Posts Tagged ‘Attention deficit’

Fish Oil for Autism and ADHD

Sunday, November 16th, 2014

It seems that the less that is scientifically certain about a nutritional supplement, the more Internet pages are devoted to convincing surfers about its value to your health.

On the other hand, certain food additives hang on because they appear to have merit. Fish oil, for example, has been a mainstay. In addition to health benefits for heart disease, depression and dementia, improvements have been documented in behavior, ADHD, communication and cognitive function – many of the core symptoms of ASD.

The Basics: (for our purposes)
The brain is rich in fats. They are membrane-stabilizing, anti-oxidizing, electricity-enhancing, chemical-carrying, and account for most of the weight of our CNS.

A healthy metabolism requires dietary polyunsaturated fatty acids (PUFAs). One designation (Omega 3-6-9) describes the organic composition. Another important classification describes the size of the molecule (α lipoid acid-> EPA-> DHA).

There is evidence of differences in the PUFAs of people with ASD. The inference is that function can be normalized with dietary intervention by re-establishing typical levels and ratios.

Dietary sources:
Various mixtures derived from the ocean (cod, salmon, krill) and/or plants (flax, corn, nuts) are available. Claims about better stability, quality, purity, ingredients, absorption and disease-specific value are variously offered.

Particularly as regards a condition as multifactorial and enigmatic as ASD, this situation has resulted in a myriad of possible correct, useless, or even harmful choices.

Side effects:
WebMD lists a variety of adverse reactions, the most pertinent to the ASD population being:
G-I symptoms including burping, discomfort and loose stools
•Bleeding, including nosebleeds
PUFAs affect the immune system
•Heavy metal contamination
•Allergy to the source
•Exaggerating mental disorders
•Lowers blood pressure (many patients take bp lowering meds for sleep and anxiety).

Scientific papers reporting various dosages and formulations have demonstrated cautious safety, even in research that does not support assertions of improvement.

Results:
There is more than one study that refutes any positive effects, particularly in ADHD and ASD. There are few reports of gains in speech and language. Even the evidence offered by a popular vitamin company lacks specific supporting documentation.

Many children with ASD are on restricted diets or they are finicky eaters who could use the extra nutrition, anyway. Furthermore, there is a growing body of anecdotal reports and stories of improvement from various omega products.

There is theoretical and documented evidence that supports the proposition that this relatively safe and inexpensive nutritional supplement improves CNS functioning.

Conclusions:
Since we have limited ability to produce them, PUFAs are a dietary requirement. They are Essential Fatty Acids in various combinations, with confusing nomenclature. That situation often leads to marketing opportunities.

Little is certain regarding how this group of supplements affects patients with ASD. Users mostly rely on producer advertising for information and assurances about the “best” product.

In order to assess whether “it’s working,” caretakers should pay particular attention to gains in the most documented behavioral components, such as ADHD and aggression. Being aware of safe dosing and negative effects is valuable, as well.

Perhaps not producing as noticeable an improvement as other biomedical interventions, a high-quality oil that the child can tolerate (taste, smell), at the label-recommended dose, is a reasonable nutritional supplement for ASD.

The War on Autism

Sunday, November 2nd, 2014

In the 1980’s, President Ronald Reagan declared a ‘War on Drugs‘. The Global War on Terrorism was pronounced after 09/11/01. Early in this century, Bush 2 joined the war on HIV/Aids. This week, Obama named an Ebola Czar.

For some time now, the U.S. has only had an acting Surgeon General (Rear Admiral Boris Lushniak), because the nominee, Dr. Vivek Murthy, had the temerity to say that, “Guns are a health care issue.”

Is it any wonder that ASD has taken a backseat to other matters in our healthcare system?

More than forty years ago, Surgeon General C. Everett Koop challenged the tobacco industry juggernaut that assaulted the population of 20th century earth. He raised numerous warnings (including the dangers of second-hand smoke), and even changed the paradigms for advertising and labeling the product. In spite of some unpopular conservative views, especially regarding abortion, Dr. K was still considered America’s Doctor.

What does ‘declaring war’ mean?
It implies urgency. Somehow, more resources appear; including funding, infrastructure, media, etc. Priorities change. For ASD, a medical condition, personnel and materials would become focused on research to elucidate etiology, test treatments and evaluate prevention.

The ‘enemy’ is put on notice that the entire weight of the U.S. government is behind an effort to solve the problem. It worked when we landed a man on the moon, figured out the HIV epidemic, and Bin Laden. Autism is trickier because, like terrorism, it’s difficult to identify the opposition.

A ‘Czar’ is usually named. The Big Kahuna avoids Senate confirmation. Hopes are raised. There would be a commander to unify the disparate autism organizations.

How would the appointment of an Autism Czar help?
There would be instant recognition, finally, that there is an epidemic. Apparently, “ASD now affecting 1/42 males,” does not sound dire enough.

A true understanding of the costs should enlighten the prudent potentate about the enormous savings produced by early diagnosis and effective intervention.

There would be a respected leader to delegate resources to the areas of most need. This individual also has ultimate responsibility for education, caring for older patients, and the most affected.

More medical specialists would get involved in the search for answers. Gastroenterologists, dermatologists, immunologists, child neurologists, and pediatricians would find increased incentives to join the autism battle.

Research leading to effective medications would speed up. The major complaint by drug manufacturers is that it costs >$ 1B to develop any new drug. Perhaps, as in other crusades, the ASD maven could cut through the red tape to get things moving.

Vaccination research would take a new direction. Increased resources should include the formulation of controlled, prospective, randomized, double-blind studies about the various components of the present childhood immunization schedule, dose and timing. This would go a long way to clearing up the many lingering concerns in this area.

Unification would provide a national infrastructure for tackling the situation. The evaluation of genetic, environmental, bacteriological, nutritional, and other important disciplines by the Boss and Joint Chiefs of Autism Medicine may be the best way to gain ground on the enemy.

The Czar would be responsible for making a difference in the autism epidemic.

There is no ‘War on Autism’.
But patients, families and practitioners – those who live and fight in the trenches – could certainly benefit from some reinforcements.

Sleep and Autism

Sunday, October 26th, 2014

Persistent, altered sleep is a common finding among young children who have signs and symptoms consistent with a diagnosis of ASD. This is a key difference from neuro-typical peers.

And, like any person, changes in quantity and quality can result in further downstream behaviors; such as, inattention, poor focus, and easy distractibility. The situation can further deteriorate into tantrums, a ‘short fuse’, aggression and injurious actions (against self and/or others).

Sleepchart

Data from Ruffwarg, et.al. Science 1966

What is disturbed sleep?
Not only do young children sleep much longer, more time is spent dreaming, which is an important physiological necessity and developmental component. Since there is practically no muscle movement during REM periods, toddlers should be sleeping “like a log.” Many affected youngsters do not exhibit such activity.

Latency is prolonged. The time that it takes to fall into a slumber should be <~1/2 hour, even accounting for a great deal of individuality. Nighttime awakening is frequent in infancy, but the child should quickly drop off again. Because this process takes time, naps include less REM sleep.

For ASD affected individuals, problems can persist even into later years.

What causes disturbed sleep?
Sleep apnea is a possibility, especially for some premies, or when allergic asthma or rhinitis are frequent occurrences. More often, signs and symptoms represent GERD (reflux), of varying degrees and varied causes. Really bad heartburn, and no way to tell anyone.

Diarrhea, constipation and bowel inflammation may cause sleep alterations, as well. Since G-I conditions exist so frequently in ASD patients, this is a significant area for positive intervention and change.

Other medical issues include frequent ear infections causing fever and pain, seizures, altered melatonin metabolism, other metabolic disturbances, methyl B12 ‘shots’, and even the stimulant medications that many physicians prescribe.

A ‘workup’ is in order for any child who displays altered sleep, not a pill.

What interventions are useful?
A quiet environment at a regimented time helps everyone achieve faster, more sound sleep.

Sensory therapies can result in significant amelioration of sleep issues. Warm epsom salt baths, reading, and brushing are further examples of effective interventions, in selected patients.

After a suitable evaluation, youngsters who suffer GERD and other G-I discomfort may get a great deal of relief by proper positioning, appropriate feeding (time and volume), and occasional mild antacids. Medications that decrease acid production, such as Prilosec or Zantac, should be avoided, because of alterations in normal gut flora.

If food allergies are identified, avoidance of offending agents can calm the gut and help sleep to take hold. Unusual bacteria or fungal overgrowth should be addressed with strong probiotics, and anti-fungals when indicated.

Melatonin is a popular, safe and useful supplement. After a thorough patient evaluation, a doctor should suggest dosing. Providing this valuable antioxidant at exactly the same time each evening is central to producing predictable results. When the maximum dose is not effective in maintaining sleep, adding the natural amino acid, 5-hydroxy-tryptophan, may help.

With varying doses and results, supplements such as Valerian root, chamomile, passion flower, and kava have been recommended. GABA, an over-the-counter supplement, is a neurotransmitter that can either work quite well to assist sleep, or add to excitation in certain patients.

The most basic allopathic medication is Benadryl, an antihistamine that produces sleepiness. There are blood pressure lowering medications such as Clonidine®, Intuniv® and propranolol. These should be used short-term and the ordering physician should be alert to the cause(s) of the disturbance. Only rarely should strong CNS medications such as Depakote® be utilized. Sleeping pills that were meant for adults are just that – meant for adults.

Conclusions:
Unnatural quality and quantity of nocturnal activity often accompanies an autism diagnosis.

With such a plethora of downstream negative behaviors, interventions that reverse this situation are paramount to producing an effective autism treatment protocol.

Consulting with a knowledgeable, experienced clinician will yield the most valuable results.

Perhaps the most important improvement when affected children start to get an adequate night’s sleep is the positive effect on the whole family’s next day.

Autism, Broccoli and Cures

Sunday, October 19th, 2014

Sulforaphane treatment of autism spectrum disorder (ASD) made the news this week. According to Johns Hopkins’ researchers, an as-yet unavailable chemical derived from broccoli “…substantially (and reversibly) improved behavior…”

This is great news for parents and professionals who, for decades have been so deprived of clinical studies that are well – designed, performed, documented and published. Many families are now searching for the best way to get sprouts and seeds into their child with ASD.

Importantly, the proposed mechanisms behind the treatment lend mainstream credibility to the concepts of oxidative stress and the work of Jill James, who has published since the beginning of this century. “Sulforaphane, which showed negligible toxicity… upregulates genes that protect aerobic cells against oxidative stress, inflammation, and DNA-damage.”

The Good:
Supplements containing some of the chemical are for sale. There are ~1mg tablets, for example, that sell for ~30¢ each.  Broccoli seeds (the sprouting kind) are available for five bucks, though I’m not quit sure what to do with them.

One virtual vitamin shop advertises sulforaphane as AVMACHOL®, and that website is no longer available. It listed “365 mg of a proprietary substance made of 25mg of glucorapharin (the desired gluconsinolate form), broccoli sprout and mushroom extract.” One per day, @$ 1/per pill. Another lists Sulforaphane (From Broccoli), 0.4mg pill for only 4¢, but they were out of stock at this time.

The Bad:
There appears to be uncertainty regarding the bio-availability of the over-the-counter products. At it’s molecular weight (177 g/mol), and an average 100 uM dose (50-150 reported by researchers), it seems to represent a much larger dose (?~ 18 mg) than a broccoli side dish, or even the aforementioned supplements.

The Ugly:
Two of the authors in the study have explicitly rejected any claim to financial remuneration from sales of the expected product, due to “conflicts of interest.” Righteous! However, the son of one of those docs is the CEO of the new company.

Johns Hopkins University has U.S. patent applications and has licensed “… broccoli sprouts and seeds rich in glucosinolates… to Brassica Protection Products LLC.” That ought to raise the price.

Conclusions:
There are hundreds of patients who have been receiving reduced, (sulfur containing – cysteine boosting) liposomal glutathione for over 6 years, with great results. It turns out that the food with the highest known levels of glutathione – broccoli – works!

Parents who are already administering DMG, TMG, NAC, methyl B12, or reduced glutathione, should be alert for possible increased stimming with this added antioxidant.

At the very least, this information gives new meaning to moms who plead with their child to, “Eat your broccoli!”

Addendum:
Another opinion here

Why Don’t All Doctors Treat Autism This Way?

Sunday, October 12th, 2014

“If this protocol is so great, why doesn’t everyone know about it and do it?”

No answer seems to satisfy those who are firmly grounded in the old-time perceptions about ASD.  A patient’s (physician) family member raised this question recently, and it deserves a proper explanation.

The Top Reasons That Everyone Doesn’t Do It
(Combine a biomedical and traditional approach to reverse autistic signs and symptoms):

Time:
An accurate diagnosis is only produced by a thorough history and physical examination. “It’s autism,” is not good enough. A real medical ‘workup‘ helps determine the type of autism and co-morbidies. That is only the beginning. The most successful outcomes occur when families are involved to assist neuro-typical development.

Today’s physicians simply don’t have the luxury to spend hours per case; unless they are cutting, injecting, or physically assaulting the patient. Time, itself, is undervalued, and few practitioners choose this route.

Money:
Many of the resources that are most effective in reducing the conditions that are diagnosed as ASD are either not- or poorly- covered, by insurance. That applies to professionals, therapies, laboratory testing, supplements, and often even pharmaceutical products. The extra costs for each affected child are in excess of $ 40,000 per year, $ 1.4M per lifetime, and $ 2.4M per lifetime if there is intellectual disability.

Only recently have early diagnosis and intervention produced documented improvement, and biomedical interventions appear to be an unproven and unwarranted cost.

Big pharma is not involved:
Ah, the autism pill. News Flash: Like cancer, there won’t be one kind of ASD, or one successful treatment. However, there is research about many of the conditions that present with similar signs, including genetic and mitochondrial disorders. That work is putting doctors on the right path. As explained at a recent conference, it costs more than $1B to develop a new medication that makes it to patients. To date, 1/68 does not appear to represent an adequate market share.

Plus, many of the successful autism treatments involve supplements that are not expensive or controlled by the drug industry. Doctors are not served a tempting lunch provided by the makers of probiotics or other over-the-counter remedies.

The Wakefield Effect:
Due to controversial statements by a now-infamous British physician, the new reason that, “There are no studies to prove that theory,” is fear on the part of researchers. Really? Then, there are vaccination issues. Furthermore, not unlike previous epidemics, such as HIV-AIDS, there are a multitude of potions, and practitioners who promote them, to fill the medical void.

Parents may be willing travel to abroad or offer unusual treatments, seeking an unproven therapy. They are not crazy, they are desperate. The biomedical treatments that produce results are often lost in such clutter.

Denial:
“Selling” a newly-elucidated medical condition is a problem for family members who don’t think anything is amiss, except their version of proper parenting. Add a dash of medical jargon, and, for some, that is more difficult to swallow than reduced liquid glutathione.

Furthermore, those times when children suffer negative reactions due to die-off or methyl B12 stimulation may be easily misunderstood as regression or worsening of behaviors. Again, such events require a great deal of physician-patient interaction.

Poor Advertising:
The Child Development Center has offered services to many Florida universities, with very slow progress. Perhaps there is resistance due to NIH (Not Invented Here), or the specter of evil as regards the practice of holistic, complementary and alternative medicine. The Medical Academy of Pediatric Special Needs provides peer-reviewed research and education. TheAutismDoctor.com has a healthy readership, but obviously not enough to change popular opinion.

The gut-brain connection, metabolic problems, toxic exposure, and positive outcomes in ASD have been documented for decades. More publicity nowadays requires a book (working on that one), or a television show.

The Short Answer:
The present state-of-the-art in autism recovery is early recognition, an individualized protocol, and a complicated ongoing process of medical and therapeutic interventions.
It’s not a pill.

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.

ADHD – What else could it be?

Sunday, September 7th, 2014

In medical parlance, the title = “The Differential Diagnosis of Attention Deficit/Hyperactivity Disorder”. However, a major stumbling block to understanding, treating and preventing this childhood epidemic is that it is considered a single organic entity, mostly of familial origin. Treatment usually involves strong stimulant medications, with serious side effects, in order to semi-successfully control a perplexing mix of imprecise signs and symptoms.

It’s not ‘just’ ADHD:
When I first encountered hyperactivity in the previous century, it was called ‘minimal brain disfunction’. After adjusting the name to reflect the ‘hyperactivity‘, the term ‘attention deficit‘ was added to streamline the diagnosis. Common difficulties include distractibility, poor focus, constant motion, immaturity, a ‘short fuse’ and frequent disruptive behaviors.

Combining two conditions that are poorly understood makes the problem more, not less, complicated. Other than naming it differently, I’m not quite sure that we have learned much about ADHD in the past 40 years, except for the recognition that it is increasing.

It’s not just ADHD if the child also has:
Some other chronic, concurrent physiological infirmity. Allergies, poor sleep, bowel or bladder problems are often not separate, isolated maladies. Importantly, as the associated medical conditions are successfully addressed, many of the base signs and symptoms may be ameliorated, as well.

Notably, behaviors such as aggression, anxiety and opposition may be coping mechanisms, not core deficiencies. That would explain why prescription medications are frequently ineffective, only work for short periods, or can even exacerbate symptoms.

As in all medical conditions, the diagnosis requires a ‘workup':
This week, our practice evaluated a patient who was exhibiting aggressive and oppositional behaviors. At the start of the school year, with so many children who have similar issues, the diagnosis would probably have been ADHD, and the patient sent home with an Rx for Ritalin. Except, on laboratory workup and by physical examination, he has thyroid disease!

Conditions as diverse as ASD, dyslexia, prenatal substance abuse, and even chromosomal changes may be present. Such circumstances are frequently missed due to the lack of elucidating a differential diagnosis –  what else could this child’s problem be?

Diet is important:
The studies about the effects of diet on ADHD are often difficult to interpret. The popular Feingold Diet focuses on artificial ingredients and salicylates, and has helped hundreds of thousands. WebMD provides a useful framework: overall nutritional, elimination and supplementation. Such a classification highlights the need to perform a thorough medical evaluation to eliminate much of the guesswork. If you can see it, you have a chance to beat it.

All the confusing nutrition babble aside, vigilant parents may discover offending agents and helpful substitutes. The problem is getting your kids to listen.

There isn’t just one treatment:
Stimulant medications. Three major variations. Caffeine citrate and nicotine patches can substitute.
Anti-anxiety drugs. Three on-label listings (Intuniv, Risperdal, Abilify) and numerous adult versions.
Homeopathic, naturopathic, allopathic variations.
Neurofeedback, NAET, neuro-sensoryelectrical stimulation, detoxification, etc.

Such a multitude of treatment options leaves professionals throwing darts at a moving target. The process is not exactly experimentation, but it certainly is trial-and-error. It isn’t difficult to understand why parents search the Internet for safe, effective intervention(s).

Close followup is key:
The present gestalt of listening to a parent’s concern, observing an antsy child in the office, and handing out a ticket for more over-prescribed ‘band-aids’ seems unstoppable. It’s not only the type of intervention, but how the child is evaluated and what specific signs and symptoms are successfully addressed, given the myriad of side effects.

Importantly, children are constantly growing, evolving and experiencing internal and external changes. Dosing, frequency, timing, and type of successful therapy will change dramatically over time.

Conclusion:
When a medical professional announces that your child has ADHD without a detailed history, review of systems, physical examination and appropriate laboratory evaluations, the patient is getting short-changed. It can even be made worse by over-prescribing potent pharmaceutical agents.

Parents who research the ‘net will find the landscape quite confusing. The best advice is to find a doctor with the skill, experience and time to understand this complicated diagnosis.

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.

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.

Smartphone rule #1, is… don’t let the smartphone rule.

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Brian D. Udell MD
6974 Griffin Road
Davie
FL 33314
Office phone – 954-873-8413
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Email bdumd@childdev.org
Website http://www.childdev.org

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