Posts Tagged ‘advice’

Pediatricians and Autism

Sunday, November 6th, 2016

“I think that your toddler may have some signs of autism. That’s a complicated subject. I’ll give you a referral for…”

Sound familiar? Was that the first time that you heard what you (or your spouse) had suspected from a medical professional?

This story is not meant merely to ventilate. Education is the goal. The challenge is how to get an uninterested, overworked, under-reimbursed, skeptical group of intelligent individuals to pay attention. We are standing in the middle of the childhood epidemic of our time, and the professionals continue to worry that there aren’t enough vaccinated kids! It’s insane.

That was the ventilation part.

Education
At the first sign of a thyroid problem, e.g., a doctor doesn’t just send a patient straight to the endocrinologist. Rather, a baseline blood level is ordered, the results are evaluated in the light of the patient’s signs and symptoms. Next, the clinician is expected to explain all pertinent information, and refer to the most relevant specialist.

In the case of developmental delay, it seems that such a protocol is rarely followed. Even the expert (neurologist, or developmental pediatrician) seldom follows a prescribed course of action. An EEG and MRI? That depends on the family’s insurance status. Chromosomes or genetic testing? The usual advice is, if you aren’t having any more children, that won’t be necessary. Or, “The results won’t matter, anyway.”

External factors such as these should not be the determining factor in the 21st century workup of any patient, let alone a child whose growth is not proceeding in a normal fashion. A previous post details the top ten things all pediatricians should know about ASD. There is a workup to be done.

After a visit with the neuro-developmental doctor, a follow-up examination should take place with the ‘main’ practitioner, who ought to become the child’s medical advocate, rather than the parent. Pediatricians who believe that a family is ignorant or ill informed about the use of an off-label treatment need to learn more about all of the options, in order to assist the family in such decisions.

Discussion
This year (Jan-Nov, 2016), there were eight articles in The Journal of Pediatrics specifically about ASD. That is less than one significant article per month in our major pediatric publication.

Autism Spectrum Disorders and Metabolic Complications of Obesity
Autism and antidepressant use in pregnancy
New rapid autism screening test
Applied Behavior Analysis as Treatment for Autism Spectrum Disorder
To Screen or Not to Screen Universally for Autism is not the Question: Why the Task Force Got It Wrong
Predictive Validity of the Modified Checklist for Autism in Toddlers (M-CHAT) Born Very Preterm
Reported Wandering Behavior among Children with Autism Spectrum Disorder and/or Intellectual Disability
Comorbidity of Atopic Disorders with Autism Spectrum Disorder and Attention Deficit/Hyperactivity Disorder

The best way to address this present state of outworn medical attention is to fund and publish more research. This involves a paradigm shift in the diagnosis and therapy of ASD. The condition is of multifactorial origins and consists of a variety of signs and symptoms that can be ameliorated.

Pediatric residencies must adopt a new clinical rotation for this important malady. Practitioners who do not believe that, in complicated medical conditions, their role should be ‘captain of the ship’, might consider other medical specialties that do not carry this type of obligation.

Conclusion
It is simply not enough for a present-day pediatric clinician to exclaim, “Well, I don’t know much about autism.” The preferable, and intelligent answer should be, “I’m going to have to do a bit of study about this condition. They didn’t teach us about this in med school, but it seems important.”

Perhaps parents can use this essay to inspire/challenge your doctors to develop a modern attitude toward this medical mystery.

Getting Children to Take Their Supplements & Medications

Sunday, October 30th, 2016

take-medA common feature among children who suffer from sensory processing issues is their reluctance to take the very preparations that would help attenuate such disturbances, and the will to get their way.

Here are some tips and observations, gathered over the years at the Child Development Center of America, that may be of some use as a parent attempts to cajole junior into ‘taking his medicine.’

B-twelve lollipops simply don’t cut it. There are various strategies for those who won’t take subcutaneously administered methyl-B12, from a middle-of-the-night sneak attack, to an early morning assault. Expensive topical anesthetic agents are rarely required or helpful. Squeamish parents may hire a nurse, or ask a friend or relative. In school, we practiced on fruit. Occasionally, there have been parents who take their child to the doctor, until they become more comfortable.

Dermal creams can be an excellent alternative. Naltrexone administered in this manner may alleviate sensory issues and enable more generalized compliance. Magnesium, epsom salt baths and other agents may be quite helpful. On the other hand, every supplement does not work in a cream form, due to its composition and absorption.
This is a propitious time to mention the use of essential oils. Calming to the mind and body, these may be just the ticket for getting a mildly oppositional youngster to comply.

Many families mix preparations with preferred liquids and foods. Should a parent risk a small volume of casein or other forbidden fare? Frankly, occasionally, that may be the better option. On the other hand, some children may then refuse taking even that ONE liquid that they consider acceptable. Starting with very low doses of the offending agent may work.
We recommend oil-based products for the like; e.g. almond butter or mustard, if the supplement comes in that form. Applesauce is good for gloppy goodies.

Some children may respond to mechanical strategies, such as practicing with candy, drinking fluid first, or placing the pill in just the right part of the tongue. Another strategy involves the use of a pill swallowing cup. A non-scientific review of our experience at The Center has not found those of any real value. They look scary, and we couldn’t give them away.

Ask the occupational, behavioral or physical therapist to assist in the learning process. To the extent that the professional recognizes – and believes in – the accompanying improvements for their job, they should embrace their role in assisting the process. In a similar vein, alternative techniques practiced by chiropractors and reflexologists might include their additional expertise in helping a child acquire this skill.

Social stories may be a great aid for certain children. An artistic parent may even be able to create one (digital or analog) with your child’s pictures and voices, enabling the child to view the process and diminish anxiety. The propensity for affected children to perseverate on youtube videos might provide an opportunity to encourage an understanding and acceptance of this technique.

Most parents have already exhausted the role of bribery. Often, families have found this strategy of limited benefit after a lifelong pursuit of compliance in one or another less-daunting behaviors. From this perspective, and towards this end, this could be utilized as one of the ONLY times that your child gets the iThing.

Make sure that the child is on the most healthful diet. For parents who believe that the foods their children eat have little to affect on behavior, you should at least give a try. The end point might be as ‘simple’ as your child’s understanding and compliance.

For certain preparations, there is always the rectal route. The child may accept that oral is preferable, if they don’t bite and run for the hills (and lock the door).
Sometimes this one can backfire – literally.

Develop the right attitude. With autism, the senses of smell, taste and texture are involved. Oral-motor functioning is weak. There are medical reasons for patient refusal. One inconsequential substance may be misperceived as awful, however another foul-smelling product may not even be noticed. Plus, some therapeutic protocols may increase aggressive behaviors for brief periods. For most children, reasoning is of little value. “Because mommy says so!”

Truth be told, only ~1% refuse just about everything. Such children won’t be told, taught, or tricked. The parent has to decide how important the supplement, how likely it is to work, and weigh the consequences of continued non-compliance. But, getting a child to accept only one or two of these preparations may jump start a pathway to increased compliance in other endeavors, as well.

I never had a juvenile arthritis patient, or child with diabetes or other significant malady, where the parent didn’t bite the bullet and do whatever is necessary. To the extent that the practitioner and parent believes in results, the deed will be done.

As always, knowledgeable and experienced parents are invited to offer their stellar suggestions…

Signs of Autism in an Infant’s First Year

Sunday, October 23rd, 2016

neighborsAs a neonatal-perinatal specialist, I have been responsible for the health of tens of thousands of the smallest, sickest, and most vulnerable patients. Plus, in the past decade, I have focused on learning about, diagnosing, and treating children who are affected with the newest childhood developmental epidemic, Autism Spectrum Disorder.

It is fair to say, then, that my observations have a degree of validity not necessarily found by simply shopping around town, when parents seek answers about their child’s condition. Special needs pediatric medicine is my natural state. little-leoSo, while walking our Yorkie recently, as I was exchanging pleasantries with a neighbor, I couldn’t help but ‘examine’ the infant in the carriage. “Is this kid developing correctly?” I thought. “Are there red flags? What further questions would I want to know, short of becoming a nuisance, to help the family?”

Here is my list of key questions to best assess whether I should encourage a parent to further explore their infant’s development:

Pregnancy:
What is the age of mother and father?
Perhaps it isn’t the assisted pregnancy (in-vitro fertilization, etc.) that is the problem, since that has not been scientifically proven. But, an advanced maternal or paternal age have been shown to represent a significant association.
little-thought-cloudNo need to ask, however; I can ascertain that information by checking with my wife.

Has there been any medication use, but especially tylenol and psychoactive substances, even if they were prescribed by a doctor.
little-thought-cloudMaybe that’s too nosy.

Labor & Delivery:
Was it a full term pregnancy?
Contrary to some theories, I do not believe that pitocin (intravenous medicine given to enhance contractions) is a related issue. Rather, the fact that labor is prolonged may be due to hypotonia in the fetus, and he/she is not contributing in the tug of war. So, ‘Failure to Progress’, and late deliveries are a particular concern. Conversely, if the child was preterm, that is a significant risk factor, as well.

Did the child go home from the hospital with Mom?
This information could open up a host of possible associations, from the early use of antibiotics to birth defects.
“Why are you asking so many questions, Doc?”

Newborn:
“Well, I’m just interested. Did the child breast feed?”
Answers in the negative that are due to ‘poor suck’, breast milk ‘intolerance’, or GERD definitely increase the number of red flags related to those children who demonstrate future developmental concerns.

Infant:
Does the child have to go to the doctor often?
Numerous visits to the pediatrician or specialists imply an underlying medical problem, including asthma, eczema, feeding and stooling problems, which are frequently associated in children with autism.

Did the baby have plagiocephaly (flat head), torticollis (wry neck), or a large head size? Does he make good eye contact and follow a moving human face? In the second half of the first year, does the baby crawl/walk OK? Is there vocalization?
little-thought-cloudSkip the interrogation, I can observe many of those signs for myself.

Conclusion:
When the majority of answers are of concern, there may be enough warning signs to warrant further exploration. On one single day last week, I took care of 16 children who had criteria consistent with ASD. We don’t need more patients with autism. Something is just wrong.

Your neighbor should not be making developmental assessments, even if he is TheAutismDoctor. Pediatricians can, and must, do more to examine your infant’s development and help stem the tide. The only question should be, “What does your doctor think?”

For the clinician who may complain that this line of questioning causes unnecessary apprehension for Mom and Dad, my reply is that they are worried, anyway. Rather than help, a practitioner’s cavalier dismissal that, “I wouldn’t be concerned about that,” carries little substance in the face of this wide-ranging malady known as ASD.

The AMAZING Siblings of Patients with Autism

Sunday, October 16th, 2016

siblingAt the Child Development Center of America, it is our custom to request that parents bring the patient’s neurotypical siblings. Staff and interns can learn to appreciate the differences. I get a sense of the challenges faced by the children who are affected. An added bonus has been our observation that some of the most heroic family members are child’s brothers and sisters.

It never ceases to amaze me that even the youngest sibling will play with, fight with, endure – and teach – their affected friend. There is no correction, no repetition, and no prompting. It’s true love – even if they take each other’s stuff.

Brothers and sisters demonstrate patience and perception about the other’s wants and needs. It is a constant reminder of the important role these sometimes forgotten family members play in the affected child’s development. Their maturity frequently exceeds their chronological age.

One parent recently provided this beautiful essay written by the 11 year-old sister of a very affected patient, who has only recently begun to seek and interact with others and with his environment. Without being asked, here is what Jillie wrote:

jillie-barton   An autistic kid’s brain is like a computer keyboard. A keyboard has a chip that sends signals to the other keys. A fixed one sends a message to the keyed it gets there. When you press the key a letter appears on the screen.
  But a broken one doesn’t. The chip sends a message down the right route. But the right route isn’t working right, so the message tries to find another way.
   But the message doesn’t get there. So when you hit the key nothing happens.
   It’s sort of like an autistic kid’s brain. the brain sends a message down the nervous system. But the route isn’t working correctly. So the message tries to find a new way. But sometimes it works.

Discussion
Siblings of children with autism are the subject of a number of scientific studies. Twenty years ago, one paper described, “Sibling encounters provide a unique opportunity for such children to learn about social relationships.”

A decade ago, another study demonstrated …”strong and positive changes in joint attention and modest changes in social behavior for the latter…” but lamented, “however, the results did not provide strong evidence for generalization of increased social interactions to different settings.” Who cares? A buddy is a buddy. Another paper that year, Teaching Pretend Play Skills concluded, “… the child with autism may benefit from sibling-oriented interventions

In 2007, Sibling Interaction of Children with Autism: Development Over 12 Months showed, “… social interaction and imitation in children with autism and the special role that sibling interactions can play.”

Literature describing family challenges followed. One study summarized, “When siblings were dissatisfied with differential parenting, quality of the sibling relationship was compromised.” Another concluded, “treatment programs may need to address parental stress, which in turn will help optimize treatment outcome for the child and the family.” In Siblings of individuals with an autism spectrum disorder, the authors wrote, “Adolescents engaged in more shared activities and reported more positive affect in their sibling relationship when their sibling with ASD had fewer behavior problems… For adults, more shared activities were observed when the sibling with ASD was younger in age and had fewer behavior problems; greater positive affect in sibling relationships was predicted by greater parental support.

This year, several papers arrive at similar conclusions involving, “contradiction. Participants recognized difficulties (decreased parental attention, extra responsibility, bothersome behaviors, communication difficulties) and positive aspects (became empathetic, loved and appreciated the child, realized the experience was life-changing) of living with a young person with ASD. Younger siblings frequently reflected on childhood experiences, wished they could play together… Adolescent siblings learned life lessons from the experience, talked about life changes when ASD was diagnosed, and seemed introspective and protective toward the young person with ASD. Male siblings often wished they played more often while growing up with the young person, and frequently mentioned the child/adolescent’s aggressive behaviors; female siblings focused on relationship and communication difficulties of the young person ASD.”

Conclusion
Brothers and sisters get it. Preteen Jillie gets it! Her description of processing difficulties is spot on. Perhaps, one day, it will be the sibling of an affected child who will make the key discoveries for effective remediation of the signs and symptoms displayed in Autism Spectrum Disorder.

Staffing for the Autism Epidemic

Sunday, October 9th, 2016

The Child Development Center has been blessed to experience a stream of wonderful, young, eager students wishing to learn about caring for special needs pediatric patients. Some go into ‘the business’, while others have gone on to a variety of great life adventures. We are also lucky to have our superb Practice Manager, Karen Vossen, who is an exemplary role model, teaching parents and staff alike, how to handle the patients.

gabiskywalker

The Force is strong with this one

Our latest graduate, Gabriella Tabib, has chosen to pursue this line of work. Here is what she wrote about her time here at The Center:

I started working with Dr. Udell during my final year of undergraduate training. After listening to many of my peers discuss their volunteering experience, I wished to intern, as well. I could see a passion in their eyes and I wanted that, too. But where was I going to start? Fortunately, I had an idea about what I wanted to do.

First, I wanted to work with children. Children are amazing. They are imagination unhindered. They are bottled potential. The ‘abnormal’ side of child psychology is just as fascinating. In high school, I had volunteered on a horse therapy ranch, working with children who had ASD, cerebral palsy, and Down syndrome. For my internship, I wanted to work in a similar setting.

I found a place at the Child Development Center of America. My job included interacting with the children while their parents spoke with Dr. Udell about the child’s diagnosis and treatment plan. My responsibilities included measuring the child’s height and weight, conducting ATEC scores when needed, and keeping them engaged for the hour. Dr. Udell used my observations to gauge their progress.

I came to realize that I had knack for connecting with children on the autism spectrum. I began to understand how they interact in, and with, the world. I saw stimming – not as an unhindered, reflexive process – but a means of communication. I saw double swirls and single palmar creases as signs of genetic links to that patient’s condition. I also learned what it meant to have a child with special needs.

Whether your child is neurotypical or not, parenting is a monumental undertaking. It is a full-time job filled with changing diapers, answering hundreds of questions, and chasing after them as they grow up right before your eyes. But what if toilet training takes longer than necessary? What happens when the ‘whys?’ never come? Learning that your child has autism is life changing.

I watched Dr. Udell guide many parents through understanding autism and innovative treatment options. He truly cared about every patient that came through his doorway. He treated each condition on an individual basis. His first question is not, “What helped all the other children?” Rather, he asks, “What seems to be ailing this child?” It opened my eyes to the true nature of psychotherapy and medical treatment. Considering each patient individually may be more time consuming, but it offers the best results.

I am truly thankful for the time I spent with Dr. Udell. I met so many amazing children and their families. I learned so much about the future of autism diagnosis and treatment, and how I can personally make a difference. I look to the future full of hope and inspiration.

Working at the Child Development Center has solidified my passion for working with children, especially those whose diagnoses lie ‘on the spectrum’. I can proudly move forward in my career, knowing that I gained such a wealth of knowledge and support. This experience will enable me to become a top-notch mental healthcare professional for all of my present and future clients.

Many thanks to you, Gabi.
Your intelligence, optimistic personality and inquisitive nature has helped our practice, as well!

I Watched Vaxxed

Monday, October 3rd, 2016

I am not against childhood vaccinations.

I have expressed that opinion in more than a few blogposts. Nonetheless, it appears that more information is needed, and controversies must be addressed, before the gods of modern medicine can simply dismiss the thousands of parents who feel that their child developed autism shortly after one of the childhood inoculations.

genrescue2016

(L-R) Jenny, Jacqueline&Chris Laurita (housewives of NJ), Nico&Davida LaHood, Del Bigtree, Dawn&Ryan Neufeld, Jodi Gomes

This week, at the Autism Summit, Jenny McCarthy expressed that same opinion in her opening video, and throughout the panel discussion. Frankly, I would not have even written this story if there wasn’t a controversy when an Express-News reporter was prevented from attending the conference. He wrote, “The summit is being put on by Generation Rescue, a non-profit led by Jenny McCarthy, an anti-vaccine activist.”

One of the panelists was San Antonio area District Attorney, Nico LaHood. “In a promotional video filmed in his office, LaHood said “vaccines can and do cause autism,” and has made clear he doesn’t accept scientific evidence as proof to the contrary.” Another celebrity was Del Bigtree, the producer of Vaxxed.

So, I paid my four bucks, and watched the movie. Del Bigtree presents a compelling story surrounding the information supplied by CDC whistleblower, William Thompson, who claims that data that would have implicated vaccinations as a cause of autism was altered, so that the MMR would appear safe.

There is a fair amount of anecdotal and perhaps, overly dramatic presentations of individual case histories, which will turn off the ‘real’ scientists. Mr. Bigtree describes that as the conundrum as we, “…study the disconnect between science and parents.”

Dr. Doreen Granpeesheh, founder of CARD, appears as a credible expert. A nobel prize winner weighs in, adding validity to the story. After reviewing the data, a traditional pediatrician and family practitioner seem truly amazed – and changed their opinion about the safety studies. Cool, calm, and well-spoken, Wakefield looks to be anything but a raving zealot. His conclusion is that if the MMR were separated, that would be best solution and the issue of ‘herd immunity’ would not be breached.

I’m not against childhood vaccinations.
Hillary has declared, “The sky is blue and vaccinations work.” She doesn’t know, for sure, if they are safe for all, however. Why deliver an increasing number of antigens to an immature immune system? Why do we have a vaccine compensation fund? Why does the package insert say ‘seizures‘?

If such a movie only adds fuel to the fire, why not just refute the questions that are raised with a prospective, randomized, double blind study, considered to be the gold standard for proving efficacy and safety? Rather, people who even view the film are marginalized and considered kooky, conspiratorist, poorly informed, and ignorant.

The movie is considered to be the problem. Andrew Wakefield is the problem. Leo Kanner, a Freudian from the first half of the last century, assigned the diagnosis to the realm of psychiatry. Bruno Bettleheim, a media darling at the time, popularized the ‘refrigerator mom’ theory that persisted for another 30 years. We are still arguing if there even IS an epidemic. There is plenty of blame to go around regarding our confusion about this mysterious illness.

I’m old enough to have experienced neighbors, relatives and patients who have suffered serious consequences from childhood diseases, such as polio, measles, and congenital rubella. Furthermore, I am aware of the mountain of ‘scientific evidence’ that documents a lack of association to Autism Spectrum Disorder. In my own practice, the majority of parents do not feel that vaccines caused their child’s autism, and there are many children with ASD who never received any inoculation.

However, great concern is raised when there are stories, such as the mismanagement of vaccines in public clinics, and issues with government oversight connected to Big Pharma (documented in this movie).

This is one of the most polarizing issues that impedes real progress in our understanding of the epidemic of childhood autism. In the present circumstance, perhaps it was the fault of the conference organizers, not allowing a possibly negative story to emerge. This highlights the need for both sides to step back and listen to each other in order to uncover the truth.

Finally, I want to document that, I’m not against childhood vaccinations.

Recess is Important for Special Needs Students, Too

Sunday, September 25th, 2016

An Open Letter to School Officials

There are developmental states between having autism and having had it. It’s analogous to the ‘pins-and-needles’ feeling following a limb injury, for example, but preceding a more complete recovery.

During that healing phase, there may be muscle weakness and nervous incoordination; dysfunction about which little can be done, other than being patient. So it appears to be with children who have achieved useful speech and a degree of socialization that enables them to join the general student body.

Leftover signs and symptoms may include immaturity (difficulty transitioning to non-preferred work, impatience, non-compliance, etc.), ADHD conduct, and aggression. It is not uncommon for pupils affected with residual ASD, therefore, to display unacceptable behavior. In a Gen-Ed setting, meltdowns may tax and even infuriate staff.

When asked about their favorite activity at school, most children answer, “Lunch,” or “Recess.” Since students can’t be denied the former, personnel may turn to withholding the latter from those who misbehave, in order to instill respect and compliance. That may be a big mistake.

Indoor activities and distractions have become the norm and consume large chunks of time. iStuff, therapies, homework, tutoring, etc. all keep youngsters out of the sun and fresh air. Physical isolation with limited calorie-burning is the last thing that children with language delay and difficulty sitting still need. Who gains from such punishment? Some kids prefer to avoid the anxiety of outside play. Perhaps, bullying is precipitating a breakdown? Others do not appear to object, at all, by such censure.

Techniques to instill self control that may have been successful in previous centuries no longer apply to a neuro-diverse student body. Parents and professionals must collaborate to make sure that a proper and appropriate plan of action follows a display of maladaptive behaviors. Strategies that are more likely to be successful – and less detrimental – can be developed. Methods should be individualized, with the help of appropriate staff. Such an approach helps assure a more productive academic season.

Access to recess should be as important as lunch; maybe even more so, since so many children with challenging behaviors are on special diets and picky eaters, anyway. Just kidding, of course (but not really).just-kidding-jpeg

Processing Disorders and Autism

Sunday, September 18th, 2016

EEGleftThere are a number of newly-minted diagnoses that have been invented to explain many of the symptoms of the modern epidemic that covers autism.

They include:

 Sensory Processing Disorder
→ Visual Processing Disorder
→ Auditory Processing Disorder
→ Oppositional Defiance Disorder
→ Attention Deficit Disorder
→ Hyperactivity Disorder

→ Attention Deficit / Hyperactivity Disorder
→ Anxiety Disorder
→ Obsessive Compulsive Disorder
→ Explosive Disorder
→ Social Processing Disorder

Diagnosis:
These conditions frequently display such similar general patterns that, depending on a practitioner’s inclination to be a ‘splitter’ or a ‘lumper’, the available treatment regimens could vary widely. For example, AD and HD are usually treated as ADHD, with stimulant medications, even though inattention, poor focus, distractibility and hyperactivity may arise from a variety of physiological conditions.

Likewise, aggression, obsessive – compulsive behaviors, and opposition are usually prescribed anti-anxiety medications, such as Risperdone, Abilify, Intuniv, or even Prozac and Zoloft.

pd1©TheAutismDoctor.com

Some are more or less related, and others may be merely due to immaturity, therefore patience and time will yield preferable results.

Treatments:
It is not difficult to imagine that processing difficulties in vision, hearing, touch, and the other senses, can lead to signs, such as repetitive behaviors or ‘stimming’, to alleviate the sensory overload. Supplements, such as magnesium, turmeric, epsom salt baths, essential oils and even HBOT could address those issues, in addition to traditional therapies. Most parents of children with ASD own at least one trampoline.

Restricted interests and repetitive behaviors are core problems in patients with autism. They are not OCD, and the usual medications are rarely effective, even though the diagnosis prompts traditional physicians to prescribe higher, more frequent doses, and/or a combination of pharmaceutical preparations.

The recognition that processing difficulties underly these unusual behaviors has engendered the protocols that include ABA, PT, OT and other specialty therapies. They require significant resources, but have demonstrated improved outcomes. Certainly this approach is not as risky or potentially harmful as potent medications.

Anxiety appears to be a result of a combination of the other processing difficulties, and social processing disorder is as real as any of the other contrived diagnoses. Early socialization is, therefore, a useful intervention. The fewer pharmacological interventions, the less chance that they will poison the growing brain.

On another hand, certain abnormalities seem to be a result of difficulties in other-than-CNS processing. Aggression, opposition, and explosive behaviors are frequently gut-related. The recognition that autistic behaviors can be ameliorated by restoring the gastrointestinal microbiome has assisted many patients who have been suffering for years.

Conclusions:
The biomedical approach is unique in the treatment of this myriad of medical conditions because the basic assumption is that they are due to a variety of upstream difficulties.

The recognition that, in patients with autism, some neural pathways proceed down the right path, others stumble upon an incorrect route, some thoughts don’t propagate at all, while other symptoms are emanating from elsewhere, goes a long way to assisting patients in their improvement.

Medical Academy of Pediatric Special Needs – Fall 2016

Sunday, September 11th, 2016

This week, the Medical Academy of Pediatric Special Needs held its semiannual conference in downtown Atlanta, GA. This is ‘Ground 0’ for practitioners, researchers and professors from all over the world to meet, learn, explore and discuss a myriad of relevant topics.

Members who have been returning for 100’s of lecture hours generally choose the advanced courses. For some, the conference has become a group of ~50 experienced and knowledgeable practitioners who meet to discuss ‘workups’, basic science, relevant research and treatment protocols for those who are most affected with ASD.

Notes and Observations
Day 1 – Tough Cases
I really enjoyed our lectures by the plain-speaking Dr. John Green, of Portland, OR. Dr. Green not only reviewed those who improved because of his medical expertise, but those who got better in spite of him, those who haven’t gotten better, those who got better but he can’t figure out why, and the most frustrating – patients who improve only to suffer frequent relapses.

Dr. Sid Baker, a pioneer of the biomedical movement, described his early medical experiences in Africa that morphed into his lifelong dedication to treating patients with ASD. He expressed his disappointment that so many conventional colleagues disagree with our practice.

Dr. Baker elucidated how he initiates care with new patients. He discussed increasingly resistant cases, covering topics from severe speech apraxia to the approach to children with injurious behaviors.

The first day was filled with the most frustrating and difficult cases you can imagine. Eminent practitioners Drs. James Neuenshwander, Michael Elice, and Julie Buckley challenged our diagnostic and therapeutic knowledge, attempting to navigate the complicated courses of those who improved and those who didn’t.

Day 2
Dr. Daniel Amen‘s morning lecture was entitled “3D Brain SPECT Imaging”. The takeaway message was that SPECT scans – technology – could/should/will become a mainstay for a multitude of CNS disorders. His manner and stories of research, technical evaluation, and clinical practice, were positively spellbinding and inspirational.

Dr. Theoharides presented his research and extensive knowledge about the important role of allergy in ASD. Dr. Theo continues to publish a mountain of monumental works, not only on the topics of autism and the role of mast cells, but treatments, as well.

Toxins were the subject of the afternoon’s lectures. We learned about the identification of substances in the environment that are dangerous, how they are measured, how damage is done, and the means to control and treat. For the skeptical reader, there was a plethora of supporting scientific evidence of the relationships to autism (and many other modern conditions).

As has become customary, Dr. Dan Rossignol rounded up the day with a roundup of all of the latest scientific research. Rapidly.

Day 3 – Advanced Clinical Cases
Severe behaviors and speech apraxia. For patients who are most resistant to conventional and alternative treatments, essential oils, acupuncture, and even worms were explored as possible solutions.

Throughout the afternoon, cases got even tougher! Lyme, Persistent Lyme, Non-Lyme Lyme, PANDAS, PANS, parasites… an increasing number of reasons to have signs and symptoms that are called autism. Such information extends our knowledge and leads to better diagnoses for our patients, and possibilities for treatment.

Dr. Green discussed biomarkers. Though these ‘labs’ are not specific to ASD, per se, this will become a necessary next step to document level of involvement and response to treatments.

A brand new treatment, repetitive Transcranial Magnetic Stimulation was presented by Dr. Arun Mukherjee. The jury is still out on this expensive intervention.

Conclusions
One important reason that I return to this meeting, is simply that I feel at home among like-thinking practitioners. Members don’t agree on every subject, but we are respectful and actually enjoy our practices.

In traditional medicine, conferences are basically show-and-tell affairs, where researchers report their data, previously published in medical journals. When doctors think outside the box, practitioners with diverse skills, who are scattered over the globe, discover improved results by networking in this fashion.

Patients, parents, and families can feel confident that progress is being made (slowly), as serious, dedicated doctors continue to try to unravel this modern mystery.

Finally, I am proud to report that, at this meeting, I was awarded Fellowship status in the Medical Academy of Pediatric Special Needs.

Home Schooling Children with Autism Issues

Monday, September 5th, 2016

Home schoolADHD, aggression, bullying and being bullied, meltdowns, oppositional, auditory, visual and other Sensory Processing Disorders, are among the many challenges of modern school-aged children who are recovering from the conditions that are categorized under Autism Spectrum Disorder.

Individualized educational plans have gone a long way toward providing an increasing number of affected youngsters with a more appropriate academic environment. Yet, there remain numerous educational situations in which young children face significant obstacles.

Considering such challenges, an increasing number of families have chosen to home school their neuro-diverse offspring. Here is some of the valuable information that parents have provided about the decision to undertake such a situation.

What are the common characteristics of families who choose to home school?
The most disruptive children require additional medication, and/or one-on-one supervision. Sometimes, only a family member or therapist can achieve control, performed at home (or equivalent).

Families live in locations where there is an serious shortage of appropriately trained personnel.

The IEP and associated adjudication of services do not appear adequate to meet their child’s need. This could involve a lack of classrooms with ‘higher’ functioning individuals, or not enough services for those who have more troubling signs and symptoms of autism.

Parents concerned that, inattention, lack of focus, and hyperactivity in the neurotypical academic environment – by their own child and others – will likely negatively affect performance, grades, and self esteem. Indeed, the psychological profile scores are usually ‘all over the place’, indicating that processing is affected, not IQ.

Sometimes, the choice is influenced by the reluctance to administer stimulant and/or anti-anxiety medication, especially in the youngest students.

What are the biggest challenges?
Relationships with affected children, neurotypical siblings, and blending teaching with family activities, takes a quantum leap in patience, time and effort.

The discipline to prepare lessons and implement the required syllabus is a full-time job.

The outcome of all of this work requires evaluation to assess whether avoiding a traditional program is the preferable course. Has it been worth it?

Caretakers need to determine the best means to ensure exposure to others, and additional ways to foster socialization.

Ultimately, there needs to be a decision if/when to merge the children into a traditional academic environment.

Conclusion
Home schooling enables the ‘teacher’ to maximize learning by individualizing. Caretakers notice when affected children are ‘present’, or allow the necessary time to ‘get the jitters out’. If a youngster is able to avoid taking a test on a particularly squirrelly day, their score will probably be higher. Self esteem improves and anxiety abates.

For those under the age of 6, any suggestion that medication will ‘improve the academic situation’ should be carefully scrutinized. When there is a stay-at-home-parent, additional help, and other resources, home schooling may be the better option, especially for those who are most affected with ASD.

Though it’s not for every parent, or child, this path does provide some families with the most optimal opportunity to guide their offspring to their highest potential.

Categories Archives Links Contact Us

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

Email bdumd@childdev.org
Copyright © TheAutismDoctor.com 2010, 2011, 2012, 2013, 2014, 2015
All Rights Reserved