Posts Tagged ‘advice’

International Meeting for Autism Research 2014

Sunday, May 18th, 2014

My medical lifetime has experienced several epidemics. Although such problems are devastating to families, we learn a great deal of general science by uncovering the secrets of each new disorder. Think of Legionnaire’s disease (bacteria), the Norwalk virus, helicobacter (stomach ulcers), etc. Regarding the conditions that now fall under an autism diagnosis, these are exciting times for study and discovery.

At this conference there were 1800 attendees from all over the world, and nearly 1000 research papers. It has been great watching this organization grow; bringing advances to the science of autism spectrum disorders.

What I Liked:
This years Advocate Award went to Peter Bell. He is a true contributor to autism. More than simply offer an acceptance speech, he did a great job of expressing to this diverse, but research-oriented group, his “Top 10 List” for audience understanding. That included finding causes and treatments, environmental associations, lifetime services, and recognizing patients’ humanity, with the urgency that a only parent could feel and express.

Then, there were the short conversations with the presenters. I spoke with a pediatric neurologist who presented his work on Vitamin B12 and folic acid. Another was a social worker, whose study concluded that the new DSM 5.0 would result in fewer diagnosed cases. I couldn’t agree less, so I was able to discuss it.

At lunchtime, I sat with a distinguished, rather humble, retiring psychologist from a prominent New York clinic who said, “maybe 5% of our patients report G-I problems.” I took the opportunity to offer, “Gee, that is awfully low. I would sure like to test those patients with my protocol.”

I spoke with a young researcher whose paper detailed the changes in the neuron-type cells of the intestines, which is work that will elucidate gut alterations that might explain various autistic features.

There are so many young and promising minds. Just as HIV research enriched our knowledge of DNA, RNA and viral-human interaction, autism is enhancing scientific understanding of the development and function of the brain.

What I Didn’t Like:
There were few papers and presentations about environmental and epigenetic effects leading to the epidemic. For that matter, there was little discussion about the presence of an epidemic, though I suppose that would have been preaching to the choir.

Also, I think that there needs to be more work on how co-morbidities play into ASD. As a clinician, I find that problems, such as those in the G-I system, sensory difficulties, sleep disorders and anxiety, need to be studied as the very fabric of the condition.

Finally, this is not so much of a complaint, as a fact of life, but there is so much to read and learn in just a few days. There just never seemed to be enough time.

Best Thing at the Meeting:
Dr. Fred Volkmar, Yale autism expert, got a Lifetime Achievement award. He is an energetic and fascinating teacher who noted how few treatment studies are yielding success, especially compared to the explosion in the volume of research. Dr. V actually expressed his frustration that much of the work is not actually getting to the parents and the children.

This famous professor expressed an understanding of how parents seek Internet answers in the absence of viable medical alternatives, which is such a rare point of view in the academic world.

Conclusion:
The knowledge and information that ripples from this scientific meeting and the people who continue this work will make a difference. Perhaps not one particular study or that trial, but by their dedication to becoming part of the solution, parents can be assured that you have champions on your side.

You can access the research abstracts here.

Autism Wars II: The Wakefield Effect

Tuesday, May 13th, 2014

This month, Pediatrics published a paper indicating that there was, in fact, a “greater prevalence of GI symptoms among children with ASD compared with control children.” 
OK, so far.
Not really groundbreaking information, but it did appear in a mainstream, well-respected, scientific journal.

Somehow, the authors felt compelled to include an opinion that the medical profession has been delayed in studying this gut-autism association. The Discussion section includes, “Previous controversy surrounding the MMR vaccine and proposed causal link between ASD and infection of the GI tract probably deterred investigators from dedicating resources to examine GI functioning in this population while fostering uncertainty in the ASD community regarding the validity of this line of inquiry.
Not OK.
Investigators are not prevented from pursuing certain lines of thinking. In fact, there are several follow-up studies challenging the original postulation. That’s science, right?

Shortly thereafter, Forbes autism blogger, Emily Willingham, followed with a piece actually naming the culprit. She tattled that it was the nefarious Dr. Andrew Wakefield. He is the British pediatric-surgeon-gastroenterologist-fallen-from-grace who has been accused of concocting the measles-vaccine-autism association in order to gain riches and international fame. Thanks, Em, otherwise we wouldn’t have known who they meant.
Really not OK.
The science writer penned another less-than-illuminating piece. She posited her somewhat unconventional point of view that anxiety is the cause of many G-I disturbances, rather than the other way ’round. What has that got to do with “Blame Wakefield For Missed Autism-Gut Connection”? Has that delayed ‘Dr.’ W’s research, as well?

Yikes.
Can we get some facts straight here?

Fact: The title of the original article in question was, Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.
It began as a series of case reports, which has been totally blown out of proportion. Some of the patients had an autism diagnosis, assigned by other specialists.

Fact: The conclusion of that paper, We have identified a chronic enterocolitis in children that may be related to neuropsychiatric dysfunction. In most cases, onset of symptoms was after measles, mumps, and rubella immunisation. Further investigations are needed to examine this syndrome and its possible relation to this vaccine.”
Does that sound like science or sedition?

Fact: Dr. Leo Kanner, father of modern child psychiatry and inventor of the “autism” classification in the 1940′s, first reported on 11 patients, 8 of whom had G-I signs and symptoms. He called the problem a psychiatric disorder. That delayed correct diagnosis and treatment for about 50 years (and continues to slow the process because of the ASD inclusion in the Diagnostic and Statistical Manual of Mental Disorders).
Anyone angry about that?

Fact: Bruno Bettelheim helped prolong the ‘Refrigerator mom’ theory throughout the 60′s and beyond.
With a thick Austrian accent and faked credentials, he appeared on talk shows and became famous with that stupidity, not infamous.

The Wakefield Effect
Why is there such an emotional connection with this condition? It’s the Wakefield Effect. Because of this debacle, anything having to do with autism that is not sanctioned by the mainstream is considered an aberration; including special diets, yeast in the G-I system, vitamins, and toxins in the environment. Regarding certain establishment fixtures, such as vaccination, anyone who pursues a course of action other than the teachings of the Church (Big Pharma+ Conventional Medicine) is to be expelled from the religion and sent packing to other ports of call. With the availability of the Internet and Social Media, innuendo turns into truth.

I have met Dr. W and heard him speak several times. He is good-looking, articulate, charismatic, and tells a compelling tale. He probably could have continued his research, and even received funding, if he had followed his original work with more humility and sense of uncertainty. If this was a hoax or part of some grander plan, it has certainly failed as he (and his work) falls into obscurity.

Rather than discuss biology, genetics, objective research strategies and prospective trials that could assure safety and effectiveness, the public is fed dogma and discord. The wrong line of reasoning is being followed and now appears in more diverse venues, including popular, financial and even scientific publications.

Perhaps it is less interesting and more complicated, but the best antidote to the Wakefield Effect is for medicine to drop this non-issue and move on. The media wants controversy, but parents want answers.

A Mother’s Intuition About Autism

Saturday, May 10th, 2014
Mother's Day 2014

Mother’s Day 2014

Every new patient at The Child Development Center has a unique history and physical presentation. Often, however, the children share the experience that their mother:
a. Already knew, or highly suspected, ASD, and
b. Heard the doctors proclaim that they were “reluctant to make a diagnosis, at this time, because the child is so young.”

Is there any other serious medical condition that carries this ‘wait and see’ attitude? “It’s probably not cancer, so let’s wait a few months and see what grows.” “The eardrum looks red and is bulging, if the fever gets any higher we will consider antibiotics.” “I hear wheezing, call us in a day or two.” And vaccinations? The first one is foisted upon newborns, with many more to follow, in order to prevent disease.

Study after study documents important gains that come from early intervention for developmental delays. Despite that, there are neurologists and psychiatrists who continue to claim that “You can’t make the autism diagnosis before the age of 2 or 3.” That imposes a waiting period, postponing intervention at the most critical juncture of development.

In order to assign an accurate diagnosis, both the DSM IV, and the present iteration of the Diagnostic and Statistical Manual of Mental Disorders 5.0, contain the stipulation that delays should be noted in early childhood. The previous manual stated, “Delays or abnormal functioning… with onset prior to age 3 years… ” The present DSM 5.0 describes, “Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).” There is no mention of a waiting period.

Yet, in the midst of this epidemic, and with all of the press coverage about the rise in autism, mother is usually the one who makes the diagnosis. Is it any wonder that the parents go to the Internet to get their information or seek alternative treatments when the doctors weren’t even willing to assign a diagnosis, let alone suggest any therapy?

At our Clinic, there are now many younger siblings of children who carry a ‘Spectrum’ diagnosis. Some demonstrate developmental red flags. A 2 year-old male who doesn’t speak and walks on hs toes but shows good eye contact. A 1 year-old female who turns to her name, but doesn’t stand or vocalize. A six month-old boy who suffers from GERD, eczema and chronic diarrhea.

The youngsters were all high-risk and the mom couldn’t sleep, worrying about the future. What is wrong with offering immediate action targeted to specific symptoms? The youngest children can use a probiotic, stop using PPIs and stay away from antibiotics. The older ones need speech and language, OT, ABA and/or PT. STAT.

These are real examples of some brothers and sisters who have gone on to neuro-typical development. Did earlier intervention prevent autism? Bottom line – who cares?

Try this analogy: It is the Middle Ages and The Plague has struck several neighboring cities. The first sign is a flu-like illness that rapidly advances, ending in death. So, when a local sufferer visits the doctor because of a runny nose and sore throat, the physician should be thinking “The Black Death,” not a cold.

Twentieth century poet Helen Steiner Rice wrote, “A mother’s love is patient and forgiving when all others are forsaking, it never fails or falters, even though the heart is breaking.”  When Mom thinks that something is wrong and the doctor dismisses it, saying “It will probably will go away,” families should run, not walk, to a professional who will listen.

Happy Mother’s Day
f
rom Dr. Udell
and the staff at the Child Development Center

The Autism Wars: Frank Bruni vs. Jenny McCarthy

Friday, May 2nd, 2014

Perhaps to mark the end of Autism Awareness month, but seemingly out of the blue, New York Times op-ed contributor, Frank Bruni, decided to weigh in on the vaccination-autism non-connection issue with this April 21, 2014 article. He accused Jenny McCarthy of being an “agitator… the intemperate voice of a movement that posits a link between autism and childhood vaccinations and that badmouths vaccines in general, saying that they have toxins in them and that children get too many of them at once.”

In this corner – Foodie Frank
Who is Foodie Frank to attack Gorgeous Jenny? His bio in the Times describes, “Over his years… he has worn a wide variety of hats, including chief restaurant critic… Rome bureau chief…  also written two New York Times best sellers: Born Round (“as in as in stout, chubby, and always hungry”), and Ambling Into History, (about George Bush)… coauthor of A Gospel of Shame: Children, Sexual Abuse and the Catholic Church.” Wikipedia adds that he “… became the first openly gay op-ed columnist…” of the Times.

Nothing in Mr. Bruni’s curriculum vitae points to any learned knowledge of science, biology, immunology, ecology or child development. The only extant association between Mr. Bruni and autism is this vacuous article that he penned. There is no evidence that he possesses any special information. Oh, that’s right, he did say that Yale’s autism expert, Dr. Fred Volkmar, told HIM that the vaccination controversy “diverts people from what’s really important, which is to focus on the science of really helping kids with autism.” A diversion from the important stuff, huh? As in, this bullshit op-ed story.

And, in this corner – Gorgeous Jenny
And what role does Jenny McCarthy play in this complicated, emotional and misunderstood quagmire that is the present autism epidemic? Her pediatricians didn’t even know what she was talking about when her child was diagnosed with autism. The conventional medical community says that, “Autism is what it is… you got what you got… deal with the situation and get (really expensive and difficult-to-find) therapies. Good luck.”

Parents are admonished not to listen to anyone who says that they can help with medical treatment, other than the standard psycho-stimulant meds. Even if Mom witnesses a change (from a GF/CF diet, e.g.), professionals warn that “It’s probably just a coincidence, like that disproven vaccination theory.”

Ms. McCarthy warned the country and the world that a storm was coming. Regarding ASD, doctors have displayed ignorance at best, and have even caused harm, due to delays and misdiagnosis. And, while we’re on the subject, if it turns out that her son, Evan, has one particular version of autism, that hardly constitutes some sort of fraud for the purpose of gaining visibility. Smack of bullying, Frank?

The child’s complicated diagnosis – made by the doctors -  doesn’t make McCarthy someone “who sows misinformation, stokes fear, abets behavior that endangers people’s health.”
Only the CDC, FDA, and AMA are allowed to do that.

I have been witness to the miraculous improvements served by childhood vaccinations. I recommend them to our patients; perhaps more diligently than might serve the ‘herd’, however, in susceptible individuals, doctors need to be very conservative. It shouldn’t be so complicated for the medical community to produce independent, prospective studies about the present vaccine schedule with 3 year follow-up aimed at developmental outcome, especially as it applies to higher risk infants.

No Winner is Declared
My advice is for Mr. Bruni to go back to his core competencies, Ms. McCathy to continue to fight for her child and help raise money for autism awareness-treatment-and-prevention, and for medical science to work on a better explanation(s) for this epidemic.

An agitator produces lots of heat with little light.
What a desperate mother does, is search for answers why her perfect, beautiful toddler became non-responsive and stopped talking.

Assessing the Skills of Your Child with ASD and ADHD

Sunday, April 27th, 2014

How prepared is your child for school?
What is the best classroom for next semester?

Dr. Udell's Fish Tank

Dr. Udell’s Fish Tank

As the school year comes to a close, and plans are being made for appropriate placement next fall, these are the questions that parents of ASD and ADHD kids have to face. IEPs are generated to provide documentable services, and professional assistance is sought to understand choices that will best address your child’s situation.

The Examination
In order to help families evaluate these difficult choices, various points-of-view come into play. There is the school the child goes to, the one he is going to go to, the one that you want him or her to go to, the administrators, teachers, and all of the other professionals who interface with each child. At The Child Development Center, we have found that, by observing the actions of our children, the reactions of their parents, and the interactions with the staff as patients enter our playroom and gravitate toward the tropical fish tank, many of the skills that are under consideration may be appropriately assessed.

“Hi, did you see we’ve got baby fishies in the tank?” I ask. If mom or dad immediately interrupts, to prompt the child to listen to the doctor, there is a reason. Sometimes a parent will say, “Look at the doctor. What is his name?” Often, they will repeat my question – several times. It is the rare parent who, if the child doesn’t attend, let’s time pass to see what their child will do.
Symptom – The child doesn’t pay attention.

“Do you see the biggest fish?” Does the child look at me? At the tank? At the TV? “Do you see the rainbow fish?” “Do you see the treasure?”
Symptom – The child won’t focus.

“Where is the red fish… we have one red fish.” The child looks at the train table.
Symptom – The child is easily distractible.

If they point to the orange carp, that’s ok, but there are two of them.
“How many fish?” If they start to count, that is BIG.
Symptom – The child is really smart, and even though it LOOKS as if he isn’t listening, he actually does.

The Diagnosis
And, it’s not just the aquarium, of course. Many activities that take place in our playroom provide a framework about your child’s abilities and challenges. For many young children who do not seem to pay attention, can’t seem to focus and appear easily distracted, the diagnosis is immaturity, not attention deficit or hyperactivity. Stimulant medications and anti-anxiety drugs may not help the situation, and often make behaviors worse.

Making A Plan
Parents prefer their child to be with verbal, non-disruptive classmates. Often, special educational environments do not seem to fit their children’s needs. Here’s the bottom line for many of our recovering ASD patients: in the best of all worlds, each child would spend some time in a neuro-typical classroom for socialization, with pullouts for required therapies and academic challenges, and a shadow to redirect. Resource allocation will determine the combination that best fits each family’s situation.

Be realistic about what accomplishments you really want to see in the next school year. For the youngest patients, speech acquisition and play are the most important skills. Five and six year-olds need to get along with others and pay attention to the teacher; or at least, appear to pay attention. In elementary school, it is not in the child’s best interest to force too many academic challenges that affect self-esteem and create anxiety.

Therapies and homework need to be balanced with outdoor activities (golfing, swimming, martial arts, etc.). Do not force multi-player sports such as soccer, because of difficulty with eye contact. Importantly, find a way to limit video games and television stimming.

Conclusion
The world of autism evaluations includes tests such as the Autism Diagnostic Observation Schedule (ADOS), Psycho-educational Profile Exams (PEP), Modified Checklist for Autism in Toddlers (M-CHAT), the Clinical Global Impressions Scale (CGI) and many others.

Then, there is my fish tank.

Autism Un-Awareness

Saturday, April 12th, 2014

March 27-March 29, 2014. The MedMaps.org meeting of Special Needs Pediatricians in California.

Friday, March 28, 2014. The CDC announcement that “about 1 in 68 children has been identified with autism spectrum disorder (ASD)…”

Wednesday, April 2, 2014. Autism Awareness Day (and Month).

Pretty much, such news should have set off a call to action, don’t you think? Yet, there seems to be very little traction. We’re already into the 3rd week of the month, and it doesn’t seem that publicized questions go beyond, “So, do you really think that there is more autism, or have we just changed the criteria?” And, as always, the vaccination issue… Or, nothing.

With deference to those with autism who are pleased with their life and lifestyle, what other childhood epidemic has gotten so little attention? In my youth, polio created summertime panic for our mothers and we were often kept indoors (and that was pre-ac, where I lived). In 1952, at its highest incidence, combined cases (paralytic and non-paralyzing) occurred in ~58,000 out of a population of 158 million people, with approximately 37 million susceptible youth. That was a risk of 1 per 2000 children.

Some may argue that, “Polio carried the risks of death or paralysis, this is just autism.” “Just autism,” is not a term that I have heard any parent express. Ergo, we need to erase Autism Un-Awareness.

Knowledge and experience will get us beyond this rhetoric. The first part is expanding daily. The associations between autism and inflammation, G-I heath, environmental toxins and genetic susceptibility continue to be re-confirmed in the conventional scientific literature.

Parents now request much more information about pre-pregnancy and maternal health. Families bring younger and younger children for evaluation. Developmental delays that were previously considered as ‘minor,’ or ‘normal’ may get evaluated and addressed. Sadly, the pediatric community continues to follow a more traditional course in the diagnosis and treatment of this epidemic. Children, nowadays, don’t appear to simply ‘outgrow’ slow language development in the presence of some repetitive or unusual movements. Medical evaluation and intervention does not appear to be consistent with their version.

With so few practitioners willing to learn about and tackle this condition in an aggressive and non-traditional manner, experience is evolving at a slower-than-expected pace. Technological tools, such as relational databases, can play a significant role as conventional medicine catches up with the explosion of cases in such a disparate group of patients and practitioners. Autism360.org is a great example. (Thank you, Dr. Baker)

I’m not quite certain what percentage increase it will take to sway the general population that we have a real problem on our hands. Maybe it won’t be a percentage at all. President Roosevelt’s story warned a previous generation about polio. In 1963, the plight of President Kennedy’s premie spurred the development of NICUs with trained specialists to solve the problems of prematurity, while preserving healthy development. It took Magic Johnson to get the public riled up about HIV and the risk to the entire community. Angelina Jolie exposed the BRCA gene, etc.

Real autism awareness will come when we stop asking the old questions and start considering the condition(s), as it (they) is (are). Autism was around and has been creeping up on us. What we call ASD is a new disorder in a new century. Speaking of polio, epidemics were virtually unknown in the US until the 20th century.

New shit happens.

Vitamin D for Autism and ADHD

Sunday, April 6th, 2014

One of the more common out-of-range laboratory findings in the children who come to our clinic is a low vitamin D level. Learning about the myriad effects of this important nutrient ought to encourage parents to ask their pediatric specialist to check the blood concentration when evaluating patients with ASD or ADHD.

Effects:

  1. Vitamin D enhances the intestinal absorption of:
    1. Calcium
    2. Iron
    3. Magnesium
    4. Phosphate
    5. Zinc
  2. It is involved with the immune system:
    1. Normal functioning
    2. Inflammatory response
  3. There are effects on neuromuscular functioning.
  4. Bone mineralization is influenced.
  5. The vitamin is involved with modulating genes that regulate cell growth, proliferation, differentiation and death.

Metabolism:
The sequential manner in which this hormone-like vitamin gets into the body, and becomes active, helps explain possible reasons for insufficiency, and observed effects.


 

Dietary Sources:
According to an interview on WebMD, “Surprisingly few foods contain vitamin D…” Dr. DeNoon lists “Super foods,” such as (wild caught) salmon, mackerel, shellfish and mushrooms. Mostly, though, humans were built to get our vitamin D through the skin, so foods are now fortified to make up the difference.
Based on bone health, and given acceptable calcium levels, dosages of 600 IU/d for non-seniors “meet the requirements of at least 97.5% of the population…” BTW, the RDA for vitamin D was derived based on conditions of minimal sun exposure.
There is apparently conflict among the experts, however, about the definition of standard levels. Recommended intakes for infants and children vary from 400IU to 1000IU per day, with unanswered questions about increases.

You can take too much:
This is a fat soluble product, meaning that it can accumulate and become toxic. That is why a doctor should evaluate and follow levels, especially in high-risk children.

Evaluation:
The laboratory evaluation is usually done by testing for blood levels of 25-hydroxy Vitamin D, which is NOT the active form. A calcitriol (1,25 di-hydroxy Vitamin D) level must be ordered separately. The results, and variation from the standards vary, depending on the laboratory. Calcium, zinc, iron and magnesium may be checked, as well.

Autism and ADHD
ASD patients do not represent a ‘normal’ population. RDAs are, in my opinion, the amount below which some neuro-typical people can get symptoms. It seems to me, “Low normal,” is “low.”
There are numerous reports of children spending less and less time outdoors in physical activity,
especially those ‘on the Spectrum’.
Many kids are picky eaters or have been placed on restricted diets
that might affect absorption and levels.

The dermatologists have warned about the dangers of ultraviolet exposure, so SPF 188 was invented and applied copiously.
Often, children have eczema and other skin conditions that
might interfere with normal metabolism.

The conversion of chemicals to the active form assumes a healthy circulation, liver and kidneys. Many of the patients do not appear in optimal health.
There are genetic disorders of calcium metabolism
that present with autism.
There is even evidence that maternal levels may play a role in ASD.

Mostly, however, I am not sure why
so many patients exhibit decreased vitamin D levels.

Treatment:
Children with values that are at, or below the low range of ‘normal’ (depending on the lab), are usually given”D3,” 1,000 – 2,000 IU extra per day.

Treated patients are re-evaluated by periodic testing, plus documentation of daily supplemental intake.
Positive effects, such as a healthier immune system, are usually noticed within a month or two of getting the correct dose. Sometimes, sleep improves (try giving at night). The other therapies appear to work more efficiently; there appears to be better cognition, focus, and eye contact as vitamin D levels are normalized.

Conclusions:
It is difficult to sift through, and pinpoint, the specific biomedical intervention that leads to healthier and happier children. “Documentation,” as they say, “is lacking.” It certainly feels as if adding vitamin D3, when it is low or deficient, helps practitioners achieve improvements in signs and symptoms of ASD.

Oral supplementation is inexpensive, usually well-tolerated by the child, can be followed by documenting the course of treatment and laboratory confirmation.

Autism Conference 2014

Sunday, March 30th, 2014

This conference represents a major opportunity for serious professionals who want to learn about state-of-the-art autism diagnosis and treatment. Other pediatric specialists should take note that the Medical Academy of Pediatric Special Needs is a formal, scientific forum for doctors who wish to care for complicated cases.

Day 1 – ADHD Sessions
Dr. Elizabeth Mumper (Rimland Center) reviewed neurotransmitters. Her focus then shifted to the pressure that Big Pharma has (openly and clandestinely) foisted upon parents, patients, and doctors to diagnose ADHD and prescribe medication. Plus, there is a lack of research demonstrating long-term improvement from these pharmaceutical products.
The disorder is better characterized as a network-communication problem, rather than focusing on one or two specific areas of the brain.
Dr. M then reviewed treatable, metabolic causes of behaviors that may be diagnosed as ADHD. Therefore, the signs and symptoms deserve an appropriate workup; not merely a knee-jerk Rx for stimulant medication.

Dr. Dan Rossignol summarized the most recent and pertinent literature about laboratory assessment for ADHD. A reasonable medical workup was presented, so that treatable conditions can be identified.

Dr. Nancy O’Hara followed with her interesting proposals about non-drug interventions, including dietary changes and addressing environmental issues.

Dr. Stuart Freedenfeld spoke about the forces that drive the diagnosis, many of them non-medical and more related to socio-economic status, especially as regards pharmaceutical intervention.

Case presentations and discussions filled out the rest of this first day.

Day 2 – Environmental Medicine Sessions
Dr. O’Hara reviewed detoxification physiology and the factors that might affect normal functioning, including genetic variation and the myriad of toxins in the air, food and water. Poisons have detrimental effects on mitochondrial operation, the CNS, and can lead to thyroid disruption, altering normal physiology. Various helpful interventions were offered.

Dr. David Quig reviewed laboratory assessment of metal exposures and the concept of body burden. Single toxins can be detrimental, but there are many environmental poisons that multiply negative effects, called the Multiple Hit Phenomenon. He discussed the issue of net retention of toxins, and various therapeutic modalities.

Dr. Stephen Genuis expressed his opinion that airborne pollution represents the most important source of toxic load, resulting in chronic illness for the mother, child, and future generations. He also introduced the topic of ‘nano toxicity’, new pollutants of very small molecular size, in bedding, for example. Evidence for direct and indirect effects of the ever-increasing burden of toxins on multiple body systems was reported.

Dr. David Dornfeld added to our knowledge about total body burden of multiple toxins. He also discussed various forms of detoxification, including chelation – the active removal of heavy metals with chemical compounds.

Case presentations and discussions followed.

Day 3 – Plenary Session
Dr. William Parker spoke about “Post-industrial factors underlying immune system destabilization and subsequent inflammatory diseases point toward dramatic changes for medical practice in the near future.” His discussion was about the manner in which modern society has disturbed our microbiology and the effects that has had on the immune system and created a whole host of auto-immune conditions.

Dr. Paul Schreckenberger gave a fascinating talk revealing that, contrary to common scientific belief, urine is NOT sterile. The take home point was thathere is whole host of new thoughts about the human microbiome (our micro-organisms and their genetic components). There is a need to identify new species and get a better understanding of good and bad bacteria.

Dr. Michael Cabana presented the evidence about the use of probiotics and the effects of ameliorating auto-immune conditions, especially asthma. Important variables are when the supplement is delivered and the requirement for high potency products.

Dr. Rossignol presented the evidence for HBOT to address gastrointestinal inflammation.

Dr. Bob Sears gave a lecture about thyroid disorders and the ‘workup’ to assess thyroid function.

Finally, Dr. Rossignol presented evidence about the newest therapies for autism.

Conclusions:
Coincidentally, this conference commenced even as the CDC announcement that 1/68 children are now affected with ASD. Each year, it seems, the numbers can’t possibly go any higher, but they continue to rise.

The professionals who attend this conference are serious about getting a better understanding about this epidemic and trying to help, and I am proud to be part of that group.

Vitamin B12 and Autism Stories

Saturday, March 22nd, 2014

The topic of methyl B-12 injections, administered to help induce Speech and Language, and to address other autistic behaviors, is among the most popular web searches that parents undertake in order to help their affected offspring.

These are some of the experiences of families who have explored this protocol, under the direction of The Child Development Center. Various common reactions are presented to assist parents who wish to learn about whether this could help their child, what resources are required, improvements to expect, side effects, and when to start and stop SubQ m-B12.

I can’t give those shots!
The advice that a parent will have to administer ‘shots’ to their fragile young child is rarely met with immediate acceptance. For that reason, there are various protocols that have been proposed to 1) lessen the pain to the child, 2) decrease the child’s anxiety, and 3) reduce the pain and anxiety of the parents.
Whenever possible, I request that Mom or Dad “Bite the bullet, and give a shot in the ‘tush’, upon awakening, two or three times per week (before school or therapies).” Having cared for many asthmatic and diabetic patients over the years, this is a small price to pay for such a large improvement.
One mother who took quite a bit of convincing over many months, recently thanked us profusely for finally helping reverse Junior’s speech apraxia.

I found an ad for oral stuff that is well-absorbed and supposed to be just as good.
This is the usual complement to the first reaction.
B12 is a rapidly absorbed, water-soluble vitamin. Any form, even lollipops will get into the bloodstream quickly. It is the speed with which the vitamin leaves the body that mandates an alternative route of administration. Therefore, deposited in, and slowly leaking out of the fatty tissue (if your kid has any), does the trick.
You can’t keep a sucker in your mouth all day (and night) long.

How long will we have to give these shots?
The short answer is “Until you are satisfied with improvements in communication and the treatment no longer seems to be helping.” Another useful response is, “Consider discontinuing mB12 when stimming becomes more disruptive than language acquisition.”
I find it peculiar that parents pose this question at all. Try asking the pediatric neurologist, “How long will we have to give Ritalin?”
Although some children continue this treatment for years, it usually requires much less time.

What are the side effects?
Stimming. And more stimming. Whole body stimming, then oral ones. Chewing. Chewing on everything. Pushing on the chin. Vocal stims, including shouting, barking, echolalia and scripting.
Also, we have seen amplification of ‘yeasty’ behaviors, such as silliness, outbursts, poor sleep and hyperactivity.

With methyl B12 treatment, this caveat cannot be overemphasized:
In order to observe this therapy’s optimal effect, gastro-intestinal health needs to be optimized.

I haven’t seen any progress yet.
It takes about 2-4 weeks to begin to observe improvements. However, there are many factors that affect timing, and sometimes progress depends on the eye of the beholder. Expected advances depend on the present skill set.
Recovering from autism is a process, and gains generally occur in small increments. Some children show significant increases in communication in the first few months, and others take a bit longer.
For many, the initial signs that the vitamin is actually working are behaviors that some might consider regression, such as oral-motor overstimulation. Parents, let’s not to try to fix what ain’t broken.
In the face of little or no gain in communication, experienced practitioners will search for other co-morbidities or provide supplements to enhance the intervention.

It worked so well that we decided to stop all of the other supplements.
Mono-therapy with subcutaneous injections of methyl B12 is not a preferred protocol to successfully treat autism.
Gut health must be monitored and maintained, usually with probiotics and sometimes anti-fungal medications.
Investigating and addressing deficiencies of minerals and other key nutrients is equally important for treating other signs and symptoms of ASD, particularly inflammation and oxidative stress.
Food and environmental allergies will often respond to therapeutic interventions beyond mere B12 administration.
At The Child Development Center, we have noted that assuring adequate reduced glutathione (by oral administration) optimizes this treatment.
Please, ladies and germs, don’t stop the other supplements! And, certainly, continue the traditional therapies.

You can’t do this at home
The reason that I keep utilizing the medical term “subcutaneous injections of methyl-cobalamin” is because it is a medical treatment. Parents are less likely to be successful if they attempt this vitamin supplement without professional assistance.

Pediatricians must learn that autism is not merely a diagnosis to be ruled out by the neurologist, and specialists need to know that a medical workup and modern treatment protocols can be more effective than conventional therapies alone.

Two Hundred Child Development Stories

Sunday, March 16th, 2014

This is my 200th official blog. Yay.

There were several reasons that I started writing back in 2011, and why I continue to produce these stories.

  1. To aid the constant Internet search that families go through in order to assist their developmentally-affected children. The reader’s ability to scrutinize the authority and basic science of medical information is proportional to the knowledge gained by “seeing it on the web.” Surfing is not research. I hope to provide a venue where readers can trust that the material is well researched and presented in a palatable form. Hyperlinks to the original articles are provided whenever possible. “Don’t argue with me,” I tell my skeptical colleagues. “Discuss it with the professors who wrote the paper!”
  2. My competition is the Internet. “My esteemed neurologist colleague,” who hasn’t changed his views on autism in the past 20 years, is still a respected professional. So, I write to enlighten and, hopefully, entertain, while making sure that TheAutismDoctor.com is accurate and up-to-date. If you can’t beat ‘em, join ‘em.
  3. Producing this blog is homework. Days, and sometimes even weeks, are spent thinking about, researching, writing and editing each story. I am encouraged to organize my thoughts and to learn about new subjects. To teach is to learn.
  4. I can refer to these discussions for patient questions and clarification. These stories can provide a valuable aid to understanding some very complicated subjects. Plus, I invite readers to ask their pediatrician and other medical specialists to examine this information.
  5. The Child Development Center is a single practitioner private practice. With a small, but interesting and interested support staff, we are busy taking care of the patients, not studying them. This is an effective setting to tell our stories.
  6. Through this website, families from all over learn about this enigmatic epidemic and explore effective treatment options. TheAutismDoctor.com reaches a worldwide audience. More than 150,000 visits have been recorded, there are now nearly 10,000 views per month, and the site remains high in Google searches. Importantly, I have the honor of caring for patients from around the globe.

Personal Facts
My favorite posting is “Joe the Plumber“, one of my first literary attempts in this digital venue. It was an attempt to convince parents that there were doctors willing to assist in the recovery of their affected children.

The most difficult work was the HBOT series. Such a complicated topic cannot be understood by advertising, testimonials or word of mouth.

My most emotional stories are on Mothers and Fathers Day. One Dad told me that he keeps a copy of the 2011 posting by his desk whenever he needs a healthy reminder about how lucky he is.

The busiest single story is not even mine! I’m not sure how she does it, but this mother warrior tells a great tale and has attracted many readers.

The most popular over time is the information about methyl B12 injections. I continue to refine and update that page; as well as to report that, under professional direction, this is one of our most effective medical therapies.

I am rarely at a loss for words about the epidemic of childhood developmental issues. Loyal readers, have no fear: I have over 60 blogposts ‘in the can’, ready to be fleshed out, awaiting more information, and/ or more interest. There will be more conferences to report about, and new research to be presented and explained.

To me, these are more than just stories.

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Brian D. Udell MD
6974 Griffin Road
Davie
FL 33314
Office phone – 954-873-8413
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Email bdumd@childdev.org
Website http://www.childdev.org

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