Going Beyond Biomedical ADHD Treatments

Message from TheAutismDoctor.com Mobile Site:
11.29.2015 “Dr. Udell, my six year old grandson has autism. He was diagnosed right after his 2nd Birthday. He is in a special needs kindergarten class and has speech, occupational, and physical therapy regularly. He is non verbal. For the last week he has had some terrible meltdowns that last almost all day. We have tried everything. He is on rispiridone and guanficin. He kicks screams cries and had multiple bruises on his arms from this. His pediatrician told my daughter to take him to the er and have him put into an in patient facility to be seen by a psychologist. Putting him in a “home” is not an option!!! We live in <<deleted>> and cannot find anyone to help my precious grandson…”

November seems to bring unusually dramatic challenges to the more developmentally neuro-diverse. It is a most likely time for caregivers and teachers to complain about lack of focus and attention, fidgeting, daydreaming, easy distractibility, opposition, negative and/or aggressive behaviors.

Here are some of the questions, posed to families at The Child Development Center, which readers may find useful (or not).

Has anything changed in the family?
Fitting in to a more rigorous schedule is quite disruptive to the repetitive-behaviors-restricted-interest (incorrectly referred to as OCD) crowd, especially if there have been changes in family dynamics and living situations. Obviously, life happens, and there is little that can be done. It takes love, time, patience, ABA, other therapies, and a medical evaluation, to determine the best next step.
Treatment with stimulant or anti-anxiety medication should be the last, not first, remedy. Pursuing a less chemical route is helpful because the parent can feel that they have left no reasonable ‘stone unturned’. Moreover, if / when medication is required, dosage may be more manageable.

What has changed at school?
Pre-K to K, K to 1st, 2nd and 6th grade, seem to require the most maturational skills. Large gaps in socialization, and / or unusual behaviors will set that child apart. The ability of the intelligent youngster to perceive their shortcomings can be even more frustrating, leading to a downward spiral in cooperation.
Difficulties include out-of-the-ordinary problems with homework, digital devices, getting to sleep, sleeping, staying asleep, (not) getting ready in the morning, not caring, listening or following directions, and / or poor grades and aggression at school.
If the parent of a child who is older than ~6 years uses those behaviors as measuring sticks, it could be worthwhile to speak with a qualified practitioner about ‘doing a workup‘ and prescribing meds.

Has ‘The DIET’ has been slipping?
Strangely, the customary first step when observing a toddler’s improvement is related to a change in diet, yet it is one of the last things that families think of when things are unravelling. Parents will frequently find an increase in cooperation and concentration by merely re-starting a previously successful one, or giving a trial to The Feingold Diet (Quackwatch.com‘s opinion notwithstanding).
Also, think YEAST. If the child responded previously to anti-fungal intervention, perhaps it is worth giving that another try. It’s safer/more useful/less addictive/and less expensive than Risperdone or Adderall.

Any Recent Illness?
It takes more time for a child with immune system issues, such as ASD and perhaps ADHD, to recover from a cold, ear or sinus infection. They usually receive an antibiotic or two, maybe steroids, and lots of tylenol. That seems to be sure to take the clock back, a bit, on optimal health. Strong probiotics can help address that deficiency.
A more in-depth examination of the child’s constitutional state may reveal simple, safe and useful supplements, or milder medications to improve mitochondrial functioning.

Get Sleep Under Control.
Nothing can be more effective for ameliorating the signs and symptoms that we call ADHD than a good night’s sleep, every night. Don’t forget about the more natural sensory improvements that may come from massage, warm baths, or essential oils.
Melatonin is useful to decrease sleep latency (the time it takes to fall asleep) though it may not hold throughout the night. Occasionally, 5-hydroxy-tryptophan may lengthen the rest. Sometimes, it may even be necessary to add an antihistamine, such as Benadryl. It is less risky/harmful/expensive than a drug, such as clonidine.

Conclusions:
There are definitely families who have found that the best and most lasting improvement has been due to a (some combination of) pharmaceutical preparation(s). Indeed, medications seem to help with school in non-ADHD patients, as well.

Alternatively, as experienced by the family in this email, many parents have been frustrated by the medications, because the child became too ‘stoned’ or more combative.

Socialization will enable maturation to turn on self-control. It’s that switch that no one, including the child, seems to understand. “To medicate or not?” is a decision between the parents, the doctor, and perhaps, the child as well, and should not be the school’s decision, based solely on compliance.

Finally, our response to email requests, such as the one that was presented, is to recommend a local MedMaps.org practitioner, or to ask the family to undertake at least one visit to sunny South Florida, so the child can be properly assessed.

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Brian D. Udell MD
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