Posts Tagged ‘advice’

Escaping the Spectrum: Focus Attention Hyperactivity

Sunday, December 6th, 2015

“Teaching is the one profession
that creates all other professions.”

Late November, 2015
Note to the teacher: We will be going down to the Dr. in South Florida.  If you have any new concerns with him academically, socially, etc, please let me know and I can ask him as well.

The only concern I have is Ollie’s level of attention and focus. I’m not sure if this doctor is even the one to discuss that with. It is extremely difficult to get and maintain Ollie’s attention on any task. I have noticed that as the expectations are starting to rise, Ollie’s lack of focus is becoming more and more apparent. It is really starting to impede his learning… He is really unable at this point to work independently in any way during writing time… he is still very distracted and will often bother others around him when he should be reading…

Later response:
I would love nothing more than to keep Ollie in my classroom all day. Unfortunately, with the level of academic support he is requiring right now, he would have to have someone with him for both the reading and writing block and Ms. Billie doesn’t have anyone to spare for that time. I am proud of Ollie for the work he has done with his letters! I think he will actually start enjoying reading and writing time a little more with the smaller setting and increased support he will receive. Of course I know you wanted Ollie to continue to thrive in the gen ed setting…and I certainly believe that Ollie is still a great fit for gen ed socially; he just needs more academic support right now than I am able to provide for him with me being the only adult in the room. Please let me know what the doctor says, and if he has any additional suggestions that he feels might help…

You might (or might not) be surprised about how many of our patients experience similar reports, at this time of year. We are learning that, as children recover from their type of autism, a special form of focus, attention, and hyperactivity problem seems to rise to the top of the ‘chief complaints’ section of the medical record.

In May, when school and homework are less a part of children’s lives, we work on skills and biomedical interventions, which generally provide perceptible, but incremental improvements. In the Fall, more serious choices are considered. Some parents have hired ‘shadows’ – if the school allows them and families possess the resources. Curiously, this option is not always helpful, and can even add additional demands to the classroom situation. After “leaving no stone unturned,” many parents choose pharmaceutical preparations.

To be sure, such a decision becomes a PROCESS, not a solution. Sometimes, it works, which is, obviously, great. Some effects are unwanted, such as weight loss (or gain, depending on med), sleep or personality (“He looked stoned”). There are instances where the drugs can spawn even more disturbing behaviors.

My opinion is to wait as long as possible to initiate stimulant medications. If it takes an inordinately long time to do homework, or there is little self-control (especially in school), and the child >~6-7 y.o., it is understandable that there are parents who want to explore drug treatment.

“Which one? What dose? What side effects?” Such important issues should be discussed with the doctor responsible for prescribing them. And, following the patient. These aren’t antibiotics.

Anyway, by the time a child is >~10y.o., if the school continues to complain or threaten expulsion, or aggression at home cannot be controlled, many families have tried medication.

In some children, there may be a proper place for Concerta and the like. First, however, a complete physical examination and a thorough workup for nutritional, or other metabolic abnormalities should be performed. Alternative treatments, with less addictive preparations, should be evaluated. Finally, during the time away from academic pursuits, whether it is Summer, holidays, or even weekends, drug ‘vacations’ should be explored, as well.

The longer we wait to impose chemical cures, the better the chance that when/if we do have to use them, we see fewer long-term side effects, may use less drug, administer less frequently, with fewer additional combinations, and provide more secure futures for the affected children.

Brian D. Udell MD FAAP
Medical Director
Child Development Center of America

Going Beyond Biomedical ADHD Treatments

Sunday, November 29th, 2015

Message from 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 (‘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.

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 practitioner, or to ask the family to undertake at least one visit to sunny South Florida, so the child can be properly assessed.

Some Thoughts on Alternative Medical Alternatives to Autism

Sunday, November 22nd, 2015

Dr. Udell & Vicki Martin RN

This month’s Autism Society of Broward Speaker Series featured autism expert, Ms. Vicki Martin, who gave an interesting and thorough discussion assessing the medical causes of behavior in ASD, and my talk covering some of the latest biomedical treatments for autism.

Purpose – Improve our Understanding of the Range of Treatment Possibilities
Doctors get questions about these more-than-off-label treatments quite often, so it’s necessary to be current about the literature in order to give a learned response. It’s like homework.
I have an opportunity to give something back to The Autism Society of Broward. It has been my pleasure to have served on this Board for over 6 years. This not-for-profit (and, trust me, we have very few $) organization brings services, such as yoga, sensory-friendly movies, and golfing, etc., to the family level.
Public speaking is always a networking opportunity. There are parents who may not know about The Child Development Center of America and how simple protocols may improve outcomes, especially when they are combined with the traditional therapies. Attendees ask questions and learn about our medical practice.
It’s fun to discuss these topics, and more interesting than reviewing epidemiological data that questions whether autism is an epidemic.

Topics of Discussion
These were not necessarily chosen because they are truly the most recent or popular, but mostly because they have been hyped a great deal, lately, by social and other media.

Improvements have only been accurately documented, so far, in ASD patients with seizures. Any other use of the product at this time is purely trial-and-error, and the safety of hemp oil extract safety in children has yet to be proven. To the extent that patients may be able to take equivalent dosing, more information will emerge. The myriad of patients who try it, however, complicates evaluation about efficacy.

Helminth Therapy
While this unusual treatment of administering live organisms to successfully restore-reset immune function has been documented in adults with specific conditions, as concluded in a recent review, “Studies are neededto move helminth-related interventions that show promise in animals, and in phase 1 and 2 studies in human beings, into the therapeutic development pipeline.”

Chlorine Dioxide (CD)
Following up on that ‘worms or elimination of worms?’ question was a discussion about Chlorine Dioxide (CD) treatment. I ain’t sayin’ that it cannot/does not work in some individuals, but there are problems.
1. The science is weak and contradictory. There is no supporting research for terms, such as “Parasitological Vaccinosis.”
2. The main proponents, so far, are, the mother of an affected child, and scientist with questionable credentials.
3. Treatment can be risky.
4. Treatment involves a fair amount of resources; including frequent administration (every hour, sometimes), adjustment of dose, and which specific sites on the body to administer a dose (systemic, eyes, ears, rectum, etc.).

This peptide, which is produced in the brain, has been called the ‘love hormone’, and has been shown to be deficient in some patients with ASD. Animal models have demonstrated improvement, though humans haven’t responded the same way.

The most recent prospective, controlled, double-blind crossover study that involved 31 patients, demonstrated improvement. This has not necessarily been the experience at The Child Development Center of America, where it has been used for over 4 years, yet only a handful of parents continue to administer the product.

Transcranial Magnetic Stimulation
This type of mechanical device has been used for over a decade outside of the US, but has recently received FDA approval as a device for “major depression in adults who failed to improve on medication.” This is an expensive treatment option, in the range of $6,000 – $12,000 or more, and requires daily 1/2 hour treatments.
Adverse effects are listed as fainting, possible seizures, pain or discomfort, mania, changes in cognition, and transient hearing  and memory loss.

A recent review stated, “Though preliminary data suggests promise, there is simply not enough evidence
yet to conclusively support the clinical widespread use of TMS in ASD,
neither diagnostically nor therapeutically.”

Essential Oils
There is a paucity of literature to support the use of these products for patients who exhibit signs and symptoms consistent with ASD. On the other hand, they are relatively safe, have been around since the beginning of civilization, and do not cost a great deal to try. Furthermore, there are many studies demonstrating improvement in processing with occupational therapy and other ‘sensory diets’.

As in many of the other treatments, this has demonstrated the least improvement in our most apraxic and/or disruptive individuals.

Present medical therapies are woefully inadequate.
Many treatment options have been offered, but few have undergone sound scientific scrutiny.
Parents, desperate to help their non-typically developing child will be tempted to pursue less-than-helpful, less-than-safe protocols.
For the lesser affected patients, many forms of treatment will help.
For the most affected patients, such protocols offer only spotty improvements.
More research is needed. Physicians, who are in the best position to understand the complicated science, must understand the variety of presentations of autism and the myriad of treatment options in order to give families the best advice.

Doctors Failing to Understand Autism

Sunday, November 15th, 2015

When faced with the unknown or uncertain, physicians will often rely on language that, while sounding scientific and medical, just restates the obvious or says nothing helpful at all.

“I’m not aware of any literature on that topic.” Does that mean that the clinician has read everything and there isn’t any, or is the doctor displaying ignorance? A better answer would be, “Let me read about that and I will get back to you.”

“I don’t want to give you a diagnosis at this time.” It’s not up to the physician to decide. At least,  there could be a presentation of possible diagnoses, with the statement about a workup and interventions that the parent can initiate.

“It’s eczema. I’ll prescribe a steroid cream.” What is causing the skin rash? And, steroids will temporarily clear up any skin condition.

A 3-year-old wanders in circles and does not play with other children. “It looks like your child has developmental delay.” Stating the patently obvious is a frequent technique to deflect the physician’s lack of knowledge. The oncologist wouldn’t just say, “It’s a lump.”

“It’s not speech apraxia.” If a toddler wants to communicate and cannot say any intelligible words, that IS the name for that symptom. The converse situation occurs when the professional says that child has autism AND speech apraxia. It’s autism.

“I’d like you to come back in 6 months to see how the child is doing.” If that is the only reason that the doctor has for your return, he should be paying YOU for the visit.

“It’s not autism, I’d say more like PDD-NOS (pervasive developmental delay – not otherwise specified).” The DSM 5.0 has been published. The medical establishment has spoken. If a child exhibits repetitive or unusual behaviors and has communication delay, it’s Autism Spectrum Disorder.

“Those special diets are risky and can lead to nutritional deficiencies.” How about checking nutritional status with some appropriate lab testing? Better, check is as part of the initial workup, especially in picky eaters.

“He’s a boy… You speak two languages… She’s spoiled… Your grandfather was that way, etc.” We are in the midst of an epidemic. The child should be thoroughly evaluated for ASD.

“Studies have not shown significant results.” That depends on what research the practitioner chooses to read and believe. And, whether a treatment is worthwhile is best determined from the parents’ point-of-view.

“We can give medication to get rid of those ‘stims’.” One, repetitive behaviors are often communication, so reprimands may cause even more frustration. Two, those drugs are potent and have serious side effects.

“We can give medication for that anxiety.” One, nervousness is frequently appropriate. The affected child is concerned about not having the skills to join the group. Simply depressing the child’s response is not necessarily a good thing. Two, those drugs are potent and have serious side effects.

“We can give… Miralax for constipation… Zantac for refluxantibiotics for everything.” How about a thorough evaluation of why?

“It’s not anything to be concerned about.” The number one lesson that any pediatrician should learn is, “Listen to your mother(s)!” Worrying is part of their job. The child’s physician should perform an appropriate evaluation.

“Those ‘autism doctors’ are just quacks who will waste your time and money.” The parents can see progress for themselves. Families will continue to search for answers when traditional therapies alone do not seem sufficient.

The parents of today’s children who show signs and symptoms consistent with the epidemic of ASD are often more well-read than the doctor. These questions should spark interest on the professional’s part to offer more than lip-service to such a serious situation.

A Brief Discussion of Mitochondrial Function and Autism

Sunday, November 8th, 2015

Previously only of interest to researchers and a few doctors, this topic has become a popular subject to families of children affected with signs and symptoms that are grouped as Autism Spectrum Disorder.

Click to see the action…

The amount of information is dense, complicated by the myriad of bodily processes that are involved. Genetics, energy production, chemical reactions, membrane potentials and movement along the electron transport chain are basic to the understanding of these cellular organelles, called mitochondria.

Learning normal cell anatomy and function is a prerequisite to understanding what can go wrong and why.

There are discrete diseases of mitochondria, in which the specific steps involved in making energy don’t perform correctly. Additionally, there are numerous conditions caused, or exacerbated by, mitochondria functioning in some imperfect fashion, including autism.

Considering that mitochondria are the cells’ batteries, suboptimal functioning results in symptoms that reflect the particular organs that are affected.

Poor motility in the smooth muscles in the gut, e.g., could lead to reflux, or constipation and possible yeast overgrowth.
Weakness in the skeletal muscles may lead to poor core tone, developmental delays such as unusual or absent crawling, and eventually strength and energy as well.
Organs, such as the liver, that detoxify and so require a great deal of energy would not function optimally. A vicious cycle could ensue, as power stores become even more taxed. Additional potentially harmful substances would likely be less tolerated.
Throughout the nervous system, constant communication is necessary for proper perception. Affected individuals could exhibit various unusual sensory issues. Likewise, perhaps, there might be disturbances of motor function leading to atypical movements.
Poor energy function in the brain, which has to manufacture and reabsorb neurotransmitters, make electricity, grow new brain and prune the older, may lead to difficulty processing signals; therefore memory or focus would appear inadequate.

With an increased index of suspicion after a thorough history and physical examination (including the family history and review of systems – other than the chief complaint), a physician may decide whether to pursue laboratory and other appropriate testing.

Specific mitochondrial diseases are best addressed with diet and necessary medication, depending on the primary signs and symptoms and the affected organs.
In patients with ASD, in whom research has demonstrated low reduced-to-oxidized glutathione levels (GSSH/GSH), vitamins and supplements that address that situation, such as methyl B12, folate, SAMe (S-Adenosyl-methionine), cysteine and glutathione have led to improvement.
Mitochondrial ‘cocktails’ and supplements are popular; much of the work has been described here by Dr. Richard Frye.

The complexity of this topic is daunting, with much more research needed by universities and other scientific institutions. Armed with 21st century knowledge about mitochondria, doctors need to learn as much as possible, so that parents don’t have to figure all of this out on their own.

Oxytocin for Autism – Again

Saturday, October 31st, 2015

For the past couple of decades, oxytocin – ‘the love hormone’ – has been postulated as a possible remedy to the social deficits associated with ASD. TheAutismDoctor has previously reviewed the use of this peptide, released by the pituitary gland, which is located in the center of our brain. Animal models to determine value have shown promise, however, the experience in human subjects has met with mixed results.

This Newest Study, published in Molecular Psychiatry, claims to be “the first clinical trial to support the potential of oxytocin as an early intervention for young children with autism to help improve social interaction deficits.”

10/2015 The effect of oxytocin nasal spray on social interaction deficits observed in young children with autism: a randomized clinical crossover trial
Thirty-one children with autism received …oxytocin and placebo nasal spray morning and night… for 5 weeks, with a 4-week washout period between each treatment. Compared with placebo, oxytocin led to significant improvements on the primary outcome of caregiver-rated social responsiveness. Overall, nasal spray was well tolerated, and the most common reported adverse events were thirst, urination and constipation. 

Other selected recent (human) literature:
04/2010 Intranasal Oxytocin Improves Emotion Recognition for Youth with Autism Spectrum Disorders
This study provides the first evidence that oxytocin nasal spray improves emotion recognition in young people diagnosed with autism spectrum disorders.

01/2014 Oxytocin but Not Testosterone Modulates Behavioral Patterns in Autism Spectrum Disorders
8 children with ASD were recruited and underwent psychological profiling… Higher oxytocin levels were connected with more severe adaptive behavior in ASD patients. Increased oxytocin levels in children with more severe phenotype could be a result of compensatory mechanism of impaired oxytocin signaling. Oxytocin seems to employ distinct mechanisms in regulating social behavior in autism and healthy population.

03/2014 Nasal Oxytocin for Social Deficits in Childhood Autism: A Randomized Controlled Trial
Compared to placebo, intranasal oxytocin did not significantly improve emotion recognition, social interaction skills, or general behavioral adjustment in male youths with autism spectrum disorders.

08/2014 Plasma oxytocin concentrations and OXTR polymorphisms predict social impairments in children with and without autism spectrum disorder
These findings indicate that <<oxytocin>> biology is not uniquely associated with ASD

04/2015  Salivary Oxytocin Concentrations in Seven Boys with Autism Spectrum Disorder Received Massage from Their Mothers: A Pilot Study
Seven male children with autism spectrum disorder (ASD), aged 8–12 years… were assigned to receive touch therapy During the period of massage therapy, the children and mothers exhibited higher oxytocin concentrations compared to those during the non-massage period. 

12/2015 Oxytocin enhances attentional bias for neutral and positive expression faces in individuals with higher autistic traits
This effect of oxytocin is strongest in healthy individuals with higher autistic trait scores, thereby providing further support for its potential therapeutic use in autism spectrum disorder.

12/2015 (in progress) Oxytocin enhances orienting to social information in a selective group of high-functioning male adults with autism spectrum disorder
Individual differences in stress-related avoidance tendencies should be taken into account when considering OXT as a treatment of social deficiencies in autism.

Experience at The Child Development Center of America
lovedrugThis peptide hormone can be rapidly digested in the gut, so intranasal spray is felt to be more reliable and likely to act directly on the brain. Any parent of a sensory child is aware of the difficulty administering a nasal spray. The kids run for the hills! So, a sublingual preparation, available by prescription from a specialized pharmacy, has been a mainstay.

♥ Of the scores of patients who have tried the product, only 3 parents continue to administer the substance. Those few report improved eye contact and focus, and give it once per day, in the morning.

♥ The most common reaction is, “It didn’t make any difference,” or that any improvement wasn’t worth $80-$160 per month.

♥ A few parents have reported transient agitation or worsening of aggression, and discontinued treatment.

♥ One male, teenage patient had a negative psychological reaction that lasted for months, according to the mother. It was very disturbing that we weren’t able to predict this extreme reaction, nor the extended time to recovery.

More clinical experience will lead to improved knowledge about efficacy and safety. Hopefully, doctors will better identify those candidates who are most prone to exhibit positive responses.

Oxytocin therapy may be worth a try in selected patients. The practitioner should be knowledgable and experienced about biomedical intervention. A thorough explanation of the risks and the benefits should be presented and documented. Due to the lack of solid evidence, close follow-up is warranted.

Lyme Disease and the Autism Spectrum

Sunday, October 25th, 2015

A disease described forty years ago due to a cluster of patients who appeared in the vicinity of Lyme, CT, has to be considered among the list of differential diagnoses when pediatric patients present with unusual developmental and other complaints.

Included on that list are PANDAS, specific neurologic disorders (e.g. seizures and cerebral palsy), chromosomal anomalies, mitochondrial disorders, and a myriad of systemic conditions, such as autoimmune ailments, G-I disease and skin rashes that ultimately may lead to symptoms and signs that fulfill criteria for ASD.

There is a complicated life cycle involving a deer tick that is infected with an unusual bacterial organism. When a human is bitten, those critters create problems throughout the human body.

The variety of symptoms are due to effects in multiple organ systems, including skin, internal organs, muscles, and neurons throughout the body. Fatigue and various CNS complaints are the most obvious and serious signs. In patients with ASD, Lyme may appear as regression or progression of aggressive and disruptive behaviors.
Recent recognition of the havoc that this infection wreaks on the immune system points to signs and symptoms in a number of modern autoimmune maladies.

The most reliable diagnosis is made when a two step protocol is positive. Using the same sample, a positive or equivocal enzyme test will lead to testing for specific antibodies. According to one commercial laboratory, their PCR test has the advantages of correctly identifying Lyme in small measure, and in a variety of tissues. Costs are approximately $300 to $800.
Unless there is specific and adequate documentation, insurance companies balk at paying for even the less expensive labs.

According to the CDC, “Laboratory blood tests are helpful if used correctly and performed with validated methods. Laboratory tests are not recommended for patients who do not have symptoms typical of Lyme disease. Just as it is important to correctly diagnose Lyme disease when a patient has it, it is important to avoid misdiagnosis and treatment of Lyme disease when the true cause of the illness is something else.”

Patients treated with appropriate common oral, or intravenous antibiotics in the early stages of Lyme disease usually recover. There is a controversy concerning the proper diagnosis of patients who fail to respond after 6 months.
The CDC prefers “Post-treatment Lyme Disease Syndrome” to the term, ‘Chronic Lyme Disease‘. There is also “Conventional medicine and the NIH have taken a particularly strong position, researching various treatment protocols with little evidence of value. However, those who continue to suffer seek additional relief.

When faced with the enigmatic and vague diagnosis of ‘Spectrum Disorder’, parents sometimes seek a more specific, treatable disorder, such as Lyme. Clinicians should elicit a history of possible exposure to infected blacklegged ticks. Though ASD patients are as likely as anyone to become infected, symptoms that begin in infancy and very early childhood are much less likely due to Borrelia.

The history, a particular rash, and an unrelenting deterioration of neurologic function should alert the astute physician to perform the appropriate laboratory testing.

Importantly, the information we learn from studying and treating Lyme disease has many similarities to our better understanding of autism, as well.

Top 10 Reasons Why Autism Remains a Mystery

Sunday, October 18th, 2015

As regards the explosion of individuals who are diagnosed with autism, progress  seems agonizingly slow. It is the parents of affected children who are leading the way, and traditional explanations are, literally, the thinking of the last century. Why is information about prevention, cause and treatment so sparse?

Researchers are still debating the existence of an Autism Epidemic. Why should it matter whether there are more affected individuals because of reason “A” or reason “B”? That confusion holds up funding for studies, however.

Professionals continue to argue about the ‘when, how, and who’ of assigning an accurate diagnosis, which impedes trials seeking to explore prevention or treatment.

The likelihood of discovering a ‘magic bullet’ is low. There will probably need to be multiple treatments for the signs and symptoms documented in the DSM 5.0, depending on the myriad of causes and presentations.

There are no practical, accepted biomarkers for diagnosis. This is especially important in order to evaluate treatments(s) in an acceptably objective manner. This discovery alone could significantly advance research.

Surrounding the topic of ASD are highly charged issues, such as vaccinations, or complicated treatments, such as HBOT and chelation. Rather than stimulate further investigation, the situation appears to impede conventional researchers from documenting efficacy (or the lack thereof) in such controversial interventions.

Successful treatments of the various co-morbidites displayed by autistic patients, such as those offered at The Child Development Center of America, which combine biomedical and conventional protocols, are frequently viewed with skepticism, at best. These protocols deserve the attention of the medical establishment.

 We drink red G-2 and it comes out yellow.
Ever wonder where the red goes?
(hint… it’s not digested)

Proven associations, such as toxins, poisoned food and the environment, are not popular areas for discussion. Preventive measures receive little promotion or even acknowledgment. Cleaning up can be accomplished, at a cost. This involves not only public education and policy making, but personal choices, as well.

Antibiotics and steroids continue to be overprescribed by doctors, and are requested or too readily accepted by patients. There is a price to be paid for taking strong pharmaceuticals for every ‘cold’ or rash.

Research findings that implicate genetic variations imply feelings of futility about the plausibility of successful intervention. “If it’s genetic, we can’t fix it.” But, every day there are new discoveries about personalized medical treatments for autoimmune conditions or cancer, for example. Tiny chromosomal errors are not insurmountable.

Tools for early diagnosis and intervention, already proven successful, continue to elude the pediatrician’s black bag. Psychiatrists and neurologists, likewise, employ old-fashioned thinking and potent, risky medications that are barely and rarely effective.

In order to take autism research and treatment into the 21st century, organizations that are responsible for actually providing answers need to address these concerns and get serious about forming a unified and thoughtful approach to this medical puzzle.

Tryptophan to Treat Autism

Sunday, October 11th, 2015

Tryptophan, which is a naturally occurring amino acid (a protein building block), has been found to be an effective treatment for several of the signs and symptoms of autism.

According to SelfNutritionData, the food that is highest in tryptophan is a particular species of Sea Lion*, followed by game meat and seaweed. Foods that we actually eat include spinach, fish and eggs. Milk is way down on the list. And, duck contains more than turkey.

Furthermore, as noted by WebMD, when taken in food, “Tryptophan has to compete with all these other amino acids. It waits in line to get through the blood-brain barrier and very little of it makes it across.”

A 1984 study about levels in autistic patients reported, “The blood serotonin level was significantly higher in autistic children than in normal control subjects… results suggest that autistic children have some defect in tryptophan-serotonin metabolism in the brain, which is responsible for the clinical manifestations and behavioral abnormalities of infantile autism.”

Following that, researchers who measured whole blood serotonin and tryptophan in ASD vs. neurotypical patients suggested, “… the possibility that increased gut production of 5-HT might cause…” elevated levels in the autistic population.

Subsequent researchers noted that their results, “… suggest that a low brain tryptophan availability… could be one of the possible mechanisms involved in the alteration of serotonergic function in autism.” Another paper concluded, “These serotonergic abnormalities in a brain pathway, important for language production and sensory integration, may represent one mechanism underlying the pathophysiology of autism.”

There is even evidence that suggests,”…the presence of a susceptibility mutation in the TDO2 or a nearby gene…” Recently, researchers wrote in Molecular Autism, “… decreased tryptophan metabolism may alter brain development, neuroimmune activity and mitochondrial function. Our finding of decreased tryptophan metabolism appears to provide a unifying biochemical basis for ASDs and perhaps an initial step in the development of a diagnostic assay for ASDs.”

Clinical Experience
To achieve higher CNS levels, it seems reasonable to administer 5-hyroxytryptophan (shown in the figure), which is available as a natural supplement. Using 5-HTP seems preferable, since there could potentially be a block at the first step. The dose varies from <50mg to 200mg per dose, and frequency may be up to 3 times per day. Obviously, administration depends on the individual patient’s age, size, diagnoses, etc.

Parents frequently report that melatonin shortens sleep latency (the time that it takes to fall asleep), but nighttime awakening can occur. By adding 5-HTP before bedtime, conversion to melatonin helps maintain sounder sleep.

Often, families observe that anxiety and subsequent frustration leading to aggression can be better controlled by administering this supplement on a daily basis.

Likewise, more focus and attention may accompany administration of tryptophan, making it one of the more commonly prescribed supplements in the ASD toolbox.

Side effects
As noted in the figure, one of the metabolites is melatonin, which influences sleep. Parents who notice that the child becomes less active or lethargic can simply lower the dose or frequency in order to mitigate that effect.

Patients who take SSRIs (prozac, etc.) may experience an exaggerated response. Therefore, caution is warranted in such individuals. Interestingly, this effect is sometimes useful when attempting to wean children off of those pharmaceutical preparations.

Rarely, individuals experiencing signs and symptoms of ASD actually get more hyperactive when taking this supplement. It’s difficult to understand this phenomenon, but by discontinuing the tryptophan, there is return to the previous state.

The experience of many parents has been positive, and this supplement has become a mainstay of biomedical intervention. My advice is to give it a try, about 1/2 hour prior to a high-anxiety event, such as church, a shopping mall, or restaurant, for example**.

*As an aside, 1 ounce of Stellar Sea Lion contains more than 2-1/2 grams of tryptophan, as well as selenium (498 % RDA), copper (97%), phosphorus (43%), iron (39%), and zinc (36%). Not available at Trader Joe’s.

**As in all things dealing with ASD and medical intervention, be sure to check with your physician prior to administering any supplement to your child.


Patient Testimonials about Biomedical Autism Treatments

Sunday, October 4th, 2015

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

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

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

Website inclusions:
♥ GraciesAutism
♥ Jacob Velazquez, pianist

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

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

Categories Archives Links Contact Us

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

Copyright © 2010, 2011, 2012, 2013, 2014, 2015
All Rights Reserved