Posts Tagged ‘ASD’

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.

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.

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.

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.

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.

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

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.”

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.

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.”

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.

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


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.

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.

The present.

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.

Do any of the doctors know that Bobbly has autism?

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.)

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?

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.

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.

Is he getting Speech and Language Therapy?

The insurance… we’re waiting for that.

(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).

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.

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.

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?

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.

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.

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.

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.

An Autism Prevention

Sunday, January 3rd, 2016

Since there are multiple proposed factors that could lead to autism, some of them, at least, ought to be preventable. Proven associations due to environmental pollution or toxic foodstuffs are under little personal control, however.

Research that recently appeared in a respected medical journal could provide a key causative factor in the rising number of cases of ASD, plus a valuable tool that women can use to decrease their risk of having an affected child.

Pro Antidepressants
The party line has been that, while perhaps not totally safe, there are increased risks of developmental and other abnormalities from stress and/or anxiety, alone. Twenty years ago, an important study ‘established safety’ when it was reported that, “Women who take <<Prozac>> during pregnancy do not have an increased risk of spontaneous pregnancy loss or major fetal anomalies…” BTW, autism was hardly on the radar when that dogma was announced in 1996.

As recently as 2013, an article in the BMJ concluded, “However… antidepressant use during pregnancy is unlikely to have contributed significantly towards the dramatic increase in observed prevalence of autism spectrum disorders as it explained less than 1% of cases.” This was in the face of their data that showed, “In utero exposure to both SSRIs… was associated with an increased risk of autism spectrum disorders…”

Anti Antidepressants
There are various types of antidepressants, depending on the neuro-chemical response in the brain (and other parts of the body that have similar cells). The most popular have become the SSRIs, and their use has taken off since the first decade of this century.

These medications are not approved by the FDA for children < 7 years of age.

SSRIs are “not for use in nursing.”

The Physician’s Desk Reference also documents, “Absorption… in about 6-8 hours… Crosses the placenta…Found in breast milk…Elimination… in about 4-16 days.”

Assuming the earliest that pregnancy can be discovered is about two weeks, even if medication were discontinued immediately, the fetus would be exposed throughout the entire first month of gestation.

The main organs that form in those early months are the circulatory and nervous systems.

Coincident with the dramatic rise in the use of antidepressant medication is an epidemic of signs and symptoms that are now referred to as Autism Spectrum Disorder.

The most recent article, Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children, concluded, “Use of antidepressants, specifically selective serotonin reuptake inhibitors, during the second and/or third trimester increases the risk of ASD in children, even after considering maternal depression.” There was an 87% increased risk.

While discussing the topic, a friend said to me, “I am not a doctor or anything, but it seems to me that if a woman cannot have a glass of wine once in a while, how could a daily drug for the brain be OK?”

Caution is not warranted. Women who wish to get pregnant should discontinue this pharmaceutical treatment for their depression and seek other ways to get relief from stress and anxiety.

Parents are not to blame for this predicament. Pharmaceutical companies are not interested in performing further testing, and doctors have been too trusting in the face of self-serving science, financial incentives, and common sense.

These medications should be highly avoided unless further study proves absolute safety, which seems unlikely.

An Autism Christmas Story: If It’s Good Enough For John-Boy

Sunday, December 20th, 2015
Karen Vossen

Karen Vossen

by Karen Vossen
Practice Administrator
Child Development Center of America

Today, I was wrapping my children’s presents. Maybe it was the 6 cups of coffee, maybe it’s the menopause, or maybe I am just a sentimental Mom. I got a little sad and shed some tears. I thought about a TV show that I loved as a child, The Waltons, and the episode was The Homecoming: A Christmas Story. At that time, December 19, 1971, I was 8 years old.

I loved The Waltons. I had no idea what The Depression was, but I thought I would be great to have 6 or 7 brothers and sisters. The story was about ‘Christmas miracles’. The whole family was worried that John Walton, “Daddy,” wouldn’t make it home for Christmas with the family. The oldest son, John-Boy, went searching for him. Long story short… Daddy got home and the Baldwin sisters returned home with John-Boy. Everyone was happy and they all got presents. John-Boy, who aspired to be a writer, got pads of paper. It was 1933. As an 8-year old, I just couldn’t imagine getting pads of paper for a Christmas gift. Who would ever want that? Jump forward, 40+ years and what am I wrapping up for my son…pads of paper!

JakeYou see, unlike John-Boy, my 14 year-old son, Jake, has Autism. All he wants for Christmas is paper. Drawing paper, copy paper, notebooks, you name it. He loves drawing. He has always loved drawing, even when he was very little.

You can believe me when I say that he has received some really great gifts. My husband, John, has bought him every remote controlled car, helicopter or robot that has ever been on the market. He opened the present and was excited. But, what did he play with all day? A drawing pad and crayons. It’s just what he likes. Every year, we think this will be the year he desires something different. But, he doesn’t. I know that I am not the only parent of an Autistic child with limited interests, as well as a limited Christmas list. It’s all part of our world. For Jake, it’s drawing or his iPad. No matter how accepting I am of my son’s disability, I wish it was different. I can’t lie.

I am, however, a person who counts her blessing in life. As Practice Administrator at The Child Development Center, I see many children who experience varying kinds and degrees of disabilities. I know how lucky I am that my son has language, can read, and can and does tell me every day how much he loves me! My son is so helpful around the house. He does chores and is always the first to get ready to go out. My son is happy.

I am thankful that my husband and I are still married! As peculiar as that may sound, it is fairly common for many couples to break up over the stress of having a child with Autism. My daughter is the best therapist and teacher my son could ever have! She loves her brother and he listens to her. Well, not always, as she would tell you, but that’s OK, ’cause that’s typical. And we all love typical moments, even if it is sibling rivalry.

So, as I wrap the rest of the paper pads, these are the things I try to remember. I will be happy when he opens his presents because Jake will be happy. And, if my well-meaning family says, “I’m not getting him notepads or markers again, isn’t there something else?” I will smile and wish I had invited the Baldwin Sisters, because they make bootleg whiskey. Gotta see the episode! Hey, if it’s good enough for John-Boy…

“Merry Christmas Jim Bob,”

“Merry Christmas Mary Ellen,”

“Merry Christmas John-Boy,”

And…Merry Christmas Jake! I love you!

Get Your Child Off the Couch and Out of the House

Sunday, December 13th, 2015

I watched a tv commercial recently, recommending that families should play outdoors for at least an hour a day. “The NFL PLAY 60 Challenge teaches educators and children to integrate health and fitness into daily classroom lessons.”

What a great idea! It shouldn’t even be necessary, since most of us grew up playing outside, until our mothers called us home for dinner – by screaming our names (no cell phones).

Outdoor play is part of a healthy existence that has, somehow, been moved lower down on kids’ to-do-list. Academics, homework, tutoring, therapies, digital devices, etc., have become top priorities, even in the youngest, and especially for special needs children.

There are a variety of questions and theories about the cause of the increase in childhood developmental abnormalities in this century. To be sure, there are poisons galore that have exploded into our air, food, and water. Perhaps just as importantly, or in some cause-and-effect manner, healthy outdoor play has dwindled in modern childhood, and deserves exploration as one of the possible associations, because treatment is so simple. Get off the couch!

Causes and Effects

Digital devices
These alluring products have taken over the lives of many, as young as the second year of life, for prolonged periods. There are two primary problems – lack of socialization and imagination. To be sure, there are educational and other apps that may be able to successfully address certain behaviors or educational weaknesses. Mostly, however, i-stuff shuts out the world and is subject to repetitive play that rarely generalizes to useful real-world skills.

Often, anti-anxiety and stimulant preparations are prescribed too easily and frequently, and rarely address the root cause(s) of a child’s difficulties. The side effects may include listlessness, poor diet or unraveling (as the med wears off) that makes after-school-play a chore. Drug ‘vacations’, during holidays, vacations, and even weekends can mitigate some of those problems.

Undernourished or overweight individuals are less likely to achieve in outdoor sports. Picky eaters, low vitamin D, high or low cholesterol, iron-deficiency anemia, and thyroid problems are often diagnosed at The Child Development Center of America. Children who experience such metabolic abnormalities may display a lack of normal desire to leave their indoor environment and socialize. A vicious cycle ensues, with even lower energy, leading to more resistance to physical activities.

Fungus in the gastro-intestinal system is a prevalent problem, at least in the special needs population. Constipation leads to slowing down the entire body ecosystem, making outdoor play a chore. Less activity can further deteriorate the situation. Warm, wet, dark, stationary places (a non-motile gut) make an excellent home for yeast, which robs nutrition, alters the immune system, and creates toxic byproducts. In addition to probiotics, healthier foods, and anti fungal preparations, adequate muscle activity will push the food along.

Perhaps created by a child’s internal constitution and altered biorhythm, or due to any combination of the formerly-mentioned medication, nutrition, and gut micro-biome disturbances, lack of adequate sleep can be a major factor in a cyclical pattern of decreased activity and less desire and/or ability to fall asleep.

Mingling with others and exploring the world breeds increased desire to expand our universe. Playing at home with family is great, but the outdoors is where kids have frolicked for all generations and in all locales. Our complicated world forces adults to work more, experience increased stress, and have poor health habits. We shouldn’t be foisting that condition on the children, as well.

The NFL has experienced and/or created a number of poorly handled issues, such as concussions, player lifestyles, recruiting and gambling. This effort needs to be applauded because the advice – to play outdoors at least 60 minutes per day – should be heeded.

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
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