Archive for the ‘Sleep’ Category

Thanks, Moms, for Your Special Attention

Sunday, May 14th, 2017

There are some great fathers out there, to be sure. Dads, don’t get me wrong, I’ll give you guys your due in June. I’m not judging and I have no idea how I might have done with such a challenging journey as raising an autistic child. I am simply reporting my observation that, by far, the majority of amazing caretakers out there are the mothers.

Dr. Martha Herbert has often begun her scientific presentations with a story about a friend whose adult child awoke from anesthesia and spent hours speaking normally with her mom. The daughter knew how difficult of a child she was and how much hard work her mother had done to get her to this point. After falling back to sleep and re-awakening, the daughter again exhibited her autistic personality. Dr. Herbert uses this example (plus more genuine scientific evidence) to teach that there seems to be a reversibility to ASD, and we have yet to even look at the problem in the right manner (as a whole body disorder). Her message is for moms to keep trying, as will SHE, until there is an answer.

Jenny McCarthy’s “mother warrior” credo has helped recover many children, I am certain of that. Her message has been that the general public cannot necessarily trust conventional medical thinking about the diagnosis, etiology, treatment, and prognosis for this epidemic. You can’t blame her for seeking answers for her son and all of the other children with autism.

So, in many of my posts, I write about planning, medication, special diets, supplements, and therapies. For the moms out there, that’s preaching to the choir. I’m only enumerating such chores as I detail the work that every ASD patient requires. I have learned most of my art – about toilet training, time management, addressing stims, GF/CF, cluster classes, IEPs, sensory conditioning and much much, more – from the insightful and relentless mothers who are determined to help their child recover.

Thank you. Thank you all for letting me examine and help care for your children. It has been one of the best experiences that I have ever had in my professional life.

The only piece of advice that I’ll offer in this post is this, take some time out for yourself and your spouse. I said “some”, ’cause I know that it is sometimes impossible. But, it needs to be more than “none”. The number of intact families in this practice is even lower than the national average.

At this time of year, mothers seek advice about how to continue administering their children’s pharmaceutical protocol, in camp or on vacation. The diet, vitamins, and medications that require prescriptions – all in order to get on a plane. Then, there is the plane! I’m not quite sure how families are able to get anywhere with all of the work that is required.

Mothers are special. Mother’s Day is certainly a deserved holiday.
Moms of Autistic Kids?
Lucky children.

Speech Apraxia and Autism Misbehavior

Sunday, May 7th, 2017

This week (May ’17), Penn State researchers claimed to have disproven a generally-accepted premise with an article is entitled, Tantrums are Not Associated with Speech or Language Deficits in Preschool Children with Autism.

The Study
The authors retrieved information from a previous data collection, which was not intended for this purpose, and reviewed 240 cases. Children, who were 15 to 71 months old, “… whose mental age was sufficient for verbal communication but who lacked speech did not have more tantrums than children with adequate speech. In fact, children with an expressive language age at or above 24 months had more tantrums than children whose speech skills were below 24 months.

Their conclusion is the exact opposite of what we all suspect. “Our findings and those of others do not support the belief that preschool children with autism have tantrums because they cannot speak or because their speech is difficult to understand.”

Discussion
In autism, THE toughest sign to successfully ameliorate is a patient’s inability to produce spoken language. Indeed, professionals who have chosen this undertaking will attest to significant challenges. Proven medical protocols are few, though anecdotal ones abound.

The second most difficult expression of ASD is immature conduct, including tantrums. Behavioral intervention is the proven successful treatment. Conventional medical protocols invoke potent pharmaceuticals with significant side effects and variable results, so alternative strategies have emerged.

For years, parents and professionals, alike, have accepted a direct relationship between these two disturbing symptoms. There appears to be general agreement that, as children get older and smarter, they are increasingly frustrated by their failure to adequately communicate. There is a 30-year body of literature that supports this position.

Why were the findings of this paper
so counterintuitive?

This perspective is supported by substantial research, as well. The authors argue, “The reason may in part be because of the effectiveness of interventions… which use behavioral techniques to teach children to use words, and not inappropriate behaviors, to communicate.”

In other words, if language improves through successful therapy, a child may still have tantrums if that issue is not addressed, per se, as well. Those patients who do not get adequate socialization skills continue to resort to outbursts, in order to get needs met.

The publication lacks several key elements. ‘Tantrum’ is used as an outcome measure, begging the question of whether more serious issues, such as self-injury or aggression, were considered in the definition. Medication usage was not documented. Perhaps, patients who were most disruptive received more drugs without relief or even negative side effects? Additional medical issues were, likewise, omitted from the data. In the diverse ASD population, this could be a highly significant variable.

Conclusion
The outcome of this paper could have been that children who have better language skills are more likely to have tantrums! The authors were careful to leave that out. Plus, the closing sentence includes, “Our findings do not diminish the importance of evidence-based interventions…”

If, as the paper asserts, the reason for fewer tantrums was an individual’s type of intervention, then the conclusion seems to be that Functional Communication Therapy is useful for tantrums due to autism.

Or, one might deduce that each individual diagnosed with ASD is so different in their physical and mental state, that there is no certainty, at this time, to explain why this group showed a null relationship.

Is it true? Could tantrums, “… in large part be intrinsic to autism and not driven by developmental processes, such as language.” Is it important? Why? Perhaps, such insight could provide a more effective and efficient window of treatment options. Furthermore, there is general agreement that traditional measures can play an important role in remediation.

An Autism Doctor’s Earliest Signs

Sunday, April 30th, 2017

In spite of an ever-increasing number of atypically developing children, and in the face of a plethora of evidence demonstrating that early intervention results in quicker resolution of problems, pediatricians continue to appear to be more concerned about whether the vaccination schedule is current.

Every day, parents relate stories about a doctor who said, “The child is NOT autistic. He has sensory processing disorder and speech apraxia.””Give it some time,” seems to be a common mantra. Are universities teaching this wait-and-see strategy?

What other medical condition is dealt with in such a fashion? No abnormal mole is considered too tiny to dissect. A small amount of blood coming from any orifice warrants the swiftest investigation. Furthermore, it is generally espoused that early identification and treatment is the best remedial policy, stimulating the appearance of screening programs for cancer and heart disease, for example.

I have examined thousands of high-risk infants, and the younger siblings of many ASD patients over the years. This is my top ten list of physical signs in the first 18 months that should raise suspicion, and demand answers, rather than a dismissive pat on the head, accompanied by a professional’s proclamation, “I wouldn’t worry!”

Your mother thinks that the baby, “… isn’t doing alright.”

There is an inability to successfully breastfeed, especially in highly motived or experienced women. La Leche League has promoted and instructed us all in better ways to get the milk flowing, but a new era of poor suck on the side of the infant has emerged. This could either be the initial sign of a problem, and/or part of a vicious cycle leading to unusual behaviors.

A child who exhibits gastro-esophageal reflux (heartburn), persistent colic, inconsolable crying, and/or severely interrupted sleep patterns may be displaying a red flag. Of course, mild cases could be due to individuality, parental indulgence or ‘milk intolerance’. In this century, think: a condition that deserves investigation, and thoughtful intervention. Prescribing Prevacid is not a workup.

Signs of poor core tone may include a twisted neck, flat head, or delays in motor milestones. In the previous century, doctors were worried about cerebral palsy. Now, it should be considered as a possible earliest sign of autism.

Likewise, the absence of crawling, or persistent ‘army crawl’ has been a documented occurrence in infants who later show ASD.

A breast-fed infant who poops less than twice per day, or a formula fed child who ‘goes’ more than 4 times should raise concern. Unusual stooling often indicates abnormal gut flora, causing direct inflammation and/or additional bacterial changes, and possibly further alters nutrition.

A very early ear infection, or any recurrent medical condition is notable. At the beginning of my 40-year experience with at-risk children, antibiotic use in the first year of life was only a fraction of the exposure that occurs in this century. Investigation of immune competence has everything to do with the modern epidemic, I am certain.

The likelihood of ‘food allergy’ in the first year of life is actually very low. When a pediatrician assigns noisy breathing or fussiness to this presumed ‘diagnosis’, beware that they are not practicing real evidence-based medicine.

After the first few months, infants will look at faces, follow, and later, begin to imitate. If social interactions, such as rolling a ball back-and-forth, do not emerge – and certainly if they disappear – the child needs to have a thorough medical evaluation.

Speech that begins, but does not progress is a worry. When language fades, it is never normal. Period.

Conclusion
Any of these signs could just be a benign variation of normal development. A few are reason for real concern, exploration, and early intervention.

I have presented similar information in previous posts. In addition to these physical signs, I have written about other high-risk situations, and associated factors that assist a physician in ascertaining a specific diagnosis. It sometimes helps to provide regular updates for parents to show their child’s doctor, in order to get things moving on the right track.

Stem Cell Therapy for Autism… cont’d

Sunday, April 9th, 2017

As doctors try to understand and consider various emerging therapies for patients experiencing signs and symptoms of autism, the question of Stem Cell therapy has come to the fore. A Duke University professor barreled onto the scene, recently, with a pronouncement that sounds like a cure, even though it’s not.

Understanding the study
The project is Clinical Trial to Evaluate the Efficacy of Umbilical Cord Blood to Improve Outcomes for Children with Autism Spectrum Disorder. This was the first phase. The goals were to determine safety, and to evaluate the usefulness of a variety of tests to assess whether the treatment works.

Does giving a child’s own cells, which were collected from the umbilical cord at birth, back into their bloodstream, result in any adverse events? The report broadcast on CNN focused on a 7 year-old who seemed nearly OK, playing with her older, neurotypical sister. The treatment had taken place a couple of years earlier.

Dr. Joanne Kurtzberg, one of the researchers, proclaimed, “We saw improvements in 6 months…” She used the word curative twice in the same sentence, even though her point was ignorance of that outcome. She concluded the interview with, “of course we have to do a placebo controlled randomized trial to answer the question…” The Dad was more realistic, as he commented, “The autism is still there…”

The research involved 25 children, 2 – 6 years old, who had banked cord blood available. “Significant improvements in children’s behavior were observed,” in the majority of children, and “were greater in children with higher baseline nonverbal intelligence quotients.”

“Assessment of adverse events across the 12-month period indicated that the treatment was safe and well tolerated,” claims the abstract. In fact, agitation was a common complaint, requiring additional medications, as the infusion was administered. The authors admitted, “As an uncontrolled open-label study, it is not possible to determine whether the observed behavioral changes were due to the treatment or reflect the natural course of development during the preschool period.”

Discussion
When considering such an extreme treatment, the primary driving force should be the child’s degree of involvement with their developmental challenges. If your youngster is proceeding on an acceptable trajectory, 1) Is it worth the known, and unknown, risks? and, 2) What improvements are you actually seeking? In this study, as in other successful biomedical protocols, the less-affected patients showed the best improvement.

This investigation was done under rigorous conditions by highly trained university personnel, and utilized the patients’ own cord blood. Do stem cell centers around the world offer a similar degree of confidence as regards cleanliness, safety, follow-up, or the ability to handle emergencies? Are outcomes the same when using fat cells that have been turned into stem cells (explained in my previous blogs on this topic)?

The type of autism has got to be a factor, as well. Would a patient with a significant chromosomal variation or metabolic disease, for example, experience the same improvement?

On a positive note, it is encouraging to observe that the conventional research community implicitly concurs that successful treatment involves “modulating inflammatory processes in the brain addressing the reduction of body inflammation to improve ASD.”

Conclusion
We all wish to see a real breakthrough in autism treatment. It appears that stem cell therapy may represent a significant advance. But, that is all that it will represent. Children will still have yeast, and need follow-up labs, and ABA, and Speech therapy. Stem cell intervention seems to represent another, maybe better, certainly more costly, alternative protocol.

Thankfully, Phase II, a randomized, controlled study to assess efficacy, is now underway.

Getting the Most from Behavioral Therapies

Sunday, March 26th, 2017

The ever-increasing number of children who experience significant developmental problems requires a proportional addition of skilled professionals for assessment and intervention.

At The Child Development Center, we have noted the emergence of certain patterns of treatment choices. Intelligent, involved parents express their concern about the paucity of well-trained professionals, the cost of treatment, the lack of insurance, and frustration with the speed or course of their child’s progress.

Applied Behavioral Analysis
The general consensus is that the proven protocols of behavioral intervention are most likely to result in significant symptom reduction in patients with ASD. As reported in the 2001 publicationEducating Children with Autism, “teaching parents how to use pivotal response training as part of their applied behavioral analysis instruction resulted in happier parent-child interactions, more interest by the parents in the interaction, less stress, and a more positive communication style. The use of effective teaching methods for a child with autism can have a measurable positive impact on family stress. As a child’s behavior improves and his or her skills become more adaptive, families have a wider range of leisure options and more time for one another… To realize these gains, parents must continue to learn specialized skills enabling them to meet their child’s needs.”

Why does utilization of ABA lag behind other treatments
in so many regions around the country?

The prevalence of children with autism is outstripping the number of qualified, interested therapists. Economic pressures appear to dictate direct provision of services by paraprofessionals who are properly supervised. Therefore, the most efficient providers frequently observe, evaluate, and mentor the less-experienced staff. For-profit companies may find such practice difficult to maintain.

Insurance companies regularly find a way to weasel out of their commitments, many times in spite of outside mandates or even advertised benefits. Denial of payment for services may take the form of incorrect coding, credentialing, and timeliness of payment. Providers are, therefore, less likely to accept their (lack of) coverage.

There are a variety of types of behavioral intervention; including DTT, EIBI, PRT, VBI, DIR, TEACCH, OT, Sensory Integration Therapy, Speech Therapy, and PECS. Devotees of each claim superiority of their strategy. Such a smorgasbord may confuse even the most attentive parent.

Discussion
Recovery from the major challenges that accompany an autism diagnosis is an exhausting journey for the whole family. Traditional therapies are the proven tools to enable a successful transformation. They are an important consideration that must be offered to every patient. Parents should use their common sense, plus their unique understanding of the child, to assess whether the plan of action really applies. Does the suggested intervention make sense? Does the child ‘click’ with the therapist(s)?

When professionals continue to insist that 1) you are not doing the right thing at home or 2) your child can’t improve in some particular function, it’s imperative to seek additional assistance. Maybe the provider is correct, but little progress will occur if the parties continue to debate.

I often advise parents who are concerned about some ‘magic’ 25-40 hour ABA requirement, that a good OT, or PT, etc., has learned to be effective by utilizing a variety of techniques. Therefore, you can add up the various interventions, and will frequently find that you don’t need to feel guilty about that numeric stipulation.

As children improve, the challenges of proper socialization and self-control become the most difficult and lingering concern. This may require an entirely new and unique skill-set to come to the fore.

Conclusion
All interested professionals; including chiropractors, acupuncturists, alternative and traditional practitioners, can be important members of the village trying to get your child on the right track. Because the present state-of-the-art is in such flux, the correct combination of traditional and alternative protocols provides the best chance for a successful outcome.

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.

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.

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.

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.

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Brian D. Udell MD
6974 Griffin Road
Davie
FL 33314
Office phone – 954-873-8413
Fax – 954-792-2424

Email bdumd@childdev.org
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