. Families should consider using these when less potent preparations fail.

Methyphenidates
Names: Methylin, Methylphenidate, Ritalin, Concerta, Daytrona, Quillivant, Quillichew, Aptensio
Plus Dexmethyphenidate (Focalin)

Class –  Psychostimulant, Methylphenidate derivates
Comment: There are actually only two choices in this category, as well. The theory of using stimulant medications for ADHD is that affected patients experience a paradoxical reaction to the invigorating effects that neurotypical individuals would sense.

From a chemical standpoint, all of these names pare down to just 4 compounds. They share these common features:
DEA – Class Rx Schedule 2. Therefore, your doctor will be very careful about documentation and prescription handling, and will require followup visits.
The choices here are usually driven by the formulation; available as a liquid, chewable, patch, pill, or capsule configurations.
Plus, manufacturers offer a myriad of confusing dosage options; from 1, to multiples of 5, to multiples of 10, to multiples of 18 milligrams.
When the medications start to wear off, there is often an increase in negative behaviors. For this reason, dosage and frequency are crucial to produce the most effective amelioration of symptoms.
However, insurance companies have become very restrictive in the preparations that they will cover, and out-of-pocket costs are high. When trying to achieve the optimal medication schedule, such stipulations complicate making the best clinical decisions.
The medical risks of any of these preparations include a myriad of cardiac maladies. The AAP no longer recommends a pediatric cardiology evaluation. This is not a good idea, and once a patient demonstrates that they will continue to take these prescriptions, The Child Development Center refers to the appropriate specialist.

Atomoxitine
Names: Strattera
Class – Non-stimulant
DEA Class – Rx
Comment – Frequently vaunted as THE ‘non-stimulant ADHD medication’. Besides an increased risk of suicidal ideation, significant growth inhibition and sudden death, in my experience, it has never been a useful choice. Really, don’t bother with this remedy.

Phosphatidylserine
Names: Vayarin, PS 100
Class – Non-stimulant
DEA Class – Medical food
Comment – The active ingredient is a natural fat that is supposed to aid cell-to-cell communication in the brain. The name brand contains an omega 3 oil, and requires a prescription. The over-the-counter product might be preferable if the patient is allergic to fish or soy.

Non-Prescription Stimulants
Despite a 2004 study that demonstrated that nicotine was equivalent to methylphenidate in ADHD symptom reduction, the practice has not become popular due to the inability to control the patch dosage and skin discomfort. However, the effects of caffeine may provide a reasonable alternative. At The Child Development Center, pure caffeine is chosen over coffee, tea or other products that contain a multitude of other ingredients, in order to objectively assess the results of administration.

Conclusions
1. The most important factor in deciding on treatment is a precise diagnosis, which requires a thorough history, physical examination, and appropriate laboratory testing. A doctor cannot simply look at your child and declare that they have ADHD.

2. Medication administration continues to be offered to younger and younger children. Deferring pharmaceutical intervention can mitigate against the most significant side effects.

3. When stimulants are initiated, it is not unusual for parents to observe that, either the med doesn’t work quickly as expected, or that the child acts like a ‘zombie’, or that the child exhibits even more hyperactive behaviors.

4. Although this guide is presented in order of medicinal ‘strength’, whether a product works depends on a myriad of factors. Preparations that are lower on the list may be far superior to more potent formulas. Plus, the mere observation that the child is sitting still does not necessarily reflect that real learning is taking place.

5. Research continues to demonstrate that appropriate behavioral therapy is a useful and effective treatment.

TheAutismDoctor’s Top Stories

Friday, December 30th, 2016

As I have previously explained, I produce this blogpost for 4 principle reasons; to learn, to teach, to offer a middle-ground, and to ventilate about the less-than-state-of-the-art medical care offered to patients with autism and ADHD. Here are my picks for 2016’s most useful stories:

January
In An Autism Prevention, we learned about medications taken during pregnancy that could be contributing to the autism epidemic. Pharmaceutical preparations that have become ubiquitous in this century are suspect. Reducing their intake could result in a decrease in the number of new cases.

February
Americans With Autism Act. This was my opportunity to blow off steam about a local fight to get a student with ASD the necessary and deserved services. The outcome was in direct conflict with decades-long evidence that ABA works.

March
I often give advice about the difficult problem with Speech Apraxia. This article lamented the sad state of affairs regarding scientific identification of the problem, let alone workable solutions.
(Happily, this situation has been somewhat addressed in this recent, randomized study utilizing folinic acid.)

April
Vaccination Redux was this year’s best effort to explain my position on the childhood vaccination schedule. What can I say? The problem won’t be resolved by bullying or vaccine industry-supported research. BTW, I am not against childhood vaccinations.

May
Folate Issues. Folic acid has been in the news throughout the year. This story was about too much of a good thing, if taken during pregnancy. Obviously this vitamin, and the pathways that are involved, are very important to our understanding of the autism mystery.

June
The importance of Genetic Testing in Autism was my opportunity to spread the word that a modern medical workup should include appropriate laboratory testing, including a chromosomal microarray. The subject material is dense, but key to understanding one group of autisms.

July
Acetaminophen and Autism presented scientific evidence to warn about the casual us of this potential culprit. Four studies were made available, so pregnant women should take note, and seek more acceptable alternatives for relief.

August
In Digital Devices and Autism, I expressed my opinion to the frequently asked question, “Is it OK to give junior the iThing?” Children who seem to gain real academic benefit are few. Mostly, iStuff provides no imagination and no socialization, fueling core deficiencies in ASD.

September
Processing Disorders and Autism, crystallizes a decade of my understanding about this set of childhood developmental and physical disorders.
By connecting the dots about the various maladies that affect patients, such as sensory processing, GI problems, and low core muscle tone, we achieve a greater understanding about the causes, and downstream behavioral effects.

October
Just in case pediatricians haven’t noticed the epidemic, and because the US Preventative Task Force has recommended against formal testing, I continue to write at least one Early Signs post each year, to enlighten the unenlightened.

November
Medical school exposes students to very-little-to-zero information about alternative healing services; such as chiropractic, naturopathic, and homeopathic remedies. This story was about my research and experience as relates to the turmeric plant. Its antioxidant properties have helped our patients with gastrointestinal, behavioral and even developmental challenges.

December
A bit of levity. I have spent months perfecting the 12 Days of Autism Christmas.
Perhaps, next year I’ll attempt to furnish new lyrics for Dreidel, Dreidel, Dreidel.

Conclusion
This is TheAutismDoctor’s year-end opportunity to rediscover the polarized world of Special Needs Pediatric diagnosis and treatment. My articles take a great deal of time, study, and thought. So, they are all important to me, and should be helpful for families and professionals, as well.

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Brian D. Udell MD
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