Posts Tagged ‘Attention deficit’

When Methyl B12 Doesn’t Work for Autism

Sunday, April 26th, 2015

pdr2The Physicians’ Desk Reference is the text that professionals turn to first, when checking on a prescription medication. Though it contains more a thousand pages describing 330 medications, the condition ‘speech apraxia’ doesn’t appear.

That means that conventional medicine has formally admitted that there is no pharmaceutical treatment for one of the core signs of significant Autism Spectrum Disorder. The result is that families will seek relief elsewhere.

The most studied and proven treatment is Speech and Language therapy, in some combination with other important traditional treatments, such as ABA or OT. Astounding recovery may take place, depending on how early a problem is recognized and addressed.

What happens when these modalities are not effective?
More therapy? Really?
That’s all you’ve got doc?

The use of vitamin methylB12 injections has shown safety, tolerance, and improvement in a subgroup of individuals in a 2010 study. At a recent MedMaps.org conference, it seemed to be the most utilized methodology by the experienced ‘DAN’ practitioners in attendance.

So, what if the mB12 injections aren’t working? 

1. Be patient. Depending on the child’s age, it could take up to a month or more of ‘shots’ to achieve perceptible results.

2. Be realistic about the next developmental step. Non-verbal children may simply exhibit increased oral ‘stimming’, including shouting, teeth grinding, making bubbles, drooling, or biting (just about anything). If the child already speaks, look for more words that require less prompting and new words to appear intermittently. The next step is speaking to toys and family members, and socialization may then generalize.

3. Don’t forget, we don’t teach toddlers how to speak, they just do it. Continue or even increase the Speech therapy. Achieving optimal health and the ability to learn must be complemented with proper instruction.

4. Suspect on-going inflammation. Yeast, bad bacteria, and food intolerance could be using up much of the energy that it takes for the correct areas of the brain to wake up.

5. The suggested dosage is 64.5 mcg/kg subcutaneously every three days. That equals ~1mg for a typical 3 year-old. Many practitioners will increase the dose and frequency if there is little response.

6. Check for a problem in the pathway leading to glutathione production. A genetic mutation in the step that makes folinic acid (MTHFR), or too much tylenol blocking the normal formation, may be interfering with mB12 treatment.

7. The practitioner may wish to add to that detoxification channel with the use of DMG, TMG, and/or N-Acetyl Cysteine.

8. Other medications that the child is prescribed, such as stimulants and anti-anxiety preparations, may be impeding progress and interfering with recovery.

9. Parents are often confused about the various formulations of the vitamin; including sublingual, patch, pill, and lollipops. It is water soluble, leaves the body easily, and needs to be administered in a form that slowly leaks into the circulation. The successful substance is injected subcutaneously – under the skin and into the fat.

10. The preparation should be ordered from a reputable pharmacy that is familiar with the product. Simply changing the compounding dispensary may improve results.

Bottom line:
What do you do when the methyl B12 still doesn’t work for speech apraxia?
That is a very difficult problem.

That Kooky Autism DIET

Sunday, April 12th, 2015

Just about every one of our patients “do the diet”. It’s different for each child. Parents are asked to avoid the foods that test in the highest range of immunoglobulin-4 (that’s I-g-G ‘four’) levels.

That is considered ‘kooky’ by medical establishment standards. I have treated several patients under the age of 7 years, lately, who were taking Zoloft, Prozac, Vyvanse, and Intunive in combination and pretty high doses, prescribed by prominent local neurologists. That, apparently, is not kooky.

The ‘diet’ is considered risky by medical establishment standards. Those are the standards that do not require testing of thyroid, lipid, vitamin, iron and other important parameters associated with autism. Checking levels is, apparently, kooky. Treating vitamin and mineral deficiencies in patients with ASD is, somehow, even kookier.

The experience of thousands of families is this: when children avoid those foods to which they are most reactive, there is an improvement in ‘brain fog’, communication, bowel movements (and, often toilet training), and aggression.

I know this to be true for two reasons. One, ‘The Diet’ – whatever it may be for each individual patient – is a pain in the ass for the family. The parents follow it because they see improvement. Two, when children transgress there is a price to be paid – in regression, yeast, sleep, hyperactivity and other behaviors.

The conventional wisdom is that IgG-4 food allergy testing is useless. That was the declaration made by the European Academy of Allergy and Clinical Immunology (EAACI), 7 years ago. The paper was entitled, Testing for IgG4 against foods is not recommended as a diagnostic tool.

It is clear that, if the problem being investigated does not include the core signs and symptoms of autism, such testing may be irrelevant.

After appropriate laboratory testing, observable results may take up to 2-3 months. Embarking upon the child’s specific diet is often challenging, but rewarding. Knowing that the results are accurate is verified when ‘fog’ lifts, there is faster processing, or less anxiety.

Skeptics frequently point out that diets are ‘dangerous’, due to vitamin and other deficiencies. Close measurement of somatic and laboratory parameters assures grandma (and others) that this protocol results in positive nitrogen balance by promoting health and preventing illness. As a result, appetite often improves and food choices become even more varied.

At a recent medical conference, one of the presenters expressed a lack of confidence about the IgG-4 food allergy findings. Those statements were challenged, and it was clear that the participants who encourage such dietary restrictions consistently observe significant positive results.

The Physician’s Desk Reference, the text that doctors use to check medications, contains ~1000 pages. There is not one mention of a treatment for speech apraxia, or eye contact. Physicians don’t seem to get it – if conventional medicine admittedly has little to offer by way of tangible treatment for their affected offspring, parents will search elsewhere.

There isn’t one ‘best’ diet. There are many reports of improvement with GAPS, FODMAPS, GF/CF, and others. Plus, there may be no value to applying the results to other conditions, such as asthma or eczema. However, imagine a parent NOT trying the Feingold diet to treat their ADHD child before giving strong, addictive medicines that carry many side effects.

Finding a diet that improves a child’s health, and gives the family some relief and hope, is not kooky. After assuring nutritional balance, it really doesn’t matter which one, as long as parents see that it is working.

Real Autism Awareness 2015

Thursday, April 2nd, 2015

Autism Awareness is not just about slogans, license plates, Autism Walks, or assorted news stories. The term carries a variety of implications, including:

Public Opinion
Awareness will come when we quit arguing about whether there is an autism epidemic or not.

We need to stop wasting time blaming Andrew Wakefield (the doctor from England who had the temerity to question the vaccine gods) for why we don’t have a cure for autism. If you want to blame someone, start with Leo Kanner and Bruno Bettelheim, who concluded that it was the result of faulty parenting.

Political / Legislative
This past August, “President Obama signed into law the Achieving a Better Life Experience (ABLE) Act, which will allow families with children with disabilities to save for college and other expenses in tax-deferred accounts. This piece of legislation is an important step toward empowering people with disabilities to achieve independence and affirms self-sufficiency.”

Insurance companies need to become more realistic about what services are required. The traditional therapies are effective, and should be reimbursed appropriately.

Autism awareness includes dealing with the situation of an aging ‘Spectrum’ population, and the resources that will be required.

Scientific
There will be more enlightenment when we stop focusing on the ‘anti-vaccine kooks’ and start researching an intelligent answer to the question, “Are all vaccinations good for all children all the time?”

We need to be cognizant that ASD continues to increase, and research has not yet uncovered the most basic questions of “Why, Who, or What?” “Where and When” is right here, right now.

Autism awareness includes mindfulness of the environmental impact.

Personal
Speaking of ‘awareness’, how about when a parent can go to the park and sit on a bench while the child plays (or tries to play) with the other kids?

Another example is the child’s awakening. Parents are thrilled when they no longer worry about elopement when the family is outside or in a crowd.

Finally, REAL autism awareness is when your child gives kisses and says, “Mommy, I love you!”

Autism Conference Spring 2015

Sunday, March 15th, 2015

The Medical Academy of Pediatric Special Needs provides this semiannual standard-of-care meeting, which is dedicated to teaching physicians and other practitioners who care for patients with ASD.

Various educational courses were offered, covering a variety of interests and experience. This being the 7th conference, an entire day was reserved for difficult clinical cases, discussed among ~30 doctors, who had previously passed the basic science courses.

Mitochondrial functioning played a significant role in this year’s presentations. The myriad of functions involved with these cellular power-plants was explored. This is a complicated topic that includes genetics (mitochondria even have their own chromosomes), over- under- and malfunctioning, environmental effects, cell-to-cell, cell-to-system and cell-to-environment interactions.

Impressions:
Prior to one of the lectures, there was a wonderful moment when Dr. Bob Sears, Dr. Jerry Kartzinel, Dr. James Neubrander, and Dr. Dan Rossignol were among those discussing the recent measles epidemic and what their practice was doing to address the situation. That conversation would have made a well-hit youtube video!

Another time I found myself eating lunch with Dr. Michael Elice, Dr. Stuart Freedenfeld, and other popular autism practitioners. There was a great sense of camaraderie and common purpose. This is one the few social experiences when doctors, such as myself, are not derided for our unpopular opinions.

Any new treatments?
Dr. Sid Baker, a true pioneer in the practice of the biomedical treatment for ASD, presented a wonderful historical perspective. Because of an earlier focus on autism as a genetic disorder, Dr. Baker opined that, “The last ten years have shown very little progress in the way of understanding and treatment of autism.”

One frequently discussed off-topic topic was the lack of research and safety of chlorine dioxide (ClO2), which is touted on the web as a helpful treatment. It is supposed to work by ridding the body of parasites. Ironically, however, one of the more popular new treatments involves helminth therapy (giving parasites to patients) to re-invigorate the immune system.

Conclusion:
It would be preferable if participants could return from such an educational experience with a list of novel therapies for our most challenging patients.

For now, learning key tricks and tips that address negative behaviors, or gut health, for example, are the order of the day. We learned about more precise lab tests, key findings that could point to more specific therapies, and important metabolic pathways that will help our patients, if not today, soon.

We consider what avenues to pursue, and those that need further evaluation. This organization is dedicated to providing well-researched medical solutions.

Because autism is so widespread, misunderstood, variable and mysterious, the ability to network with international experts and ‘pick the brain’ of those in the trenches is the most valuable feature that the conference provides.

“It’s supposed to be hard. If it were easy, everyone would do it”
Tom Hanks in A League of Their Own

10 Successful Strategies for Children with ADHD

Saturday, February 21st, 2015

Winter holidays are over. Things are back to normal at home (yeah, right, normal). School is ramping up and children with developmental concerns become even more challenged.

There is a constant stream of parents, these days, seeking relief because they are told that their child has Attention Deficit – Hyperactivity Disorder. They ask, “How do we get through the rest of this year,” and “What should we do about the next semester?”

Every child should have an appropriate workup leading to a clear, accurate diagnosis. ADHD can be a part of autism, thyroid disorder, gastro-intestinal problems, allergies, asthma, vitamin deficiency, etc. By properly diagnosing and managing a primary condition, many of the behavioral concerns may abate.

Make sure that inappropriate conduct is not due to something the child is receiving by way of medications for another condition, e.g., steroids or ‘cough and cold’ preparations.

Before becoming too aggressive with pharmaceuticals, consider the age of the child. A three- or four-year-old has time to mature and achieve self-control, while there are more academic demands on a eight-year-old.

Evaluate the difficult behaviors to better decide which intervention(s) will have the optimal chance for success with the least side effects. Occupational therapy is great if there are major sensory issues, neurofeedback might be helpful for focus, and behavioral intervention (ABA) might be more appropriate for disruption issues. Even if a parent still has to resort to medical intervention, lower doses and less frequent changes may be a result of this strategy.

Consider that inattention and poor focus could be due to mixed, missing and/or crossed signals in the CNS. With such a situation, non-preferred activities are much more difficult and therefore resisted even more than in typical peers. Until improved methods for overcoming learning disabilities are discovered, more patience and practice is required – and less criticism.

adhd bullett4dFor children who take stimulant medications, those who are able to tolerate drug ‘vacations’ will suffer less of the consequences of decreased appetite, sleep and linear growth. Sometimes, it is only for summer vacation, and other children are able to experience drug-free weekends.

Children who do not appear to be listening, are often simply listening without looking. That is not acceptable in a large, general education classroom. Nevertheless, medications that supposedly help focus and distractibility, might not do that, either. Anti-anxiety medications, starting with Intuniv, and sometimes even escalating to Prozac, are often suggested. If possible, the best improvement should come when the reason for gaze difficulty is understood.

Once parents make the decision to give medication a try, expect the most successful outcome when there is a clear understanding about positive and negative effects. It takes time to get the most desired results, and that knowledge can help the family withstand rocky periods. An ability to contact the responsible practitioner leads to increased compliance.

Be careful (and appreciative) when a treatment plan is working. Attempting to fine-tune a lingering shortcoming can lead to disastrous results. External stresses, from an ear infection to visiting relatives can disturb the calm. The child who maintains a healthy diet and necessary supplements is better prepared to weather the storm.

Inconsistency is the most consistent parental frustration. While it is in our nature to admonish the negative behaviors, remember to reward the good, as well.

To Vaccinate or Not to Vaccinate?

Saturday, February 7th, 2015

The measles outbreak that started in Disneyland has generated a fair amount of activity at The Child Development Center lately.

Many of our patients are either un- or under- vaccinated, according to the Vaccine Gods, so an increase in a preventable childhood disease in the U.S. is a very important healthcare issue.

In response to the media stories, and with the intention of addressing parents’ concerns, The Center emailed our patients.

The advice that was offered:
a. If the child has never had a vaccination, it is best to “bite the bullet” and go ahead with an MMR. We’re in the middle of an outbreak and it’s a very small world.

b. If the child has been previously vaccinated for MMR, you could get  “measles-mumps-rubella titers”. This is a blood test to determine if the child is still immune to the diseases, so it may be OK to hold off for now.

There were a variety of interesting responses.
Parent: “Thanks, Dr. Udell, for the heads up.”
Dr. U: You’re welcome. I’m just a messenger. Parents are the ones who have to make the final decision.

Parent: “What if the child has antibodies to eggs (allergy)?”
Dr. U: That is a big problem. I would look over the most recent laboratory tests and, depending on the child’s present state of health, and other findings, possibly still have to recommend. For what it’s worth, two of the products are actually grown on chick embryo, and almost all of our yolk-and/or-white-positive patients are negative to chicken. The German measles strain is grown on lung tissue derived from human fetus. We don’t test for that.

Parent: “Can’t you break up the shots?
Dr. U: No, the company that used to produce separates stopped years ago.

Parent: “My child was severely damaged by that shot. I’m surprised that you made this recommendation.”
Dr. U: It’s situational ethics, in a medical setting. I sympathize with your plight. Not only is there conflicting research; cases, such as yours, are completely ignored. Nevertheless, measles carries a 1/1000 chance of encephalitis (brain infection). 

Discussion:
After listening to so many complaints of proximate injury to an inoculation, it seemed that the best advice was to hold off vaccinating until the child improved, and/or the cause(s) of inflammation was discovered. There was little evidence of a rise in disease, so I felt less concern for the ‘herd’ than the family sitting in my office. The plan was to vaccinate a healthier child in 1-2 years, utilizing a judicious make-up protocol, if the parents agreed.

Each family will address this news differently, and act on their decision based upon what they consider as their child’s best interest. Questions and concerns persist. An epidemiologist just published a York Times editorial suggesting that there would be increased compliance if it were more difficult to obtain an exemption.

The line between the ‘good of the many’ and the ‘good of the one’ has shifted. Once the seal is broken, so to speak, and fewer than ~90% of the susceptible population is protected, there can be no accurate prediction of whether/where/when/how severe another outbreak will occur. The choice returns to the ‘good of the one’, so prevention is paramount.

The reality is that, if the AMA, AAP, FDA and CDC would express less dogma, become more sympathetic to those who claim injury, make fewer errors, and perform prospective studies to demonstrate efficacy and universal safety, parents wouldn’t be forced to make such a crucial decision on their own.

Ten Noteworthy Observations about People with Asperger’s

Monday, February 2nd, 2015

reitman1Recently, I had the honor and pleasure of being interviewed by Dr. Hackie Reitman, an orthopedic surgeon, ex-prize fighter, and now author and producer. My role was to provide additional clinical information about his newest endeavor to address the difficult challenges met by people with Asperger’s syndrome.

The eclectic doctor has written and produced a soon-to-be-released movie entitled The Square Root of 2. Plus, he is in the process of publishing his enlightening book, “Aspertools: The Practical Guide to Understanding and Embracing Asperger’s, Autism Spectrum Disorders, and Neurodiversity,” to assist patients, families, and the public in understanding what it is like to live with Asperger’s, and helpful strategies for success.

Notwithstanding the official demise of the oft-used moniker describing a like-group of individuals, this compilation covers some frequent questions and observations:

10. As with autism, which is due to a variety of causes with varying presentations, there isn’t one kind of Asperger’s syndrome.

9. The appearance of any lack of cognition or empathy often does not reflect the affected individual’s reality. They experience emotions, like the rest of us, but do not necessarily exhibit them in a typical manner. Sometimes their frustration can boil over into extreme anger.

8. People ‘on the Spectrum’, who are able to communicate and aren’t aggressive, are considered ‘high functioning’. When Dr. Asperger described the first cases, however, earlier cognition and language differentiated his patients from ‘regular’ ASD.

7. Everyone who doesn’t get a joke doesn’t have Asperger’s, and many Asperger’s patients have a sense of humor.

6. Eye contact can be fairly difficult in Asperger’s. Patients often complain, “Do you want me to talk-listen to you, or look at you?”

5. Sensory issues are a major problem, and difficult for the neuro-typical individual to appreciate. Fluorescent bulbs are a distraction, certain sounds can be like chalk-on-a-blackboard, perfume may be nauseating, taste can be very picky, and just the thought of touch may become frightening.

4. Individuals can learn from a trusted friend, family member, or teacher.  However, many educational environments produce a distracting cacophony of sensory issues. Knowing that a highly social situation will be very anxiety producing makes the sufferer easily distractible and leads to poor focus. It’s not necessarily ADHD.

3. A narrow range of interests and repetitive behaviors are not always obsessive-compulsive behaviors, they are part of the condition. That is why the usual psycho-schizo-antianxiety medications are often ineffective in Asperger’s patients.

2. This is not a diagnosis ‘du jour’. People who experience this condition know it, and are usually relieved when they find out the reason(s) for their differences.

1. As with other ‘Spectrum’ patients, there are often additional somatic issues involving the gut, allergies, and nutritional deficiencies. A thorough medical workup with appropriate medical intervention is frequently quite helpful in relieving some core signs and symptoms.

Dr. Reitman, who is the father of an Aspie, is helping to design a better understanding and treatment of this mysterious condition. It’s comforting to know that, like Dan Marino, Ernie Els, and Jim Kelly, the autism community has another true champion on our side.

Autism, Inoculations, and Fantasyland

Sunday, January 25th, 2015

Recent news about the increase in measles that has sprung up in California, has brought about the usual media finger-pointing, claiming that the cause is unvaccinated children whose parents unnecessarily worry about the risk of autism.

As documented in my previous posts on this topic, this physician believes in the value of those twentieth century miracles. Nonetheless, a lingering question remains, “Are all of the vaccinations safe and effective for all young children?”

The Three Main Reasons for the Measles ‘Outbreak’

Lack of Knowledge

We really don’t know the reason(s) for the newest episode. The increase may have little to do with lack of compliance by anti-vaccination zealots. Many of the infected individuals were Disney workers who had probably already been vaccinated, and were no longer immune. Plus, the venue is an international attraction, with visitors from all over.

The Wakefield Effect – Any time there is any story involving vaccines and ASD, the controversial and now-infamous British study that implicated measles virus as a possible cause, seems to mar all perception and reason. Media pundits are quick to avail themselves of that ill-fated research.

Conventional medicine is still debating whether increases are merely due to changes in diagnostic criteria. Every week a new association pops up; including maternal weight, paternal age, environment and toxins, stress, and circumcision. If compliance is the issue, certainly such confusion shakes one’s faith in the ‘science’.

Polarization

The experts would have a great deal more validity and success, if they could add more understanding and kindness to their approach. Those who question the status quo are considered kooky, ignorant and ill-informed. That creates more polarization, with fewer parents possibly choosing to vaccinate.

Pro-vaccination declarations are rarely equivocal, and conclusions no longer contain the statement, “The topic deserves further study.” Anti-vaccination supporters suffer a similar shortcoming, and conspiracy theories are a scientific distraction. There doesn’t seem to be any compromise position.

Issues, such as the recent CDC whistle-blower case, or reports of safety violations have not been adequately addressed.

There still aren’t any definitive, prospective, randomized, controlled, double-blind crossover studies with long-term outcomes evaluating various vaccine schedules to document safety. Holistic medicine is frequently chastised by the establishment for such an omission in alternative protocols.

Lack of Confidence & Trust

A great deal of money is handed to drug manufacturers to manage these vaccination programs. Concerns abound about whether large multi-national companies always have our best interests in mind.

The Flu vaccine fiascos that permeate each winter do not engender a great deal of confidence about how our medical establishment handles the inoculation issue.

The government continues to send out inaccurate and conflicting messages regarding our public health. Antibiotics in our food are proven unsafe, but the practice continues. There were 2 cases of ebola and Congress appointed a ‘czar’, but they couldn’t confirm a Surgeon General.

Public trust in the FDA and CDC has been eroded by frequent lapses in judgement and execution.

Conclusion:
The vast majority of the scientific literature is quite insistent that there is no relationship between the present vaccine schedule and ASD. To all of the experts, ‘true’ scientists, and colleagues – I get it!

That fact remains that there are too many parents who have noted developmental regression proximate to a childhood vaccination. They deserve better answers.

Autism, ADHD and Circumcision

Sunday, January 18th, 2015

New information has been forthcoming from a Danish database lately, specifically involving autism. This study represents data involving more than 1/3 million children, entered from 1994 to 2003 .

As might be expected, an eye-catching array of media headlines followed the paper entitled, “Ritual circumcision and risk of autism spectrum disorder in 0- to 9-year-old boys: national cohort study in Denmark”.

The Results:
In both the older and younger groups of circumcised boys, there was an increased relationship to ASD. Some adjustments (birthweight, APGAR score, etc.) were accounted for, while other known, possible associations were not (pain relief, living near pollution, diet, e.g.).

Additionally, circumcised boys in non-Muslim families were also more likely to have an ADHD diagnosis.

Other Research:
A 2013 study looked at the increasing incidence of ASD since acetaminophen (Tylenol) has been routinely used for pain relief during circumcision. The authors suggested “… the need for formal study of the role of paracetamol in autism.” In other words, they looked at the problem from the other direction; and when pain relief was provided, autism increased.

Discussion:
The Danish investigation contains a most glaring conclusion that makes the data-in-question eminently quotable, “We confirmed our hypothesis that boys who undergo ritual circumcision may run a greater risk of developing ASD.” I wrote to ask the principle author, Dr. Morten Frisch, about this.

The doctor took the time to respond to a number of questions about the information. He seemed to be somewhat sensitive that such controversy has surrounded these (admittedly) two highly emotional topics, and he is taking plenty of outside criticism. Furthermore, Dr. Frisch has assumed an “I’m-just-the-messenger” attitude about the conclusion.

For me, a major sticking point is a design anomaly which brings the entire report into question. Specifically, children who hadn’t been circumcised but were autistic were considered as not autistic until they got the operation, for the purposes of the data analysis.

For example, a seven-year-old who already had autism didn’t get classified that way, until he was circumcised at 7, (which is clinically impossible).
My question, “If a study shows that I am an architect, not a doctor, isn’t the study flawed?”
Dr. Frisch’s response, “No, in your example the methods would not be ’flawed’, but ‘imprecise’.” Either word – it’s inaccurate. The product only represents a mathematical reality.

Conclusion:
Male circumcision and autism are both very controversial issues. Supporters for various points-of-view will use self-selected segment(s) of the data to fit their particular pro or con argument.

The practice of male foreskin removal is decided according to family, friends, folklore, culture, customs, and cosmetics. The present medical evidence is far from conclusive.

Regarding the cause and prevention of autism, the more significant medical information is that vigorous scrutiny and intervention in a young infant’s nutritional and developmental status is the most successful means to fend off possible delays.

As for the present study? “There are lies, damn lies, and statistics.” (Mark Twain)

Ten Ways Pediatric Neurologists Can Help Autistic Patients

Monday, December 8th, 2014

With all due respect to the intelligence of physicians who take specialized training in child neurology, it appears that there is often some disconnect between their knowledge about autism and the approach to the families and patients affected by this modern epidemic.

10•Making the diagnosis and giving some tickets for therapies is not enough. Questions such as, “How did my child get this? How many get better? What other things can we do? Are there any tests? Where can I go for more information?” are sure to follow the diagnostic impression. At least, provide useful answers for those interrogatories.

9•The child neurologist has the opportunity to assess the risk of anesthesia versus the poor yield of an MRI. Likewise, assisting in the consideration of a short-term EEG, when there is no indication of seizure activity. Those technologies are not a diagnostic workup.

8•There is more than one kind of autism. There should be careful exploration about specific difficulties with the skin, gastrointestinal system, or frequent infections.

7•Neurologists are in a position to provide valuable assistance regarding various alternative treatments’ risks and expense. An off-hand dismissal about therapies to address other co-morbid conditions does not enhance that specialist’s stature in the eyes of the parents.

6•It might be helpful to suggest simple, possibly helpful treatments, such as dietary restrictions. What is there to lose? For the physician who is truly concerned about key deficiencies, this would be a good opportunity to check the child’s nutritional status with some blood work.

5•Doctors who continue to repeat, “You are doing a great job,” at each visit, with little documentation of change, are less likely to experience further visits.

4•In addition to the usual Fragile X-boy-test and Rett’s-girl-test, the neurologist can order a ‘chromosomal microarray’. Copy number variation affects up to 15% of ASD patients. Insurance companies pay for this. Although the results may not be valuable today, that knowledge may be quite important as our understanding about autism evolves.

3•A screening laboratory evaluation for anemia, kidney, thyroid, and liver status may yield a great deal of information. Even if the busy doctor cannot act upon abnormalities, they can be conveyed to the pediatrician.

2•Expressions such as, “I’m willing to say developmental delay,” or “We have to wait to give you a diagnosis,” are for the previous century. In young toddlers, communication is in its most formative stage. “Let’s err on the side of caution, and make sure that you get S&L, OT, ABA, right away.”

1•There are studies to show that patients can recover. Knowledge about that research and successful outcomes provides real hope for bewildered parents.

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Brian D. Udell MD
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Davie
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