Posts Tagged ‘ASD’

Hyperbaric Treatment Revisited

Sunday, September 28th, 2014

hbotx2The use of HBOT for various neurologic conditions was a central focus at the most recent Medical Academy of Pediatric Needs conference. This is an update to the extensive review presented here nearly 4 years ago.

How HBOT is supposed to work:
It’s not rocket science. Because human blood is already 98% saturated in room air (21% O2), simply breathing higher concentrations provides very little improvement, and might even be detrimental. Adding pressure to the air that we breath helps dissolve some gases into the bloodstream. Therefore, in addition to the oxygen that is already attached to (and released from) our hemoglobin, more ‘nourishment’ can become available for the tissues.

‘Hard’ vs. ‘Soft’ Chambers:
Discussed here. More oxygen, more pressure, more danger, more expense, more schlepping. More effect? Suffice it to say, most people will not have the former in their own home.

Conditions with documented improvement:
There are 14 FDA Approved conditions for the use of HBOT, with supporting evidence of varying persuasiveness.
Decompression sickness.
Whether returning from too much or too little ambient pressure, there is improvement from ‘letting the cap off’ more slowly.

Non-healing wounds and those in diabetic patients.
The scientific literature showing improvement refers to high O2 (100%), as well as pressure (> 1.5 ATM); therefore, a ‘Hard’ chamber.

Cerebral palsy, stroke, and traumatic brain injury. Controversy about efficacy is unresolved.
For CP, improvement was demonstrated with the ‘High’ pressure type. A recent paper did not reproduce those results. Another study showed no significant difference when patents were exposed to the ‘Soft’ version. Parents, therapists and physicians, myself included, have observed positive results in many severely affected children.

Depression.
There is evidence of improvement after exposure to the ‘Hard’ chamber in one patient with post-traumatic stress disorder, plus other anecdotal reporting. That was also the finding in a group of patients suffering from depression after a stroke.

Hyperbaric Treatment and Autism Spectrum Disorder:
That’s the $2,000 –  $100,000+ dollar question. For the uninitiated, that represents the cost to try, or buy, the various forms of this treatment modality.

A few years ago, respected autism expert, Dr. Dan Rossignol documented improvement in a significant number of children. That was dampened shortly thereafter, when Dr. Granpeesheh, et. al. reported, “… that HBOT delivered at 24% oxygen at 1.3 atmospheric pressure does not result in a clinically significant improvement of the symptoms of Autistic Disorder.” A controversy has ensued, no doubt inflamed by the latter study authors’ statement that, “the results of this study corroborate the findings of the only other published study on HBOT… not the study authors’ interpretations of their findings.”

Yikes, what is a clinician to do? Or, the parents? At our scientific meetings, I have pressed some of the authors about the conflict. One doctor explained that, defending the ‘good’ outcome paper appears too proprietary. In the absence of stronger scientific proof, it shouldn’t appear that they are selling HBOT chambers. A different expert questioned whether there was a CARD (Centers For Autism and Related Disorders) conspiracy, with a bias against this intervention. We have enough of those controversies in autism.

Conclusions:
Depending on the family’s resources, parents who have “tried everything else” with few results may wish to explore HBOTAdverse events are rare and mild. The FDA has issued a statement of caution against off-label use. I wish that they were as worried about antibiotics in our food.

When systemic health is restored, many of the signs and symptoms of the conditions included in the diagnosis of ASD abate. To the extent that extra pressure addresses the sensory patient, HBOT can be a valuable (albeit expensive) therapy. Anaerobic bacteria and yeast would tend to shun the oxygen rich, higher pressure environment of a chamber. And, on a percentage basis, even +1.3ATM added pressure enriches plasma. The latest buzz involves ‘dormant’, not dead, neuronal cells, which are waiting to be invigorated.

However, sustained results are often achieved with therapies, sensory diets, probiotics, appropriate supplements and medications, when indicated. One of our data-crunching tech professionals recently asked me, “Why can’t you guys figure out if one is better than the other? Or, if they complement each other?”

He’s right. We need to figure it out.

Early Intervention Reverses Autism

Sunday, September 21st, 2014

reverse autism2More than occasional skepticism has been voiced about my lead essay, “Reversing Autism“. However, because of recent research, the major media sites, at least, seem to have picked up on this paradigm.

CBS news asked, “Could early intervention reverse autism?” NBC news announced, “Treating Infants for Autism May Eliminate Symptoms.” U.S. News and World Report: “Spotting, Treating Autism Symptoms in Infancy May Prevent Delays,” and USA Today was the most optimistic, by reporting “Study: Autism signs in babies can be erased.”

What was the study?
Researchers from the University of California, Davis MIND Institute provided intervention to seven ‘symptomatic’ infants (5 male, 7-15 months) and results were compared with 3 control groups:
1. High-risk infants who were younger siblings of an ASD child, but never developed it.
2. Low-risk infants who were younger sibs of a neuro-typical child.
3. High-risk infants who were younger sibs and diagnosed with ASD by 3 years.

What was the intervention?
Twelve ~1-hour sessions were provided. In the first one, 5-6 measurable objectives were developed. Afterwards, parents were instructed on skills to address those concerns. “… Therapists also provided parents with specific interventions for other delays, which were individualized for each child to address weaknesses identified during the curriculum assessment…”

What was the result?
U.C Davis’ Dr. Sally Rogers, et.al. reported that, “Most of the children in the study, six out of seven, caught up in all of their learning skills and their language by the time they were 2 to 3… Most children with ASD are barely even getting diagnosed by then.

Conclusions:
I was a bit disappointed that no medical problems were noted in any of the children. Perhaps it will be addressed in future research. Furthermore, the child who did not improve might have had an undiagnosed physical ailment, which would have made the intervention more effective.

In many cases, autism is something that can be reversed. That is simply the way that I perceive the condition. ASD seems to present as some sort of injury; before, or up to three years after birth, from which a child may recover. As in any physical insult, there can be complete, partial, functional, little or no improvement. Also, it may take months or years to achieve significant gains. The earlier the condition is treated, the higher the chance of recovery.

Pediatricians, neurologists, geneticists, psychiatrists, psychologists, gastroenterologists, dermatologists, immunologists, family practitioners – are you listening?

MAPS Fall ’14 Conference

Saturday, September 13th, 2014

Twice a year, doctors who are interested in understanding and treating children with complicated developmental issues, convene under the direction of the Medical Academy of Pediatric Special Needs. This is our opportunity to stay up-to-date about the latest protocols, and to speak with specialists from all over the world.

In addition to introducing the biomedical approach to professionals and providing a venue for the spouse and kids, the program includes ‘advanced’ tracks. The highlights of those lectures will be reviewed.

Day 1
Dr. Anju Usman – Down Syndrome
“What does that have to do with autism?” Learning about one neurologic childhood condition helps elucidate normal vs. abnormal structure and function. Besides, there are more than a few patients who suffer from both.

The ever-changing basic science of the brain was reviewed. A medical workup is similar; requiring genetic, metabolic, immune, and gastrointestinal evaluation. Conversely, having discovered treatment for the mitochondrial issues in ASD has successfully addressed various problems for Trisomy 21 patients, as well.

Dr. Giuseppina Feingold – Cerebral Palsy and Seizures
Again, understanding seizure activity in a condition where it is not uncommon, helps our understanding about convulsions in ASD. The lecturer, a pediatrician who practices alternative medicine in a very conventional setting, described her experience with her own child, who has CP.
A thorough review on the use of HBOT for CP was presented.

Dr. Mukherjee (New Dehli) and Dr. Marois (Quebec) followed with their research and positive experience managing CP with HBOT. Somehow, their findings have been misunderstood and misrepresented by the conventional medical community, for variety of reasons.

Dr. Kenneth Stoller reviewed his clinical knowledge and experience with Fetal Alcohol Syndrome. He has successfully treated patients with HBOT and Oxytocin, and has published that research.

Case presentations and discussions – sharing our medical experiences – finished out the day. The 2000 pound gorilla in the room? (hint – it has something to do with autism). Data is lacking.

Day 2
Very exciting! This day’s lecturers are rockstars, as far as researching, teaching, publishing and treating the group of conditions that present as a post-inflammatory encephalopathy. It is rare to be among such experts, so freely discussing their findings and opinions.

The moderator, Dr. Nancy O’Hara described her extensive experience treating patients with these disorders, including her own son. Details are provided about an accurate description, differential diagnosis (“What else could it be?”), laboratory ‘workup’, treatment options (including an additional lecture covering nutritional support) and outcome.

Dr. Tanya Murphy presented a fascinating talk about the overlap between antimicrobials and psychotropic medications. Specifically, certain antibiotics can also have neuropsychiatric effects. Conversely, psychotropic drugs have effects on the inflammatory system. This finding helps explain why the disparate group of medications that we use may have similar effects.

The inventor of the term, Dr. Sue Swedo, a Director at the NIMH, presented the latest about PANDAS. She described the areas in the brain where tics and OCD behaviors lie, and how this manifests as a condition for doctors to investigate, with treatment guidelines.

Professor Madeleine Cunningham, a researcher for over 35 years, gave an elegant presentation that documented the presence of autoantibodies in certain patients’ blood and the CSF, offering evidence that those chemicals signal (or are blocked from) neuronal cells. This work helps our understanding of many of the movement disorders, from Tourette’s to PANDAS.

Case presentations and videos completed the afternoon. The take home message was that doctors should stop asking the question, “Do you believe in PANDAS?”

Day 3
Inflammation

Dr. Rodney Dietert conveyed his understanding regarding the complexity of the functional immune system, and the relationship to non-communicable chronic disease. “The tie that binds,” according to the Chief of Immunology at Cornell.
He presented with the passion and knowledge that only a man who has spent his lifetime in this research could bring.

Harvard celiac researcher, Dr. Alessio Fasano, presented Intestinal Permeability, Antigen Trafficking and Inflammation. The subtitle, “The gut is not like Las Vegas, what happens in the gut does not stay in the gut,” tells the whole story.

Canadian naturopathic physician, Dr. Zayd Ratansi spoke about HBOT and Inflammation. There were lots of associations with medical conditions such as wounds, pain, trauma, cystitis and CP. The only slide about ASD and HBOT slide was Dr. Rossignol’s controversial multi-center report.

Dr. Russell Blaylock, a neurosurgeon, researcher and author, spoke about Immunocytotoxicity in CNS Disorders, elucidating how inflammation is handled in the brain.
He explained why/how systemic disturbances activate the CNS immune system. In turn, ASD patients with inflammation, perhaps elsewhere, have behavioral signs and symptoms. Comments were offered about the risks of the present vaccine schedule on the developing brain.

Although I can’t report that there was a great deal of specific day-to-day information, there was a lot of food for thought, networking, and the knowledge that there an increasing number of serious professionals working on your kids’ difficulties.

GcMAF Autism Treatment Update

Monday, August 25th, 2014

Earlier in this century, it was reported that 1) Some cancer patients demonstrated an elevated level of an enzyme, called nagalase, and 2) When patients have been given a purified blood product, GcMAF, which acts as sort of an antidote, there have been reports that treatments were successful in some medical conditions.

Because of elevated levels of nagalase in children with ASD, it was suggested that the same treatment could be helpful to address inflammation in autism, as well.

So, for the past couple of years, The Child Development Center has been treating a small number of patients with a protocol, slightly modified for this pediatric practice. The first blog, explaining the therapy, appears here. Six months ago, I reported on our initial experience.

My conclusions at that time were: improvements were generally seen in children older than 5 years, females appeared to respond better, some showed dramatic improvements in speech and cognition, and most parents were satisfied enough to re-order the product. In the past 6 months, there have been more patients and additional experience, particularly learning about lower dosing and altering dosage depending on signs and symptoms. Most recently, there is a new, ‘improved’ version of GcMAF to evaluate.

Side effects, while not severe, are variable, from slight rashes and fevers to increased aggression, especially in the first month. The product is well tolerated.

What is GcMAF? Macrophage Activating Factor is a purified human protein. It arrives as ~1/2 tsp of a clear liquid that requires immediate refrigeration. Macrophages are cells that play a role in cleanup, immunity, muscle regeneration, and wound healing. With such capabilities, it is not difficult to imagine that some types of autism could be addressed by boosting the activity, especially if there is interference from another substance (nagalase).

GOleic, the newest preparation, is GcMAF attached to a native oil. According to the manufacturer, “oleic acid is found naturally both in the human body and in olive oil; it is the first thing GcMAF looks for once it enters the body. In the laboratory it is many times more powerful than standard GcMAF…”.

The company representative stated that, “There is a reported increase in positive results to 25% from 15%.” This may not seem like much, but it represents improvement in a population that was previously stuck at a level of autism demonstrating very-little-to-no improvement for years.

Some of the claims made on the GcMAF.eu website require additional scrutiny. The only documented ASD experience, so far, is an anecdotal report on 2000+ patients, that asserts “15% have their autism eradicated.” That is not my observation. The implication of unknown viruses as a major cause of autism has not been borne out in conventional literature.

How much does it cost? The new preparation is now available in a sublingual form, which is preferable to the subcutaneous (injection) route, for most families. “GOleic’s price is €450  plus €60 shipping. It arrives in either a vial, (treat as GcMAF) or a dropper bottle…” Given once or twice a week, there are enough doses so parents can assess response and decide whether to re-order.

Conclusion:
Protocols that assess the immune system and nutritional integrity, plus optimize gastrointestinal function, have proven quite effective in the majority of younger patients. When continued treatment does not result in communication or behavioral abatement, parents seek more assistance. The conventional medical advice is to get even more therapy (often, not covered by insurance) or prescribe harmful medications, such as risperdal and prozac.

To date, GcMAF therapy is no panacea. However, treatment appears safe and has provided some advancements in cognition and communication, especially in patients who have not seen similar improvements in years.

The jury is still out. Experienced parents have been through the cycle of hope-hype-disappointment of previous clinical trials. Autism is a huge hurdle, and GcMAF represents a possible useful piece in the treatment puzzle.

Ten Must-Have Back-to-School Autism Supplies

Friday, August 15th, 2014

Forget pencils and notebooks. Here is my take on the most important items that children who exhibit signs and symptoms of ASD and ADHD really need to make it through the coming season:

10. A weighted vest, and other such functional products. Neural systems are on overload, so any/all sensory reducing strategies need to be dusted off and utilized. My son, a Special Ed teacher, reports that one of his favorites is Chewelry.

9. A special request for an IEP meeting to review everything agreed upon in the last IEP, and how the child has progressed.

8. A written, visible schedule. The previous school year’s busy agenda needs a re-boot. With non-preferred activities about to consume more time, acceptance and self-control become paramount, so clear expectations are a good start.

7. Sleep. Likewise, the body’s internal rhythms have gone on a summer vacation. Warm epsom salt baths are great to pave the way at bedtime. Chamomile is fine, and more difficult problems may be ameliorated with the administration of melatonin.

6. Supplements and medications. Children with ADHD are often given drug ‘vacations’ during the break. Appropriate dosing and timing may have changed as the summer progressed, so try getting things started a week or so early.

5. Healthy food. Unfortunately, schools do not often assist in this endeavor. If junior has been slipping off the diet, or eating too much junk, get back to basics.

4. An app to disable the iPhone. Really. The time spent on iPads, computers and video games needs to become severely limited.

3. Playtime. It is very difficult to transition from a season of freedom to one of academic drudgery and endless therapy sessions. Going to the park, ballgames, and other outdoor athletic activities is a basic part of being any kid. Even though physical activity is not as preferable as that smartphone, try to make it happen.

2. Soap. Stress cleanliness and get the child into the habit of washing their hands. To the extent that the school will cooperate, tissue dispensers, hand sanitizers and bathroom etiquette could provide some barrier to the onslaught of cooties.

1. A big dose of time and patience. As students fit into the new school year, so do teachers, administrators and other professionals need time to understand each child’s strengths and weaknesses.

Everyone remembers that first day back at school; anxiety, fear, excitation, and dread. The assault on the senses, social stresses and academic expectations are an even more tremendous hurdle for students with challenges in those very areas.

Most of all, parents’ love and understanding gets us all through those first inglorious days and weeks.

Beating Autism?

Saturday, August 9th, 2014

When the New York Times publishes stories about autism, my world is usually alerted. A recent series included, “Kids Who Beat Autism, Kids Who Don’t…, Behind the Scenes…, Questions…,” and Videos; so people want to know, “What do you think, Dr. Udell?”

In short, it is my opinion that the series misses the point, on many levels.

Do we really ‘beat’ illness or injury? Appropriate evaluation and intervention is the accepted scientific approach. According to this article, ASD does not require any medical treatment. “It’s genetic… can’t be fixed… over- or mis- diagnosed…, brain disorder…” and can only be affected by the traditional person-to-person therapies.

The lead article introduces two similar, affected young children who go through Behavioral Analysis. “Jackie did everything for him,” L. told me, her voice filled with angst. “Everything. She tried just as hard as I did. She hired the same people, did the same work. . . . ” Her voice trailed off. She was sure that the behavioral therapy had allowed her to reclaim her son, but she could not understand why it had not done the same for Matthew.”

The non-improving child had “chronic ear infections… threw up daily for a year… but the doctor assured them that there wasn’t anything physically wrong with him.” Even if the cause of the vomiting was ‘benign’ (ridiculous), the resulting nutritional abnormalities could most certainly have profound downstream behavioral effects. Furthermore, the medical consequences of frequent antibiotic administration probably won’t respond to simpler treatments, such as “… sensory integration, megadose vitamins, therapeutic horseback riding, a vile-tasting powder,” as was acerbically offered as autism treatment.
Nutritional status and ill-health are not even a consideration and recovery is basically presented as a enigmatic rarity.

Even when significant improvement ensues, “Fein’s study found that formerly autistic people often have residual symptoms, at least initially; these include social awkwardness, attention deficit hyperactivity disorder, repetitive movement, mild perseverative interests and subtle difficulties in explaining cause and effect.” Most parents would be quite satisfied with the minor challenges that many of today’s neuro-typical individuals suffer.

Finally, before falling into simplistic anecdotes about those who ‘beat’ ASD, the story takes a wild turn to discuss patients who don’t consider their condition an illness, or that it requires intervention. Their situation, some feel, is comparable to how homosexuality was previously viewed. Notwithstanding their present opinion, when such individuals were toddlers, their parents probably sought medical assistance.

The Kids Who Don’t story begins, “The other day a stranger called our house, out of the blue, to discuss my son… he wanted to know if I’d heard about a treatment that was getting remarkable results. Something to do with ocean water, he explained.”
Other examples in the text included, HBOT and GF/CF diet. They all get lumped together. The Wakefield Effect.

The studies cited in the cover story make it clear the reasons some children recover and others don’t are not only inexplicable, they’re inexplicably random, an incalculable mix of early intervention, hard work and luck of the draw. There was no mention of an addressable medical disorder.

Bottom line:
Do readers really become enlightened by this collection, or more confused? Autism Spectrum Disorder represents a variety of developmental abnormalities, presenting in the first few years, from which children may recover completely, partially, functionally, or very little. People don’t ‘beat’ a car accident, diabetes, or asthma.

It is great that the epidemic is getting additional attention that will hopefully lead to increased funding for research that will lead to successful treatment(s). Scientifically addressing system disorders, such as nutritional deficiencies, G-I health and allergic inflammation, and combining them with traditional therapies mentioned in the article, will demonstrate that recovery is not a miracle, just a mystery because of our present level of (mis-) understanding.

In the meantime, let’s worry about treating, not beating, this devastating problem.

The Law, Antibiotics and Autism

Sunday, August 3rd, 2014

The Case:
A U.S. court ruled that the FDA is correct to continue to allow the administration of antibiotics to feed animals – even if they aren’t sick.
Argued: February 8, 2013 Decided: July 24, 2014

The Judges:
Robert Katzmann, Chief Judge, (has top notch credentials, and wrote the minority opinion.)
Gerard Lynch, Circuit Judge, (wrote 2-1 majority opinion). More about him later.
Katherine Forrest, District Judge, (a really rich, “celebrated litigatrix“).

The plaintiffs:
Natural Resources Defense Council – “One of the nation’s most powerful environmental groups… A credible and forceful advocate for stringent environmental protection.”
Center for Science in the Public Interest - Founded by 3 “scientists, CSPI carved out a niche as the organized voice… on nutrition, food safety, health and other issues… to educate the public, advocate government policies that are consistent with scientific evidence on health and environmental issues, and counter industry’s powerful influence on public opinion and public policies.”
Food Animal Concerns Trust – “Mission… is to improve the welfare of farm animals; address public health problems such as the safety of meat, milk, and eggs; broaden opportunities for family farmers; and reduce environmental pollution.”
Public Citizen, Inc. – “… serves as the people’s voice in the nation’s capital… To ensure that all citizens are represented in the halls of power.”
Union of Concerned Scientists – “puts rigorous, independent science to work to solve our planet’s most pressing problems. Joining with citizens across the country, we combine technical analysis and effective advocacy to create innovative, practical solutions for a healthy, safe, and sustainable future.”

The defendants:
Margaret Hamburg, commissioner of FDA. She is a Harvard-trained medical doctor, and appears to be a strong consumer advocate.
Bernadette Dunham, Director – Center for Veterinary Medicine. She was a clinician, professor, and has served as an advisor to several veterinary panels.
Kathleen Sebelius, Secretary of HHS, who took heat for the Obamacare Website debacle.

The Issue:
A lower court had decided that the FDA should have hearings about antibiotic use in animal feed. This challenge, brought by the FDA, was that they didn’t need to review the issue.

The Ruling:
The FDA won.
Rather than considering antibiotics in the feed as a public health hazard, Judge Lynch (good name) focused his ruling on “… a syntactically awkward variation that leaves the intended sequence ambiguous.” The Catch 22 is whether the drug can be withdrawn if it is thought to be unsafe, but it can’t be declared so until there is a hearing, which the FDA is not required to do.
The explanation contains 10 pages that document scientists’ concern about antibiotics in the animal feed. It is followed by 55 pages that explain why the ruling by the previous court was incorrect. “In an ideal world, Congress would have written a statute that clearly selects between one of these two possible readings. But as the statutory language is ambiguous, we must do our best to determine which of these two meanings Congress intended to convey.”

Discussion:
I asked former Florida Assistant Attorney General, Mr. Hugh Keough , about this case. “The dissent was by the Chief Judge of the District… Interesting discussion about antibiotics especially after all I’ve read from you about over prescription of antibiotics…”

“Indeed, the FDA has consistently reaffirmed that using low doses of antibiotics on healthy livestock to promote growth could accelerate the development of antibiotic‐resistant bacteria, causing “a mounting public health problem of global significance.”

The “decision allows the FDA to openly declare that a particular animal drug is unsafe, but then refuse to withdraw approval of that drug. It also gives the agency discretion to effectively ignore a public petition asking it to withdraw approval from an unsafe drug.” (Dissent).
Mr. Keough exclaimed, “17 Years ago the World Health Organization recommended ceasing! Uh, is it time to go vegetarian?”

Conclusions:
The plaintiff’s issue was the emergence of resistant strains of bacteria. However, there may be profound, as-yet undiscovered effects. Somehow, can’t the FDA see it’s way to erring on the side of caution?

In 1999, the Journal of Pediatrics, published a study documenting, “Unrecognized gastrointestinal disorders, especially reflux esophagitis and disaccharide malabsorption, may contribute to the behavioral problems of the non-verbal autistic patients.” If you don’t think that autism is an epidemic, and you don’t consider that childhood development could be affected by the overuse of antibiotics, then you wouldn’t ever know whether antibiotics in our food is a threat.

 Given this decision, it’s going to be a while until any change is made in this area.

 Don’t allow your doctor to prescribe antibiotics for every little illness, and don’t beg for them, either.

 Take strong probiotics – lots of colonies, with varied strains.

 Try to eat as ‘organic’ as possible (given that they are telling us the truth about ‘organic’).

 If we want better oversight, we should let our government know.

Smartphone Rules for Autism

Sunday, July 27th, 2014

There are a multitude of programs designed to engage, and hopefully enlighten communication-challenged youngsters. A great place to start is Autism Speaks’ Autism Apps webpage. That site contains a preferences filter, research ratings, and nearly 600 choices, as of this story.

The most affected and youngest patients with ASD seem to easily learn to navigate to their favorite game or YouTube video. Their facility in this arena frequently exceeds neuro-typical peers.

Since the landscape changes so quickly, specific programs are really not the issue. We have observed a new phenomenon of persistent play in developmentally delayed children who have easy access to their parents’ iPads, iPhones, etc.

Here are some of the issues that parents might consider when the child grabs for that partially broken, heavily armored, totally smeared and nearly unreadable device:

Even 1-year-olds are able to navigate the system. Parents should make sure that children are not merely doing visual-auditory stimming. What appears so cute, at first, can become a major annoyance. For some, just the credits of a favorite video or a certain song may seem quite fascinating. That is just a digital version of watching wheels, or a ceiling fan, spin. It’s not really play, and the time spent with this entertainment should be kept to a minimum.

Metabolic abnormalities found in our patients include a number of nutritional deficiencies. Vitamin D activation comes from the sun, not an iPad screen. Children must go outdoors and exercise. As old-fashioned and paternalistic as that aphorism sounds, it should be heeded, if parents have a sincere desire to help their children enjoy good health.

Try to avoid allowing such a compelling device to become the babysitter. With all of the variety, every child can find one or more apps that tickles their fancy. Busy parents may see the activity as a short break in their day – time to cook, take care of the other kids, or just relax. Unless the child is moved to another endeavor, the pattern could become a preferred, fixed, repetitive action that is difficult to manage.

Watching a small variety of videos, or various games on a device is still playing on the ‘pad. A core deficiency in autism is the existence of a narrow range of interests, so therapies should be targeted at promoting a diversity of experiences.

Apps that encourage learning basic concepts, such as number, color, letter and word recognition, can be a great educational aid. Once those skills are mastered, communication, starting with pointing, and skills that lead to sharing would be ideal.

The ultimate goal as toddlers mature is to be able to learn in a classroom with human teachers and classmates. Electronic programs can help prepare kids for the academic environment, but do the stated gains of any app promote the skills needed to succeed in school; such as, attending to the teacher, following verbal directions, and playing with other children?

Take advantage of this learning opportunity. Help your youngsters to get some socialization out of their digital experience. Join them as they master the games, and try to work on understanding how the app is somehow connecting to your children’s brains.

A final word of advice, then… don’t let the smartphone rule.

Probiotics for Autism

Sunday, July 20th, 2014

One of the most effective treatments that MAPS doctors utilize to address the signs and symptoms of autism is probiotic supplementation.

What they are
Fermented foods, such as cheese, yogurt and kefir, for example, contain microbes. Over 100 years ago, researchers at the Pasteur Institute discovered the role of gut bacteria and demonstrated their importance to proper immune system functioning, as well as digestion.

In the second half of the 20th century, as antibiotics became popular, the simpler, more natural probiotics took a back seat. The overuse of prescription medication and routine use of genetically modified foods has altered a symbiotic relationship that existed since the earliest humans.

The term is now used to describe proprietary microorganisms (bacteria, fungus) that are ingested to help create a healthy mix of G-I flora.

What they do
The bacteria inside our gut outnumber the cells in the rest of our body. The modern term “microbiome” describes the complicated interplay between those microorganisms and the various cells in our digestive environment. There are profound effects on the functioning of our immune and nervous system.

Altering this delicate relationship has downstream effects, such as chronic infections, auto-immunity (?self vs. non-self), nutritional deficiencies, food allergy, and digestion.

Probiotics offer the potential to re-invigorate a depleted microbiome and alter the downward spiral, resulting in better stool patterns, fewer infections, improved nutrition, less distraction and disrupted behavior.

What About Autism
Patients with ASD appear to represent a percentage of the population who are susceptible to interruptions in the microbiome. The association of the core signs and symptoms of autism with immune irregularities, abnormal digestion, chronic infections, antibiotic over-prescribing, nutritional deficiencies, distractibility, poor tone and developmental delay is conspicuous.

Probiotics have been a mainstay of biomedical treatment because they are reasonably priced, safe and effective.

Side effects
After initiating appropriate probiotic therapy the clinical course is variable. Some children have no apparent change, at first. Other patients seem to have 3 to 5 to 7 days of die-off, as healthier organisms vie for the food supply and toxins are released.

Diarrhea, constipation, flatulence, silly behavior, rashes, poor sleep, aggression and regression are possible symptoms in the earliest phase. When behaviors become too intense, (oral doses of ) activated charcoal can sometimes temporize, as the healthier bacteria take hold and survive.

After a variable amount of time (depending on the age of the child and the presence of G-I symptoms), most parents report a lifting of their child’s ‘fog’, improved eye contact, and the initiation of communication.

Which is the best one
There is a general belief that probiotics are ineffective because the microorganisms do not survive the trip all the way down the digestive system where they need to take up residence. The best way around this issue is to pick products with a very high density of cells. There are trillions of bacteria in the body, and it appears that many billions are required to do their job.

Likewise, the body contains a variety of bacterial types. Look for products that contain an assortment of healthy organisms. Biomedical protocols often include the use of Saccromyces, which are supposedly ‘healthy’ yeast. At The Child Development Center, there are many children who demonstrate anti-yeast antibodies, so that is only utilized in a pinch.

Conclusion
Addressing the HIV-AIDS epidemic improved medicine’s abilities to understand viruses and the immune system. So, too, is our increasing understanding about the mysteries of autism assisting in a better understanding of a variety of gastrointestinal and allergic disorders.

Autism – The Money Issue

Sunday, July 13th, 2014

While ‘expertscontinue to debate about the autism epidemic, parents are paying the price.

This week, the Journal of the American Medical Association published a study from the US and UK that documented a cost of (US$)1.4 million over a lifetime, if there was no intellectual disability. That’s seventeen thousand extra per child per year – 1/2  of the US median income. Add another 1 million dollars if mental problems persisted (46% in one study).’

Of course, I’m preaching to the choir here. Families are well aware of the financial burdens. The problem seems to be that the medical profession is clueless. Parents are told to get therapies that are very expensive, and even if they are ‘covered’ by insurance, the co-pays can be prohibitive. And, if the child fails to meet intellectual milestones? More therapy.

In 1987, Dr. Louvaas reported, “Follow-up data from an intensive, long-term experimental treatment group (n = 19) showed that 47% achieved normal intellectual and educational functioning, with normal-range IQ scores and successful first grade performance in public schools. Another 40% were mildly retarded and assigned to special classes for the language delayed, and only 10% were profoundly retarded and assigned to classes for the autistic/retarded. In contrast, only 2% of the control-group children (n = 40) achieved normal educational and intellectual functioning; 45% were mildly retarded and placed in language-delayed classes, and 53% were severely retarded and placed in autistic/retarded classes.

In 2010, Dr. Grenpeesheh, “… completed a study which found that 6 out of 14 severely autistic children who obtained treatment by CARD had fully recovered.That’s 43%. 

Regardless of the exact diagnosis, the reasons for increasing numbers, and questions about ‘recovery’, the lifetime costs of caring for more than half of the patients with ASD are considerable.

The commentary in that aforementioned issue of JAMA was entitled Autism – Moving Toward an Innovation and Investment Mindset. The Drexel University professors wrote, “…We wish to reflect further on the conceptual and measurement advances needed to reach a point where we can meaningfully link investments in services to life course outcomes…”

This is an indication that conventional medicine will be forced into evaluating the epidemic from the financial side, even as science fails to provide data supporting flawed theories. “… This accomplishment is especially remarkable given the challenge presented by a profound lack of infrastructure for routinely monitoring costs and outcomes in people with autism spectrum disorders.”

An important finding in the study was that the second highest cost of autism was lost productivity to family members who must care for an affected patient. That means that earlier diagnosis, with prevention of long-term disability, and the amelioration of intellectual disabilities, will have the greatest effect on decreasing costs.

I am not qualified to offer financial planning advice. There are experts on that side of the equation. Given the present state of our understanding about the cause(s) and useful autism treatment(s), such assistance in assuring your child’s future may prove valuable.

Protocols provided by MAPS physicians are certain to impact these tremendous expenses. At The Child Development Center, we have been very successful at achieving neuro-typical educational status by 1st to 3rd grade in the majority of infants and toddlers. That is a tall statement to make, and it is not offered lightly. Biomedical protocols involve a great deal of work by the families and counseling by the staff. Traditional therapies, such as behavioral, physical, occupational, and speech are a necessary accompaniment to assure improvement.

As noted in the editorial, “We need to recognize innovations that are already occurring in community settings and establish ways to learn from them about what works for whom. Accumulating practice-based evidence will require mutually beneficial partnerships between researchers and community health care… This approach would foster active learning from experience.

As in other medical conditions, such as hypertension-arteriosclerosis-heart disease or the HIV epidemic, a sizable cost savings may be the initial driving force to accurate diagnosis and effective treatment. If that is the impetus resulting in better medical care for autism, that’s OK, as well.

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

Email bdumd@childdev.org
Website http://www.childdev.org

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