Posts Tagged ‘advice’

A Letter to Autism Researchers

Sunday, March 13th, 2016

The title of a recent article in the Journal of Pediatric Gastroenterology and Nutrition was Evaluation of Intestinal Function in Children with Autism and Gastrointestinal Symptoms. The headlines featured by most of the lay press, “Tests Show No Specific Gastrointestinal Abnormalities in Children with Autism.” Big difference.

The Study
According to the authors:
• There was no difference in the activity of the enzymes that break down key sugars in autistic vs. non-autistic children who are evaluated for gastrointestinal disorders.
• Specific biomarkers of intestinal inflammation were elevated equally in autistic vs. non-autistic children with GI signs and symptoms.
• Biomarkers of a ‘leaky gut’ were not found more frequently in autistic vs. non-autistic patients with similar symptoms.

Discussion
A scholar.google.com search for gastrointestinal problems in autistic children returns >24,ooo results. There are reports of poor oral-motor function, sensory issues of taste and smell, GERD, eosinophilic esophagitis, abnormal gut flora, chronic constipation, chronic diarrhea, alternating constipation and diarrhea, and delayed toilet training.

The authors noted that, “Common problems such as gastroesophageal reflux or constipation may present with atypical symptoms such as stereotypical behaviors, aggression, or self-injurious behaviors. Consequently, gastrointestinal problems that might be easily recognized in a neurotypical child may go undiagnosed in a child with autism.” They concluded, “There is no evidence to support that gastrointestinal disorders cause autism.”

This crystallizes what’s wrong with research in the ASD universe.
There isn’t one kind of autism. Addressing the individual co-morbid conditions frequently allows traditional therapies to take hold.

The diagnosis itself is a collection of signs and symptoms categorized in this manner, especially since the DSM 5.0 has included PDD-NOS and Asperger’s Syndrome under the Autism Spectrum. There are conditions that present primarily with aggressive or disruptive behaviors, genetic variations – large and small, immune system regulation difficulties, central nervous system abnormalities and seizures, significant skin rashes, and probably many more.

It is only a matter of time until a colleague announces to me, “Well, I heard/read/thought that it has nothing to do with the GI system.”

Conclusion
Even when respected professionals, such as Dr. Buie, et.al., research and document important information, it is frequently misunderstood by the general media to dismiss the tragedy of this epidemic.

Evidence-Based Pediatric Special Needs Medicine

Monday, March 7th, 2016

EvidenceAt an autism fundraiser lately, I took the opportunity to speak with one of the leaders in our local treatment community. I felt that his understanding of complementary and alternative protocols was limited at best, and looked upon with suspicion and even derision at worst.

When I stated to the Director that I was a pediatrician who treated children with autism, he exclaimed, “Well, we do evidence based medicine. What’s with that Wakefield fellow?” “Ummm,” I replied, “that was, like, over 15 years ago. Why am I responsible for that stuff?”

“And, what about that Bradstreet guy? I went to hear him speak once, and the information about secretin was already in, and he was still lecturing about it’s value? What makes you different?” asked the gentleman.

“Well, we do a suitable medical workup, and, depending on the findings, treat patients with safe and often effective interventions.

Perhaps we could go to lunch and talk about the manner in which doctors, such as myself, practice? And by the way, what about that decision by the AAP that early autism screening isn’t supported? They claim that more evidence is required. Do you subscribe to that?”

Evidence Based Medicine
Certainly, the goal of modern treatment is to follow best-practices protocols, which have been documented as safe and effective, and evaluated with scientific scrutiny. The gold standard for medications has been a repeatable and repeated, double-blind (examiner not aware if drug is med-in-question or placebo), crossover (give real med to one group then reverse), randomized (who gets, who doesn’t), controlled (follow specific protocol) trial of sufficient number of patients (determined and crunched by statisticians).

A noted expert has written in the British Medical Journal, What it is, and what it isn’t:

It’s about integrating individual clinical expertise and the best external evidence.

The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.

Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough.

Evidence based medicine is not “cookbook” medicine.

May raise rather than lower the cost of their care.

It will continue to evolve.

As noted in Wikipedia, “A 1994 study concluded that 58% of life science companies indicated that investigators were required to withhold information pertaining to their research as to extend the life of the interested companies’ patents… A major flaw and vulnerability in biomedical research appears to be the hypercompetition for the resources and positions that are required to conduct science… seems to suppress the creativity, cooperation, risk-taking, and original thinking required to make fundamental discoveries. Other consequences of today’s highly pressured environment for research appear to be a substantial number of research publications whose results cannot be replicated…”

Discussion
This past week, a mom reported that her 5 year-old child with signs and symptoms of autism was taking “some type of sleeping pill” given by a respected local psychiatrist. The medicine was Buspirone – an antipsychotic. Where is the evidence for that? Another child had just gotten a sleep study – from another physician – with no history of any sleep problems. Antibiotics for colds, Tamiflu for upper respiratory infections, and anti-seizure medications, are all routinely prescribed with less-than-solid evidence. Not to mention the complete lack of a laboratory investigation.

For several years now, the Medical Academy of Pediatric Special Needs has stressed that conventional therapies combined with a proper medical evaluation and appropriate intervention results in better ASD outcomes. There is a large body of evidence to support the protocols that are so successful in reducing unusual behaviors and prompting communication. Dr. Dan Rossignol has led an organization that stresses the use of evidence-based research and applying that knowledge to patient care.

Anyway, it’s not simply complementary and alternative medicine that we practice. Nor is it holistic, integrative, allopathic, osteopathic, Western or Eastern. It’s the provision of safe and effective interventions that ASD families seek. It’s medicine.

High vs. Low Functioning Autism

Sunday, February 28th, 2016

MeasureAfter a thorough history and physical examination, if there is an autism diagnosis, parents frequently ask the question, “So, do you think that my child is high or low functioning? How much autism does my child have?” They are especially thinking, “Will my child be OK?”

The answer depends on the underlying cause(s), the child’s age, developmental trajectory and skill set at the time of diagnosis, the response to therapies so far, and how they go on to respond to the various treatment regimes.

Screening validity
According to the CDC, “Research has found that ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable. However, many children do not receive a final diagnosis until they are much older. This delay means that children with an ASD might not get the help they need. The earlier an ASD is diagnosed, the sooner treatment services can begin.” The webpage even provides a detailed algorithms for parents and professionals to follow.

The site also provides links to the various tools that families and diagnosticians can access. The CDC even displays an Autism Fact – Myth Table, with references, at the bottom of the page. Begging the question, is how accurate the tests are, as far as assessing and predicting the future course of a patient’s autistic involvement.

Discussion
Presently, there are no practical biological markers to measure and follow the ‘level’ of autism. There are certainly tests, such as chromosome and abnormal metabolic laboratory findings, that carry more predictable courses.

In my experience, the important predictors of a more positive outcome are:
• Initial score less than 50th% of top possible score.
• Scores that are higher in speech.
• Scores that are lower in negative behaviors.
• Scores that continue to improve over time.

Conclusions
The good news is that many of the negative behaviors attributed to autism are often gut-related. As the astute clinician diagnoses and successfully treats that co-morbidity, children often respond with improved communication skills, including the difficult-to-treat speech apraxia problem.

Likewise, accurately understanding and treating the lack of interaction with the environment – lifting ‘The Fog’ – with biomedical intervention, goes a long way toward lowering the bad scores and improving the child’s ability to attend to the traditional therapies.

Attainment of the skills that are required to join a general education classroom is more important than any score – developmental, intellectual or academic. Perhaps sadly, the non-disruptive and compliant child is more likely to remain mainstreamed than those with more advanced abilities who are aggressive or less-responsive.

Finally, I like to point out that the term ‘high’ or ‘low’ functioning doesn’t just apply to the developmentally challenged. There are lots of low-functioning neurotypical individuals. We meet them every day.

Helping Pediatricians Understand Autism

Sunday, February 21st, 2016

I publish these ~weekly essays for 4 principle reasons.
1. To learn. This is the main purpose. In order to provide educated answers and advice, it is necessary to delve into all of the science surrounding this epidemic. Basically, the blog is homework, and this venue is often a recording of those literature searches.

2. To teach. Useful treatments are available to alter the course of this possibly life-long condition. The amount of information underlying etiology and diagnosis is dense, and getting more so day-by-day. However, present treatment options are simple to understand and herein made available for all to explore. The situation is clearly made worse by the frequent overuse of conventional medicine.

3. To provide a sense of balance in the polarized, media-drenched world of autism diagnosis and treatment. Nearly 70 million web pages instantly respond when ‘AUTISM’ is googled, with information from The Mind Institute to Quackwatch. These essays are about research, observation and experience.

4. To keep my head from exploding. Sometimes, even with the alarming increase in cases, and all of the effort that the various autism societies put into chronicling the situation, ASD is misrepresented, misunderstood and ignored.

This story is presented for reason #4. Recent events affecting the establishment of a diagnosis that could lead to earlier effective treatments are so garbled by the traditional medical community, I feel compelled to speak out.

The Issue
previous blog detailed my reaction to a ‘US Task Force on Autism’ recommendation against early screening. I noted the following inconsistencies the line of thinking:
There exists incomplete research as to the value of treatment. Should that stop us from trying to treat them, or screening all children?
Potential harm from screening included, “… time, effort, and anxiety associated with further testing.. Behavioral treatments… can place a large time and financial burden on the family.” The burdens of lifelong ASD are considerably greater.
A common theme among most of the parents who are interviewed about the manner in which their child’s autism diagnosis was handled, is the wish that the pediatrician had been more knowledgeable and forthcoming about developmental red flags.
When it comes to all-vaccinations-for-allebolapoisons in our environment, etc., the government has rarely demonstrated reluctance to recommend. When it comes to children’s health, what happened to erring on the side of caution?
The task force VP said, “… of course you should screen if the parent is concerned.” Isn’t that the doctor’s job?

This week, the American Academy of Pediatrics released a ‘Final Recommendation Statement on Autism Screening’. “The AAP stands behind its recommendation that all children be screened for ASD at ages 18 and 24 months, along with regular developmental surveillance.”

They confirmed the Task Force’s belief that early screening could lead to unnecessary concern and expense for the parents. Here’s the thing… THE PARENTS ARE ALREADY WORRIED. Plus, if the doctor is not accurate, THE EXPENSE OF EARLY INTERVENTION IS NEGLIGIBLE, compared to years and years of necessary therapy.

The present line of thinking would be that, if your child is not speaking at, say, 15 months, makes poor eye contact, exhibits low core tone, interrupted sleep, sensory issues and chronic constipation, it’s more worthwhile to wait 3-9 months until making a diagnosis and instituting conventional interventions.

Discussion
So far this month, I have received emails from the FDA, the Florida Department of Health, The CDC and  the American Academy of Pediatrics notifying me of the signs and symptoms, the dangers, treating, reporting and preventing Zika. I haven’t gotten any such warnings for years, regarding ASD. Where is the call for more research on Ebola, e.g., before alarming the public?

“I really don’t know much about autism,” is often a Pediatrician’s response to parents’ questions about the condition. This AAP confirmation of the Task Force’s recommendation is pointless, and only prolongs the professional’s continued ignorance.

This recent formal statement is not merely a letdown to the autism community, it represents a slap in the face.

Reading, Texting, and Arithmetic for Special Needs Children

Sunday, February 14th, 2016

While on summer vacation as a child in the middle of the last century, I would pass booths along the Boardwalk in Atlantic City, NJ, where hucksters would proclaim their ability to accurately evaluate any personality by examining handwriting. Sloppy or tidy text, large or small font, left- or right-leaning, dotting i’s and crossing t’s, for example, were alleged to represent telltale signs about the kind of person you were.

Today, ‘graphology‘ continues to be a skill offered by trained professionals who scrutinize calligraphy to expose weaknesses, point out strengths and certain personality traits. There are even computer algorithms that claim similar results. Information may be used by the legal system and employers to better determine veracity, aptitude, and job success.

History
According to Wiki, the earliest reference appeared in “The Confessions of Saint Augustine” AD 401… For those first lessons, reading, writing and arithmetic, I thought as great a burden and penalty as any Greek.” The original phrase “the Three Rs” came from a speech made in 1795.

Handwriting has thus been included in the necessary skill set that any educated person should possess. Well, it’s the 21st century, and we need to revisit that requirement.

‘Rithmetic
When calculators arrived, they were eschewed by an older generation, who claimed that, “If you were stuck on a desert island without a calculator, what would you do?” Of course, the answer was that, if you were so marooned, you wouldn’t need to cypher, you would need to survive! The point as regards mathematics, is that the concept needs to be understood – that 7 is greater than 5, and that 5 apples do not necessarily equal 5 oranges.

What about memorizing times tables? It’s basically the same issue; there is a larger concept that requires comprehension. If you don’t conceive of 12×12 = gross, you will have a difficult time ordering parts, making a budget, or figuring if you have enough money to buy a Big Mac and fries. Entire skill sets are based on math; from plumbing, to painting, to architecture, to all scientific pursuits. Understanding math is a basic necessary skill, handwriting is not.

Reading
An argument could possibly be made about reading being an archaic competency, as well. After all, computers can now read aloud, and podcasts and audible books are ubiquitous. Such reasoning will certainly rankle traditionalists. I am an avid reader, so believe me, I see holes in this line of thinking.

‘Riting
Most patients who experience fine motor difficulties, whether as a result of their autism, ADHD, dyslexia, dyspraxia, or various other physical challenges, find that they are terrible at handwriting. Practice, Practice, Practice. There is no pill for dexterity. If there were, we would all take them, and learn piano! But, what if you don’t want to learn to play an instrument? Should you be forced to, and will it make you anything but a terrible musician?

When my son taught Special Education to 5 and 6 year-olds, we would speak about the struggle that his students were experiencing as they tried to fit into a conventional academic experience. Later, while trying to instruct 10 and 11 year-olds, however, capitulating to the usefulness of typing became the logical choice. The child’s self-esteem would improve and the frustration of managing this skill would disappear.

Discussion
Watch people use a keyboard nowadays. Some use their thumbs, poke with one digit, stab with two fingers, utilize the old qwerty touch-typing method, point with a stylus, and even talk into a machine that turns voice into text. How well would a 50-something do on a job interview, if thumb-texting were the required skill?

The only ‘C’ that I received throughout my academic experience was for handwriting, when I was in third grade. My cursive was – and still is – nearly unreadable.

You know what? My mom said that I could still be a doctor. She was write right (no thanks to my spell-checker).

Americans with Autism Act

Sunday, February 7th, 2016
ADA

George I signs Americans with Disabilities Act 7-26-90

Our local Board of Education was sued in Federal Court this week for not providing proven services to children affected with autism here in Florida.

The Sun-Sentinel declared, “The Broward County School District is once again under attack for its handling of special needs students.” Our educational services are not meeting the needs of the population, is how I read that.

The Case
The parents of 2 families are asserting that ABA should be provided, since it is the proven method of getting kids on the right track. The School Board response is that it is not a good idea, ’cause they have a better plan. Well, not really. They might get a better plan, and if they did, this ruling could prevent implementation of their better plan.

A 2000 Autism Task Force, put together by an independent body of experts, put out a well-researched Report on successful ASD treatment, and the efficacy of ABA therapy.

Surely the fact that the system in this Florida locale has already been cited for deficiencies in services to the educational needs of 30,000 students raises suspicions about the tactics, motives and abilities of the defendants.

Moving Parts
The first draft of the Americans with Disabilities Act (ADA) was introduced in Congress in 1988. After that, the bill went through numerous drafts, revisions, negotiations, and amendments. All over the U.S., disability advocates began working to educate and organize the disability community, and to collect evidence demonstrating the need for a strong anti-discrimination law.”

Insurers
Eight years ago, then-governor Charlie Christ signed a bill in Florida that called for health insurance companies to negotiate agreements with the state on how they will cover diagnosis and treatment of autism-related disorders. Companies not entering into such agreements were to be required to enter into such agreements within a year. Coverage was capped at $36,000 a year, or $200,000 over a lifetime. Needless to say to Florida residents, traditional therapies remain the least-authorized treatment for our patients.

Recent settlements have been for the defendants, against state agencies and insurers. It even made the news when Washington State became #38 to require autism benefits.

Boards of Education
There appears to be a common thread that Boards of Education do not have the available resources to address such daunting numbers of affected children. From California to New York; not only for ABA, but for lack of appropriate assessments, training and transitional skills.

Funding is also challenged when the Federal Government holds back their fair share of support due to red tape and squabbling over the definition of appropriate services.

Employers
As reported only 2 years ago, “Boeing, which employs more than 80,000 residents in Washington, was sued in a class action for allegedly excluding applied behavior analysis autism therapy implicitly — by having its claims administrators reject all coverage of ABA therapy and not including ABA providers in its networks, the lawsuit alleges.”

Discussion
A significant part of the problem is that the DSM 5.0 – The Diagnostic and Statistical Manual of Mental Disorders – is the wrong place to put this diagnosis. ASD is a medical, not a psychiatric disorder. That paradigm alteration puts the onus on the health and educational system to provide relief.

Another obstacle is the continuing debate about the increasing numbers of children with an ASD diagnosis. If the epidemic is not real, it shouldn’t be necessary to allot increased resources.

Most important is dollars. If the numbers are real, it’s going to cost lots of money to provide $75/hr. personnel to a portion of the student body. Over a lifetime, costs exceed $1.5M, and depend on the degree of intellectual disability. Presently, resources are woefully underestimated.

Conclusion
There shouldn’t need to be lawsuits against government, insurers or employers so that they obey a law that was passed thirty years ago.

There shouldn’t need to be a separate Americans with Autism Act.
ADA is already in place.

Responsible parties need to act responsibly, and laws need to be correctly and fairly interpreted and enforced.

Concerns About Nutrition in Restricted Diets

Sunday, January 31st, 2016

Achieving an Optimal Medical Outcome
A Play in 3 (very short) Acts
By Brian D. Udell, MD

CHARACTERS

Dr. Udell Medical Director of Pediatric Special Needs Practice. Forty years of experience. Doesn’t take any crap. Prone to voicing his opinion.
Mom A great mother who tries to listen to all the professionals, research the ‘net, and get the best care for her child. Seeking another opinion from Dr. Udell.
Bobby – the kid Beautiful 4 year-old child with autism. Speech apraxia and social isolation are the most significant problems.

SETTING
The Child Development Center of America, in Davie, Florida. Typical tropical rainstorm on the outside. While the child is being observed via cameras in the playroom, a discussion ensues in Dr. Udell’s medical office.

TIME
The present.

ACT 1
MOM
I came to see you because the doctors over at the hospital want to put a gastric feeding tube into my child. He got sick with intestinal blockage 3 months ago, then pneumonia 2 months ago, and now he won’t eat anything but Pediasure. Also, we have to give Miralax all of the time, or Bobby won’t poop for 3 or even more days.

Dr. UDELL
Do any of the doctors know that Bobbly has autism?

MOM
Well, I guess so. But they are all worried about his nutrition. Without the Pediasure, he won’t eat anything. He wasn’t growing and we are all scared. But, I don’t want to put a tube into my child.

(Dr. UDELL performs a physical examination and goes over the chart containing information from previous visits.)

Dr. UDELL
I see here that the child is really intolerant of casein. Also, our notes reflect that there was some variable response to biomedical protocols. What happened with that?

MOM
We did everything that we could to get him to eat. Especially after he got sick recently, this was the only was to make sure that he was fed. At least now, he drinks the Pediasure – just won’t eat anything else.

ACT 2
Bobby enters. He makes pretty good eye contact with his mom, mostly ignores the doctor, says some words that make sense and are very clear (“go home”), and others that are unitelligible. Echolalia and scripting. Then, back to the playroom. The staff interacts with him, but mostly he wanders by himself, with occasional hand flapping.

Dr. UDELL
Is he getting Speech and Language Therapy?

MOM
The insurance… we’re waiting for that.

ACT 3
(Dr. Udell seems upset. He closes the door, slowly raising his pitch, and pointing his fingers.)
Everything that you have told me, and everything I know about your child tells me that all his problems are really one problem – Autism. Somehow his immune system and his gut are involved. Nutrition is surely a factor.

(Dr Udell’s voice more sympathetic now.) You are a great mom. What these doctors are suggesting is not only un-helpful, it could lead to permanent problems. Where does this cycle of Pediasure and Miralax for constipation lead to? Abilify for stimming and Adderall for hyperactivity.

(Dr. Udell sounding more authoritative.) The main deficit is speech. At this crucial time in your child’s less-than-5-year-old development, whatever you do from this point forward, ought to be focused on improving communication, especially producing useful speech. And, Bobby even exhibits occasional flashes of that skill… he’s in there!

To the extent that addressing gut and nutritional issues advances that goal, we should capitalize on our ability to pursue. But… THE BRAIN TRUMPS THE GUT. The child will reach the age of ten or twenty – either bigger or smaller. But, will he talk?

(Dr. Udell’s right finger pointing in the air). To prove my point, I offer the following scenario: A doctor says, “I have a pill that will definitely increase the chances that useful language will emerge, but it may result in a loss of a few pounds in weight or inches in final height. Otherwise, there are no other significant risks. And, it will take time, effort, and resources. It may seem that the child is starving, but we will make sure that doesn’t happen.”

Or, the family could be satisfied with a rubber tube that pumps fake milk into a child’s stomach, assuring nitrogen balance and optimal growth. The child’s autism? That’s not their problem – and, anyway, there’s little that can actually be done, other than conventional therapies and take your chances.

(Dr. Udell seems really upset.) There really is no in-between. ASD is associated with gastrointestinal issues, including oro-motor functioning, sensory processing, GERD, and constipation. And, there are no pickier eaters than those who suffer from restricted interests and repetitive behaviors.

Whatever it takes to achieve some minimal nutritional support, a way can usually be found to address the lack of interest in real food. And, it starts with a speech and language professional who understands that feeding therapy is the most basic part of the patient’s issue. If it takes 3 or more months of slowly introducing necessary supplements, medications, and yes, even foods, that’s OK. Because communication – not nutrition – is the paramount issue of that period in the child’s recovery. (Dr. Udell is standing, and breathing rapidly).

EPILOGUE
Nearly 30 years ago, as a practicing neonatologist, I introduced the first computer program for feeding tiny babies. As a pediatrician treating infants who were suffering from cocaine addiction, poor prenatal care, and even HIV/AIDs, our NICU was responsible for working with nutritionists, nurses and parents to best address dietary needs in very sick newborns.

So, as the epidemic of signs and symptoms that are presently called Autism Spectrum Disorder evolves, my perspective on the topic of achieving optimal nutrition has advanced and adapted to meet the needs of each individual patient.

Marking Improvement in Your Toddler’s Autism

Sunday, January 24th, 2016

In typically-developing children, the second year of life ushers in socialization and mobility. Eye contact becomes more sustained. Babbling precedes talking. Motor skills lead to physical independence. That gives rise to play, and achieving the skills that will be required later, in school.

The treatments that are utilized in successful alternative and complementary techniques are meant to improve youngsters’ overall health. This approach, combined with appropriate traditional therapies, often leads to the necessary communication skills and maturity that enables escape from the most devastating effects of ASD.

Altering the Course
Understanding this revised trajectory is important for recognizing the positive and negative changes that accompany recovery. Speaking at 3 years of age is now a ‘smarter’ individual, who displays the ability to repeat words seemingly without fatigue (echolalia) and can remember entire phrases (scripting).

  1. Words. There are a few to start, plus some that are only occasional. Then, more consistent speech ensues. Two word sentences materialize, again, only sporadically at first. Gibberish precedes understandable language. Self-talking and whispering proceed to talking to toys, then parents and siblings, older and younger children, finally leading to age-appropriate play.
  2. Socialization. Turning to voices and the child’s name signals more awareness. Eye contact is a skill that engenders joint attention and learning by looking. Pointing is the earliest sign that this skill is emerging.
  3. Strength. As core tone improves some remarkable changes can take place, from better posture and ambulation, to the ability to climb monkey bars and push bicycle pedals. Improved mitochondrial function leads to better energy efficiency and less gastro-esophageal reflux, and even decreased strabismus (eyes crossing).
  4. Sensory processing. Pain thresholds decrease, resulting in a more normal response to getting hurt. Self injurious behaviors and toilet training can respond to reasonable remedial efforts.

Discussion
The good
– A modern ASD protocol encourages the awakening of a toddlers’ neural pathways. This enables better oral-motor functioning; from proper chewing, to sensory improvement and the ability to tolerate a more varied diet, to words, and eventually, functioning speech and language.

The bad – Improvement initially results in increased self-stimulatory behaviors. Especially annoying signs, however, are teeth grinding, screaming and screeching, verbal tics, decreased focus and attention, and even aggression. Therapists’ attempts to ‘control’ these behaviors would be better served by redirection, rather than employing strategies to extinguish such symptoms.

The ugly – Calling restricted interests and repetitive behaviors ‘Obsessive-Compulsive’ is imprecise at best and destructive at worst, especially when doctors try to pharmacologically ‘fix’ the situation. The anxiety that naturally accompanies a child’s awkward development should not reflexly signal a psychiatrist to prescribe strong central nervous system remedies. And, the impression by a neurologist that lack of focus and increased activity may be addressed with stimulant medications is likewise, unwise.

Conclusions
There are multiple causes and presentations that fall under the diagnosis of Autism Spectrum Disorder. So far, the myriad of treatments – both conventional and alternative – reflect the lack of specificity in understanding the epidemic.

It is not readily apparent exactly which therapy sets off that quantum leap in development in each individual child that enables a parent to observe some glimpse of intellect that indicates neuro-typical processing.

By correctly recognizing those moments of clarity and capitalizing on realized gains, professionals and parents can maximize the chances for a more complete reversal.

Antibiotics and Autism, too

Sunday, January 17th, 2016

One of my most re-tweeted essays is The Law, Antibiotics, and Autism, which is a discussion involving a recent Federal Court ruling. The final verdict was that, even though antibiotics in our food are admittedly harmful, the LAW’s hands are tied, and the practice would continue.

The evidence shows that resistant strains of bacteria are being created due to the addition of bug-killers in animal feed. Tweeters questioned my jump to the association with autism.

Is there any association
between antibiotics and ASD?

Evidence
More than 10 years ago, a proposed mechanism was offered as evidence that demonstrated increased antibiotic treatment in “… 206 children under the age of three years with autism… A significant commonality was discerned and that being the level of chronic otitis media.”

A well-researched paper entitled Microbiology of regressive autism concluded, “This shows that penicillins and cephalosporins… have a major impact on the normal bowel flora and therefore might well predispose subjects to overgrowth of such organisms … of particular importance for autism…”

There is even information (animal and human) that microbes in the mother’s G-I system affect the developing fetus.

Mostly, however, the overwhelming evidence is the preponderance of children with signs and symptoms of ASD who offer histories consistent with multiple trips to the doctor, and suffer from a myriad of gastrointestinal ailments, which seem to respond to probiotics, anti-fungals, and targeted antibiotics.

Discussion
Women who are pregnant, or thinking about becoming so, should try to avoid all pharmaceutical agents, unless absolutely necessary.

Doctors should take note of this and make every reasonable effort to avoid the knee-jerk response to prescribe a ‘z-pack’, or 10 day course of amoxicillin, at every turn.

Conclusion
Once it became established that antibiotics in the food chain cause harm, it shouldn’t really matter exactly what havoc they wreak, for the FDA to protect us. If medication gets into the livestock, it pretty much gets into mother’s milk and your kid’s chicken nuggets.

However, autism is the epidemic that hundreds of thousands of parents are facing. While an increased rate of two variables doesn’t prove a relationship, common sense dictates caution, at least, in their continued indiscriminate use.

Premies and Autism

Tuesday, January 12th, 2016

crack-baby-mythAs a practicing neonatologist for over 25 years, it has actually come as bit of a surprise that premature infants are more likely to develop signs and symptoms that are associated with autism.

In an earlier position as the Director of one of the largest neonatal units in the country, I examined thousands of high-risk children through the age of 3 years. The emergence of ASD in that population did not become apparent, however, until the first decade of this century.

Recent Evidence
Coincident with the rise in autism was a 2008 article entitled, Positive Screening for Autism in Ex-preterm Infants: Prevalence and Risk Factors. “Early autistic behaviors seem to be an underrecognized feature of very low birth weight infants,” was the conclusion.

A 2015 sampling “… of 1655 at risk children for developmental delays who were 17–37 months of age,” demonstrated that, “Premature births were almost twice as common for the atypical development group versus the ASD group.”

Other research concluded, “Overall, the results suggest that <<very premature>> children with ASD have different brain structure in the neonatal period compared with those who do not have ASD.”

study that examined serial MRIs in premies noted, “…brain structural alterations, localized in the regions that play a key role in the core features of autism. Environmental factors were stressed. The authors concluded that, “Early detection of these structural alterations may allow the early identification and intervention of children at risk of ASD.”

A 2016 paper examining very premature infants, found that “…alterations had functional implications for information flow, rule learning, and verbal IQ.”

Risks Associated with Prematurity
Immune system – Does not develop fully until months after full-term delivery. In premature babies, the safety of the environment has been breached.

Brain – The last 3 months of gestation are important for complete development. Bleeding and disrupted architecture may occur in key areas.

Gut – Nutrition in this population is anything but normal. The muscle that prevents backup of food from the stomach to the esophagus is very weak and prone to leakage. The modern treatment using PPIs could be adding to the problem with poor vitamin absorption. Clinical fragility and deterioration instigate antibiotics, which further disturb a healthy microbiome.

Skin – In premature infants the dermis is paper-thin and subject to the same maladies as a burn patient. In addition, the main barrier to invasion by cooties and toxins is deficient.

Socialization – Modern incubators are like a womb-with-a-view; but plastic, noise, and lights are far from the norm for the tiny baby.

Conclusion
The epidemic of children affected by autism has multiple causes and presentations.

If some types of ASD are due to susceptible individuals in a toxic environment, this scenario of prematurity – and the treatments – can add to the risk. Furthermore, the increase in incidence in this population can provide clues to the condition.

As for prematurity – keeping the baby in the oven as long as possible is always the best course, if Mom gets the choice.

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