Posts Tagged ‘Attention deficit’

Notes from the Autism Education Summit

Sunday, September 27th, 2015
theo and me

September 26, 2015 Dr. Theoharides and me

In the beginning of the autism epidemic, conferences included practitioners and families interested in assisting patients in their journey toward recovery. As the information has become more extensive and complicated, the needs and expectations of various parties have spawned more specific meetings.

Tufts University professor, eminent autism researcher and program sponsor, Dr. T C Theoharides, invited me to lecture at this year’s Generation Rescue conference in Dallas. It was a chance to speak to, and with, a worldwide audience of over 700 parents whose children had an ASD diagnosis.

An Alternative Biomedical Approach to Autism Spectrum
A group of ~ 50 ‘newbies’ attended. The topic was chosen because I wished to simplify the issues and offer hope that, despite what the conventional doctors have declared, recovery is possible.

The take home messages were:
1. Traditional medicine only offers bandaids for very complicated signs and symptoms. When the only tool that a person has at hand is a hammer, everything looks like a nail. The usual medications are very powerful with lots of side effects, and provide little in the way of genuine relief.

2. There is more than one way to skin a cat. Many of the other ‘DAN’ practitioners seem to utilize more complicated and expensive protocols, not necessarily superior to the approach that I find most successful. A basic workup was offered to identify laboratory variances indicating less-than-optimal health. Addressing those areas and improving energy with techniques that are not difficult to understand or institute, usually leads to significant progress.

3. Ultimately, autism really IS ‘rocket science’. There are multiple causes and a variety of presentations that even experienced practitioners are hard-pressed to understand and treat. By understanding the basics, parents can lead a team of professionals to get their affected offspring on the right track towards an optimal outcome.

Other Lectures
For 3 days, there was a full roster of presentations covering cause, effects and treatments. In addition to Dr. Theoharides, world-renowned researchers and practitioners, such as Drs. Dan Rossignol, Richard Frye, Jerry Kartzinel, and Anju Usman, gave their learned and extensive points-of-view about ASD.

It is my belief that sometimes the lectures were too demanding. Although the audience was quite intelligent and knowledgable, they seemed to expect more in the way of treatment options for their child, than basic science.

Jenny Group

Ryan Blair, Jenny, Jodi Gomes, Ryan&Dawn Neufeld, Jacqueline&Chris Laurita

Jenny McCarthy
Cue the music, lights, cameras, video screens and action! To this crowd, the lady is a rock-star. She definitely delivered a great message, filled with personal anecdotes, humor, empathy and hope. A panel discussion followed, consisting of famous, and not-so-famous, warrior moms and dads. This was certainly one of the conference highlights.

When I announced on Facebook that I was attending this conference, one of my ‘followers’ wrote, “I think I’m going to unlike this page now,” presumably because of the ‘misguided’ position of Generation Rescue regarding the issue of vaccine injury.  Talk about the polarized world of autism diagnosis and treatment.

Bottom line – I would definitely recommend this yearly conference to parents who have the time and resources.

Sensory Processing Issues in Autism

Sunday, September 20th, 2015

What do parents mean when they express concern that their child “has sensory issues?” Even the DSM 5.0 now lists sensory processing differences as a core diagnostic symptom. A new study appeared last week showing that children on the spectrum actually respond to odors differently.

Researchers “measured the non-verbal non-task-dependent sniff response concurrent with pleasant and unpleasant odors in 36 children—18 with ASD and 18 matched typically developing (TD) controls. We found that whereas TD children generated a typical adult-like sniff response within 305 ms of odor onset, ASD children had a profoundly altered sniff response, sniffing equally regardless of odor valance.”

SmellParents may notice that an affected child smells everything and displays unconventional preferences. Some children do not even notice yucky odors, such as oral liposomal glutathione, or refuse multivitamin preparations that seem to smell just fine.

Previously, such information has provoked the proposal of a new syndrome, e.g., Visual Processing Disorder, Auditory Processing Disorder, etc. Is this Olfactory Processing disorder?

The Other Senses

Vision – parents notice eye stimming, such as staring at ceiling fans, spinning wheels or video screens. Temple Grandin has even highlighted a problem with fluorescent lights; that the cycling annoys those who are visually affected. Therapies targeting this sense have been shown to be effective.

As a clinician, visual ‘stimming’ needs to be distinguished from absence seizures, which have a vastly different cause, treatment, and potential downstream behavioral consequences.

Taste – Many parents report that their children are extremely picky eaters. Sometimes, the problem is with texture (such as crunchy, mushy, etc.) or temperature. Patients who experience speech apraxia often have difficulties with oro-motor functioning. Chewing may be a problem that necessitates blended foods and even more restriction in variety and nutritional value.

Affected toddlers who continue to drink a great deal of PediaSure® are often either allergic and/or addicted to that product because of a leaky gut, and weaning can be a slow, difficult process.

Hearing – Sometimes, affected children put their hands of over their ears as a ‘stimming’ behavior.  It can be communicating avoidance and so affected patients are literally putting their ‘head in the sand’. Often, is it due to certain frequencies (another child crying, a siren) or amplitude (vacuum cleaner, hand drier) that seem to set off a negative or aggressive behavior.

Other times, it may be due to processing, when the child doesn’t turn to voices or their name. Weakness in cognition can be another underlying cause for this difficulty. In any case, and similar to the other sensory conditions, auditory processing is definitely disordered.

TouchTouch – It appears that many affected patients have issues about being touched. Parents may report that they can only cut the hair or nails while the child is sleeping, or not at all. Some patients have complained that their skin feels like it’s on fire, while others do not seem to even notice a significant trauma. Repetitive hand washing, or tantrums from a wet shirt may be symptom of this issue, due to the child seeking input, rather than this being an obsessive-compulsive behavior.

Challenges in this sense include proprioception – the unconscious perception of movement and spatial orientation controlled by nerves within the body – as well. Some children will bounce for hours – on anything from the trampoline to the doctor’s couch – to address this issue. Temple Grandin even invented her own ‘hug machine‘ to alleviate her difficulties in this sensory realm.

These are issues indicative of crossed/missing/inadequate signaling in the CNS. Interventions that decrease inflammation and produce more efficient metabolism improve health. That leads to changes in these sensory signs of autism; as well as speech apraxia, repetitive behaviors or aggression.

Therapies directed at reducing the patients’ sensitivities to the various and specific system that is impaired can help. They can range from Occupational Therapy to Spinal manipulation.

How about our ‘sixth’ sense?” Google describes it as “a supposed intuitive faculty giving awareness not explicable in terms of normal perception.” It’s probably present in patients with ASD more than we think.

Medical Marijuana for Autism

Sunday, August 30th, 2015

Families pose lots of questions, lately, about the use of cannabis products for children who experience signs and symptoms of ASD. This brief review explores the latest available evidence regarding experience, safety and efficacy.

A turn-of-the-century review about the pharmacology of cannabis products revealed two different types of receptors; one affecting neurons, and a second that acts in the immune system. This discovery led to products that are “… already used clinically, as antiemetics or as appetite stimulants… suppression of muscle spasm/spasticity… the relief of chronic pain and the management of glaucoma and bronchial asthma.” Other ingredients, the article proposed, “… may also have clinical applications, e. g. as appetite suppressants and in the management of schizophrenia or disorders of cognition and memory.”

Some useful reviews are available on the web, and even neurosurgeon Dr. Sanjay Gupta presented his learned point-of-view on a series of CNN special reports, entitled Weed.

The active ingredients include THC (tetrahydrocannabinol), the portion that produces euphoria, etc., and CBD (cannabidiol), which appears to have more medicinal effects. Both hemp oil and CBD oil are low in THC. 

For patients who have signs and symptoms of autism, their young age and sensory issues dictate only a few palatable forms of the product, which makes absorption – and blood levels – especially variable.

What improvements?
Anecdotal stories of better seizure control, decreased aggression, and increased communication appear throughout the autism community. The most famous product, Charlotte’s web, takes its name from a child with Dravet syndrome, which causes frequent convulsions, who demonstrated remarkable results that conventional medicines failed to address, and even led to severe complications.

What harm?
Little is known about the effects in children, especially those who are developmentally challenged.

On the other hand, little is really understood about the potential harm of stimulants, anti-anxiety, anticonvulsant and antipsychotic preparations, which are often prescribed by the conventional medical community.

What risks?
Parents frequently question whether their child will become addicted to the various supplements and interventions that physicians suggest. The answer to CBD oil may be in the affirmative, but depending on the symptom improvements, that may be of little concern.

Researching and reporting this information involves separation of the medical issues from all of the other stuff that surrounds this topic. Political, emotional, social, moral, legal and self-promotional issues are woven throughout the literature.

There are different forms of autism, various strains of hemp, diagnostic differences, and individual metabolism; any or all of which could be expected to produce a myriad of possible behavioral changes.

Even though 3/4 of physicians report being in favor of medical marijuana for needy patients, it is difficult to find practitioners to dispense these substances. Let’s not kid ourselves; we have little knowledge about the individual responses of normal people to psychotropic medications. The ASD population has far less ability to express emotion. This is basically, experimenting on children.

Based on the evidence so far, there is too little scientific evidence that it is of value for the ‘milder’ signs and symptoms of autism. Anecdotally, it appears to be quite helpful for intractable seizures, as suffered by some ASD patients. Any claims of superiority from one manufacturer to another would be difficult to verify.

If the medical community had more complete answers, families wouldn’t seek help elsewhere. For years, governmental interference from disparate agencies has crippled research for problems, such as Post Traumatic Stress Disorder, even in adults.

With the explosive increase in the numbers of individuals diagnosed with ASD, it would seem that a well-designed study to assess seizures, aggressive behaviors, anxiety, focus and communication in patients with autism should be in order.

Seven Critical Developmental Milestones for Autism

Sunday, August 23rd, 2015

Unless there is a change of heart by the powers-that-be, pediatricians will continue to leave concerns about developing autism in mom’s and dad’s hands. Since ASD is among the most common modern childhood disorders, here is an informal, but well-informed list of similar developmental variations, reported by parents of children who were later found to be ‘on the Spectrum’.

Who is at risk?
There are correlations with a positive family history for speech delays, ADHD, or autoimmune disorders, especially thyroid. Other factors include; being male, born small or prematurely, moms taking certain medications, and other health conditions (diabetes, obesity).

Not much can be done, obviously, for such situations, so parents may want to just keep a closer eye.

4 months
3monthUnusual, unrelenting screaming, or an extremely ‘good’ child – parents have reported both.

Observations about feeding are important. Moms should be concerned about a weak suck, difficulty breastfeeding, or signs of colic or reflux. For formula-fed children, frequent changes due to intolerance may cast a shadow for future development.

A diagnosis of ‘torticollis’ (a condition where the head is turned to one side), or ‘plagiocephaly’ (flattening of the head), may be an early indicator of poor muscle tone.

7 months
6monthUnusual stooling patterns, including constipation and/or diarrhea, may become evident, possibly requiring medical intervention. Persistent skin conditions, such as eczema, or other chronic illness, such as bronchitis, may join other red flags.

By this time, infants should be smiling, making sustained eye contact and turning to their name.

Muscle tone should be increasing and the child should show the ability to sit.

10 months
9monthCrawling is acquired and in a typical fashion, so that ‘army’ moves or asymmetry may be a worry. The child is typically babbling.

There should not be continued, prolonged, repetitive movement, such as rocking back and forth or head banging. Neuro-typical infants are usually watching all of the action.

13 months
12monthSome type of walking should be present and there ought to be 2 or three words.

The youngster should be exploring and showing interest in others.

The introduction of new foods is not a big struggle in most infants. Delays in any of the one-year-milestones demands an exploration by the pediatrician.

16 months
16monthThere should be added suspicion if there are repeated ear infections, or other chronic medical conditions. Also, any requirement for Miralax™ should raise concern.

Staring at wheels, ceiling fans, and other spinning objects is typically only for the briefest period of time.

Any loss of speech, or lack of progress by this age is a red flag.

20 months
20monthsIf a child has required evaluation by more than 3 doctors for medical conditions, a central theme, such as autism should be considered.

Also, parents will want to be on the lookout for children who are stuck on few foods, and/or certain textures. An addiction to Pediasure™ can be an important clue.

Children who do not seem to be keeping up with peers warrant further observation. So, for first-timers, advice from an experienced, nonjudgmental grandparent can be valuable.

24 months
24monthBy now, children are playing appropriately with toys, talking to them, and playing with others.

It would be unusual to observe lining up things, looking to the side, continuing to put their hands over their ears, or excessive toe-walking.

At this age, it should be possible to separate the child from a digital device.

Most of these signs, by themselves, are only an indication for increasing watchfulness. As behaviors persist when normal milestones are missed, concerns are heightened.

In our modern world, “Waiting until the child is three,” is not an option. The earlier that appropriate intervention is instituted, the better chance of shedding the diagnosis.

By noticing these variations in childhood development, a parent can speak to their pediatrician about formal testing for this problem.

Docs, Glocks and Autism

Thursday, July 30th, 2015

gunMiami Herald
July 28, 2015
Appeals court upholds doctor-patient gun law

According to the article, “The law subjects healthcare providers to possible sanctions, including fines and loss of license, if they discuss or record information in a patient’s chart about firearms safety that a medical board later determined was not “relevant” or was “unnecessarily harassing.” The law did not define these terms.”

The law did not define these terms
It has been reported that U.S. Circuit Judge Gerald Tjoflat, the author of the majority opinion, understands that, in a patient at-risk for suicide, this might be a valid medical concern.

How about this case?

A fifteen year-old male who suffers from moderate-to-severe autism (or any other medical – psychiatric condition), takes Zoloft for aggressive behaviors, perseverates on violent video games, and doesn’t seem to grasp the line between fantasy and reality.

Would it be fair to say that a discussion by the physician with the parents about weapons in the home is appropriate?

The risk factors

  • The patient’s sex.
  • The person’s age.
  • Medication(s) use. There is even a ‘Black Box’ warning on SSRIs about the increased possibility of suicide.
  • The predilection for violent video games related to behaviors.
  • The teen’s inability to discern reality vs. fantasy. When asked, “Who is your best friend,” for example, one patient responded with the name of person who he had never met.
  • Constant bickering with parents over school.
  • A loaded gun in the house.

Such a situation might be equally as valid when a patient experiences conditions other than ASD. Indeed, people ‘on the spectrum’ are probably less likely to act with outward aggression. Certainly, a discussion about elopement is absolutely a necessity in the face of autism, as are questions about a pool safety and the ability to swim.

Surely, there are a gaggle of gun-toting attorneys who can poke holes in my case. After all, I’m just a healthcare provider.

The lawyers representing the doctors got it wrong. This is not about the first amendment rights of physicians to discuss the issue of guns. This is about public safety. And, let’s face it, when it comes to vaccinations-for-all, as an example, there’s no problem protecting the herd.

Perhaps just as certain, is the possibility that, should a shooting death occur in this scenario, a lineup of litigators would appear on the radar screen, accusing the (ir)responsible doctor of not taking the obvious and necessary steps to prevent such a tragedy. “An Accident Waiting to Happen,” might be the headline.

This is an insane law that supports the NRA’s unyielding position about the rights of gun ownership. It is proof of how corrupted our system has become, due the superabundance of lobbying money.

Gun control is what we need, in the face all the senseless shooting deaths by too many young men, who obviously have mental challenges. However bizarre, it is a standing law that has now been upheld by the Florida Court of Appeals.

More information will be required to illuminate the holes that are created by this imprecise lawyer-speak.

Fixing Facebook Autism

Sunday, July 19th, 2015

IMG_6413-highA couple of years ago, I wrote complaining of’s condition of Facebook Autism. The symptoms included social media isolation, repetitive posting of signs and symptoms, and trouble with digital communication.

But recently, merely by posting a change in my Facebook profile picture, I got more ‘hits’ than stories that took hours to research and report. The uploaded photo was actually a mistake. I just wanted to comment about my interesting Amsterdam trip, for those who might have been wondering what I was doing out of the office for a week.

My beautiful and patient wife, Jackie, remarked that, the increased interest was because I was finally telling something about myself, and sometimes people want a real person behind the blog.

Why autism means so much to me…
There are many similarities between the present epidemic and my career in neonatology. I have been a pediatrician for over 40 years, and I was one of the earliest adopters of machines, monitors and medicines for the tiniest premature babies.

Many of our patients were ‘cocaine babies’, and considered to have incurable conditions that were futile to address. They were broken children and families that needed our help. I was able to optimize the infants’ environment and nutritional status, and many of our patients went to wonderful parents who were quite pleased.

The next epidemic that affected my practice was HIV/AIDS. Like autism, I was taking care of patients for many months and wasn’t aware of the scope of the problem. At first, there were no diagnostic tests, and after they were available, it could take weeks to get results. There were no medications for treatment, and the future looked bleak. Patients were going to foreign countries for exotic treatments. Even when the first antiretroviral drugs were introduced, it was difficult to get them for our mothers and children.

Epidemics are so interesting because, by solving a finite problem(s), there are many other affected patients who can be assisted, as well.

Also, I probably have a few autistic tendencies myself…
I admit that I have some sensory issues. I prefer to control my personal space, and so I like to have healthcare and grooming performed by familiar professionals.

I would rather not have more than 2 or three items on the plate at the same time. At first, I wasn’t aware that I was a picky eater.  However, at a recent ‘surprise’ dinner, for example, the waitress asked if there were any foods that I didn’t wish to order. “Do you have a notebook handy?” I asked.

I possess a high predilection toward computer products. I was an Apple programmer (machine language) in the olden days, and still spend way too much time on digital devices.

My patients are well aware that I ask that medical protocols are followed, as directed. Introduction of  a new medication or supplement should take place one at-a-time, with alteration only reserved for a possible negative reaction.

I can relate. 

OK, enough about me, let’s move on to helping your children affected by ASD.


The Media and Autism

Saturday, July 11th, 2015

Emily Willingham, Forbes blogger and self-appointed autism expert, couldn’t let the story about the death of Dr. Jeffrey Bradstreet pass without injecting her two cents.

Dr. W commenced her comments with a 2,000 by 1000 pixel, scary picture of a syringe and needle. I never saw that photo at the beginning of one of her ‘Vaccination is Perfectly Safe‘ stories. She went on to detail the nefarious activities of a doctor administering a dangerous serum to unsuspecting patients. Em, have you ever heard of botox?

Conjecture, innuendo and professional jealousy notwithstanding, Dr. Bradstreet was the parent of an autistic son, and an early adopter, researcher, and lecturer of biomedical treatment for the disorder. He popularized medical evaluation and protocols to address metabolic variations at a time when the generally accepted cause of ASD was considered to be bad parenting.

All but the most conventional treatments are presented as kooky at best, harmful to patients at worst, and a waste of time and money. Some of the latest national news headlines regarding autism will illustrate:

  • ABC – Jim Carrey Apologizes for Posting Photo of Autistic Boy
  • CBS – Authorities: Anti-vaccine doctor dead in apparent suicide
  • CNN – Another study finds no link between MMR vaccine and autism
  • NBC – ‘You Don’t Outgrow Autism’
  • Fox – Woman says diet is healing son’s autism

Perhaps this situation, more than any other circumstance, hinders further worthwhile (i.e. causes and treatments) autism research. Headlines are made when a researcher is proven incorrect, statistics are questioned, and even a teen’s murderous rampage is presaged with possible links to Asperger’s Syndrome.

Regardless of the manner in which autism as a medical condition got so far off track, a new attitude needs to accompany the message that academics, practitioners, parents and charities project. Even skeptics who questioned the HIV/AIDS situation abandoned the ‘it’s their own fault’ line of thinking.

What can be done?

Autism foundations need to work together. Autism Speaks, The Autism Foundation, Autism Societies, and Local chapters have to find a way to advance positive publicity and useful information. There is little room for discord at this time. An unpopular stance, perhaps, but it can only help in the search for effective treatments.

Researchers need to get out in front of the media so that the epidemic proportions are clear, and that real work is being done to further study. Disagreements, such as increased incidence only being a perception, have already been addressed by the CDC.

Knowledgeable parents are doing the most effective job of finding professionals and insisting on protocols to help their affected offspring. Doctors need to join in this effort and announce the remarkable improvements that occur when biomedical and conventional treatments are combined.

Neurologists need to get on board. Frequently, parents are admonished that, “Nothing more can be done.” Improvements following biomedical protocols are either dismissed as coincidence, imagination, or magic.

Other specialists need to get on board. This means that allergists, pediatric psychiatrists, immunologists, dermatologists, gastroenterologists, and pulmonologists, have to broaden their knowledge base and focus on the patient, not their particular subspecialty. Too often, parents are only informed that the problem does not lie in their domain.

Pediatricians and family practitioners need to get on board. This is the childhood epidemic of our time, doctors; embrace it, learn about it, and take the time to talk to your families.

Autism heroes, such as Temple Grandin, Drs. Martha Herbert, Susan Swedo, Robert Naviaux, Richard Frye, and Jill James are modern medical role models for the next generation. The media, including Forbes, needs to highlight these personalities, rather than obfuscating this important issue with titillating stories and dogmatic posturing.

People who have Parkinson’s disease are not Parkinson’s experts, nor are people with cancer oncology specialists. Lorenzo’s oil is the exception, not the rule. Insiders and outsiders alike, need to embrace those who are doing real work to solve this problem.

The autism community includes a large, diverse population of well-meaning, knowledgeable and competent people. Together, we will understand and conquer this devastating scourge on our youngest constituents.

Wouldn’t it be nice if the media extended a helping hand?

Cali-Vaccination Law

Sunday, July 5th, 2015

Senate Bill 227, mandating childhood vaccinations, will take effect in California in 2016, joining 36 other states that no longer allow an exemption for personal or religious beliefs. Non-compliant families will not be able to use licensed daycare facilities, in-home daycare, private or public preschools, and after-school care programs.

Children who are not up-to-date will be required to home school. Also, the legislature may add any additional vaccines that they deem necessary. Parents are left with few viable alternatives.

Ironically, unvaccinated students with IEPs will still be able to access those programs.
Those with a preexisting personal exemption may continue until the next school year.
Parents requesting a medical exception must provide a physician’s statement that details which ‘shots’ are not OK, and the reason(s) for non-compliance.

The Government Doesn’t Always Get it Right
According to the Innocence Project, 330 post-conviction DNA exonerations have occurred since 1989. Twenty people were on death row and the average length of time served per exoneree was 14 years. Whoops.
The CDC keeps dropping the ball with the flu vaccines. After admitting that the 2015 ‘shot’ is ineffective, as in previous years, the universal message given to the public from the government and mainstream media was to “get the flu shot anyway.” There is evidence that some flu vaccines could make things worse.
As demonstrated in the case of antibiotic overuse, the FDA can’t regulate even when scientific research is convincing. Important practical issues, such as incorrect vaccine labelling and storage have never been adequately addressed.

Future studies may identify specific individuals, such as those with genetic Copy Number Variations, G-I, and immune system difficulties, who are susceptible to vaccine injury. Differences have recently been identified regarding the effects of medications on men vs. women, infants vs. adults, and there are now even individualized chemo treatments. In medicine, one size does not fit all.

The herd has been protected so far.
Even though the number of cases increased sharply in 2014, there were still less than 700 reported measles and 1150 mumps cases. Many patients had  previously been vaccinated, or were too young to get a shot. Worldwide, there were ~ 400 cases of polio reported in 2013. Working together (mutually beneficial relationships), drug companies and governments have done a fairly effective job.
With CDC surveillance and public health reporting, outbreaks can be detected using appropriate testing with inoculations to avert tragedy.

Based on an incidence of 1/68 children, the number of patients with autism equalled nearly 60,000 in the US.

There doesn’t seem to a great deal of wiggle room for parents who remain convinced that an inoculation altered the course for their typically developing child. Does a previous child with autism after a shot count? How about those who are already not developing normally? Many children have fevers and diarrhea following a vaccination, so that is significant. Should febrile seizures be a concern? Does a child with Tuberous Sclerosis who does not show signs of autism (yet) count?

An already elevated titer against a disease seems to be a contraindication to revaccination. There are patients with high or low white blood cell counts, so this might become a possible possible temporary exemption.

Finding a physician willing to assist in the process is one part of the journey. Crossing t’s and dotting i’s to adhere to regulations will take time for already-resource strapped families.

The change in the law is a knee-jerk reaction based on inadequate scientific information, conflicts of interest from those who are supposed to be protecting us, and presents an unnecessary barrier for thoughtful, intelligent, concerned parents.

For many parents, homeschool dot-coms may be the most preferable alternative.

What Pediatricians Can Do About the Autism Epidemic

Saturday, June 27th, 2015

Pediatricians are the first line of defense against childhood conditions that have lifelong effects. Traditionally, that has included the Denver Developmental Exam, frequent doctor visits in the first few years, and vaccinations to prevent childhood diseases.

News Flash
There is an epidemic of childhood conditions that include ADHD and ASD, conflicting opinions notwithstanding. That means that pediatricians ‘stand at the door’, and are responsible for prevention and treatment, no matter how much they resist this reality.

Stay up to date on pertinent literature. As the HIV epidemic began to emerge, medical science experienced a quantum leap in our knowledge about the immune system. Similarly, the increasing volume of parents who are concerned about their children’s delayed speech, lack of focus, and hyperactivity, demands more research and knowledge and less kindly reassurance, which is based on the experience of the previous century.

Carry a high index of suspicion. Five or ten minutes spent with a parent and child is not enough time to perform a thorough physical examination and elicit pertinent clinical information. The visit should include a documented nutritional summary.

Make a presumptive (if not definitive) diagnosis. Parents need information, and the child’s pediatrician is the expert. It’s fairly simple – delay in communication, repetitive behaviors and lack of socialization demand an explanation and exploration. Loss of language, lack of eye contact, and poor tone are red flags to be explored, not ignored.

Do a proper workup. At least check the blood count, thyroid, liver and kidney function. What is over-kill about exploring vitamin and mineral deficiencies in a picky eater? Then, the doctor could evaluate whether appropriate intervention makes a difference in the signs and symptoms that concern parents.

Make appropriate consultations as early as possible. In a recent UC Davis study, six of seven high-risk children who received therapy alone lost the presumptive diagnosis. Parents will be more upset with the pediatrician who says, “Let’s wait,” and improvement does not occur, than one who advises, “Let’s err on the side of caution,” even if symptoms could have abated without intervention.

 Advise parents to try the gluten free – casein free diet for a few months. What is there to be afraid of? Uneasiness about creating a nutritional deficiency can be easily checked with laboratory evaluation and documentation of proper growth.

Perform an appropriate evaluation for associated signs and symptoms. Explore the cause of frequent infections, rather than responding with the knee-jerk reaction of prescribing antibiotics. Miralax® should only be given for brief periods and for occasional constipation, and isn’t even approved in children. GERD that is treated with antacid preparations can lead to vitamin deficiencies. Steroids may reduce skin rashes, but do not address to the root cause.

When a child has the diagnosis of ASD, the doctor should explore safety issues. Elopement is not uncommon, so family plans should be devised. Although learning to swim is no insurance against a tragedy, acquiring that skill helps provide some peace of mind. Incongruous laws notwithstanding, discussing gun security is a must.

Provide parents with a reading list. is a good start, where discussions are presented to address the polarized world of autism diagnosis and treatment. When possible, the essays have hyperlinks to the original research. The Newsworthy tab includes the most recent and pertinent literature.

Become knowledgeable about the variety of protocols. The doctor who has read the literature (both pro and con) about alternative treatments is the only one qualified to give advice. Practitioners who assert, “I’m not aware of this or that treatment,” may be highlighting their ignorance, rather than providing up-to-date info. Therefore, unless the pediatrician knows about a therapy, the patient will surf the ‘net, and listen to the professional who does.

Video Games and Autism – ADHD

Sunday, June 21st, 2015

“Watching that TV is going to make you stupid!” Such has been the advice of older generations since the first Philco screens appeared in our living rooms over a half-century ago.

In 1980, University of Pennsylvania professors wrote in the Journal of Broadcasting, “…television has inhibited intellectual development on a broad social level; it discourages students from reading, fun concentration skills, and impedes the acquisition and practice of scholastic discipline.” Apparently, that advice was not heeded.

tv graph 1In 2004, a paper in the Journal of Genetic Psychology concluded, “In sum, children who watched more television tended to spend less time doing homework, studying, and reading for leisure. In addition, their behaviors became more impulsive, which resulted in an eventual decrease in their academic achievement.” Viewing continued to increase.

“Playing those video games is going to make you stupid!” Again, the advice offered by older generations since Super Mario became popular a quarter-century ago. TIME magazine reported that “… the average U.S. gamer age 13 or older spent 6.3 hours a week playing video games during 2013. That’s up from 5.6 hours in 2012, which was up from 5.1 hours in 2011. “

Differences have evolved, however, in society and technology, so that children of all ages may be at risk for impaired neuro-typical abilities, especially in the social domain.

The i-Differences

Ease-of-Use (for those under 40)
Doctors should research how Steve Jobs was able to reach the most basic areas of the brain. Easily managing the user interface is a skill that children barely out of infancy can achieve. It doesn’t make the child “…good with computers.”
Entertainment that comes with so many movements, bells, and whistles is very attractive to developing minds. Non-electronic toys require real imagination and encourage socialization. Previously, dolls and such that talked usually ‘sucked’ because they were boring. With iPhone, there are infinite possibilities.

Variety of Formats
No longer are kids sitting on the same couch doing the same activity. One might be texting her BFF while another is annihilating aliens on the big screen. On personal devices, it is not necessary for another human to be present. And, even if present, it is not necessary for someone to exist in the same room (or country).
This situation adds to the disconnection that already exists in our world. When asked, “Who is your best friend?” patients are frequently stumped.

Games are Violent and Graphic
Similar concerns accompanied the warning about promoting violence in previous technologies. This time, however,  the viewer has control. There are blurred lines determining good and evil, spirituality, or even a sense of humor. A 2007 paper demonstrated, “… a physiological desensitization to violence.”
As 3D and VR improves, there are blurred lines about reality, as well.

Nature of ASD and ADHD
Anger, frustration, anxiety, lack of focus and attention, distractible, short-fuse, non-social, in-their-own-world, bossy, and sensory overload are not characteristics that a parent would ever want to encourage in a child who has developmental difficulties.
Sleep may be disturbed by a teen’s insistence on continuing play. Homework, already a non-preferred activity, may become a major distraction.
A new wrinkle in the video game arena is ‘you-tubing’ another player play. What is that about? Lots of teenage patients spend HOURS each day viewing this. “Why, I ask?” “It’s funny!” is a typical response. One parent offered, “He’s learning techniques.” I never got better at golf by watching golf.

On health-related issues alone, researchers noted, “… while television use was not related to children’s weight status, video game use was.”

The next generation of video experience represents a possible sea change for childhood growth and development. A recent analysis concluded, “The evidence strongly suggests that exposure to violent video games is a causal risk factor for increased aggressive behavior, aggressive cognition, and aggressive affect and for decreased empathy and prosocial behavior.

Pathological gaming has been noted in those who, “… spent twice as much time playing as nonpathological gamers and received poorer grades in school; pathological gaming also showed comorbidity with attention problems. Pathological status significantly predicted poorer school performance even after controlling for sex, age, and weekly amount of video-game play.”

Neuro-diversity may take years for understanding, and biases endure. This technological circumstance may be an advantage that encourages certain skills, but could be a deal-killer for others, especially those with academic and social challenges.



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Brian D. Udell MD
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