Posts Tagged ‘Attention deficit’

I Flunked the IEP

Saturday, June 14th, 2014

At this time of year, when Individualized Educational Plans are discussed and recommendations are offered about the coming year, parents are often unsure about optimal placement for their children affected with ASD.

If assigned to an Exceptional Student Education classroom with disruptive students, will their child copy the behaviors, in order to gain attention? Is being exposed to a great deal of ‘stimming’ a cause for concern? Will nascent speech be nurtured in a more neuro-typical classroom or ignored in a apraxic group? Are there youngsters who will become friends or others who promote bullying?

This is the conundrum faced by the parents of many of our recovering patients. The medical side of autism and ADHD is my primary concern. However, one family insisted that I voice my opinion regarding their 5-year-old’s upcoming formal classification. I agreed to assist by speaking with the appropriate school staff, including the teachers, administrators, school psychologist, and therapists.

For the first 20 minutes or so, each professional detailed, “hyperactive,” “lack of focus,” “easy distractibility,” and academic performance issues.

“What is your opinion, Dr. Udell?”
My answer, “It sounds as if you are describing the child’s immaturity.”

I expressed that the majority of medical professionals who heard these concerns would most certainly recommend stimulant medications (e.g. Adderall, Ritalin); if not now, then within the next few years. “Oh, no, Dr. Udell,” was the answer. “That’s not what we meant!” Regardless of staff intentions, most pediatricians, child psychologists, psychiatrists and child neurologists give the knee-jerk response – meds.

Recommendations:
Be realistic about what goals YOU expect in the next school year. For young children, speech acquisition and play are the most important skills. Occasionally, no school is likely achieve these goals, and parents should consider other options (home with appropriate therapies).

The school is expected to document progress in fine motor skills (e.g., drawing, writing, cutting), group activities (circle time, following directions) and academic skills (letters, colors, reading).  Will your child “make it” in that environment, or are those the biggest weaknesses?

Auditory, visual and sensory processing difficulties need to be addressed in order for children to succeed in a neuro-typical setting. Extra attention outside of school (OT, PT) can provide significant benefit.

The proven therapy for behavioral difficulties is ABA. Disruptive conduct cannot be ignored in a neuro-typical classroom, so any behavioral resources that the family can provide are paramount. Habits (such as face and hair ‘touching’) that appear “cute” in a toddler, may be unsettling in a 6-year-old, more-than-troubling in a pre-adolescent, and out-of-order in a teen.

When the teacher says, “Look at the chalkboard,” Junior has to respond appropriately. Kids need to look like they are attending, even if they aren’t. Often, the situation is quite the opposite – the child is listening, but adults misunderstand.

Don’t compare your child’s progress to that of the others in the class. Keep your eye on the main goals - independence and productivity.

Don’t have your doctor attend – I was an unhelpful distraction.
It’s back to letter writing for my practice.

In the best of circumstances, most children who are recovering from their ASD would do best in a neuro-typical classroom, with pullouts for extra services and tutoring, and a shadow to redirect. Obviously, that requires significant resources and the school’s cooperation. However, the need for stimulant medications would be greatly reduced.

It’s Not the Asperger’s Syndrome

Sunday, June 1st, 2014

Let’s face it; anyone who goes on a shooting rampage has some mental illness. Often, it seems there was a history of family turmoil, few friends, bullying, and lack of empathy. That does not define Asperger’s Syndrome, which is a developmental disorder.

Recent sensational violent acts by young men could be due to a number of conditions, including:
∗ ADHD with feelings of inferiority because of poor performance
∗ Schizophrenia
∗ Personality disorder
∗ Watching violent video games
∗ Oppositional Behavioral Disorder
∗ Acute or transient reactive psychosis
∗ Reactive Attachment Disorder
∗ Subject to abuse
∗ Temporary insanity
In deranged individuals, such as the Connecticut and California shooters, psychiatrists would probably entertain even more possibilities.

There is no precise manner to define Asperger’s Syndrome after someone expires. The conditions that explain impulsive conduct are inaccurate, at best. Psychiatric diagnoses need to be assessed in real-time by documentation of signs and symptoms. Regarding the recent carnage, family members (and their lawyer) reportedly claimed that Elliot Roger was “on the spectrum,” and suffered a long history of mental difficulties.

How about focusing on the histories of mental illness
with easy access to firearms?

The Autism Epidemic that has blighted the child development landscape of the 21st century is a mystery, with vague descriptors and the recent inclusion of many other developmental problems, including Asperger’s and PDD-NOS. The public is left to wonder, “Why so many killing sprees?” The media is quick to supply an answer, “Perhaps it is those autistic (Asperger’s) kids!”

I have examined scores of patients who fit criteria for the disorder. Effective communication is difficult; some are depressed, some understand and address their challenges, and others who say, “That is the way that I am.”

Key traits include early developmental delays, an unusual affect, restricted interests, decreased eye contact and sensory issues. They are usually very standoffish individuals who feel uncomfortable outside of their usual environment.

There is not a great deal of published information about the association between violence and Asperger’s syndrome. In one study, 31 of 37 of the patients (85%) had a possible or probable comorbid psychiatric disorder.

A 2010 follow-up paper concluded, “The mean percentage of registered convictions was similar to that in the general male population of Austria over the studied time period. A qualitative assessment of offence types in Asperger’s former patients suggests that the nature of offences does not differ from that in the general population. In this original cohort of Asperger’s patients, convictions were no more common than in the general male population.

We should be very skeptical about media pundits’ experience, statements and motives. Sensational reporting is unfair and irresponsible because it assigns to Asperger’s patients a stigma that they do not deserve. There are many more examples of productive individuals than violent criminals committing heinous acts due to their autism diagnosis.

Just because Asperger’s Syndrome is the “diagnosis du jour,” it doesn’t mean that there is a shred of proof that affected individuals commit brutal crimes or that they are any more prone to such violence than those who are not so classified.

International Meeting for Autism Research 2014

Sunday, May 18th, 2014

My medical lifetime has experienced several epidemics. Although such problems are devastating to families, we learn a great deal of general science by uncovering the secrets of each new disorder. Think of Legionnaire’s disease (bacteria), the Norwalk virus, helicobacter (stomach ulcers), etc. Regarding the conditions that now fall under an autism diagnosis, these are exciting times for study and discovery.

At this conference there were 1800 attendees from all over the world, and nearly 1000 research papers. It has been great watching this organization grow; bringing advances to the science of autism spectrum disorders.

What I Liked:
This years Advocate Award went to Peter Bell. He is a true contributor to autism. More than simply offer an acceptance speech, he did a great job of expressing to this diverse, but research-oriented group, his “Top 10 List” for audience understanding. That included finding causes and treatments, environmental associations, lifetime services, and recognizing patients’ humanity, with the urgency that a only parent could feel and express.

Then, there were the short conversations with the presenters. I spoke with a pediatric neurologist who presented his work on Vitamin B12 and folic acid. Another was a social worker, whose study concluded that the new DSM 5.0 would result in fewer diagnosed cases. I couldn’t agree less, so I was able to discuss it.

At lunchtime, I sat with a distinguished, rather humble, retiring psychologist from a prominent New York clinic who said, “maybe 5% of our patients report G-I problems.” I took the opportunity to offer, “Gee, that is awfully low. I would sure like to test those patients with my protocol.”

I spoke with a young researcher whose paper detailed the changes in the neuron-type cells of the intestines, which is work that will elucidate gut alterations that might explain various autistic features.

There are so many young and promising minds. Just as HIV research enriched our knowledge of DNA, RNA and viral-human interaction, autism is enhancing scientific understanding of the development and function of the brain.

What I Didn’t Like:
There were few papers and presentations about environmental and epigenetic effects leading to the epidemic. For that matter, there was little discussion about the presence of an epidemic, though I suppose that would have been preaching to the choir.

Also, I think that there needs to be more work on how co-morbidities play into ASD. As a clinician, I find that problems, such as those in the G-I system, sensory difficulties, sleep disorders and anxiety, need to be studied as the very fabric of the condition.

Finally, this is not so much of a complaint, as a fact of life, but there is so much to read and learn in just a few days. There just never seemed to be enough time.

Best Thing at the Meeting:
Dr. Fred Volkmar, Yale autism expert, got a Lifetime Achievement award. He is an energetic and fascinating teacher who noted how few treatment studies are yielding success, especially compared to the explosion in the volume of research. Dr. V actually expressed his frustration that much of the work is not actually getting to the parents and the children.

This famous professor expressed an understanding of how parents seek Internet answers in the absence of viable medical alternatives, which is such a rare point of view in the academic world.

Conclusion:
The knowledge and information that ripples from this scientific meeting and the people who continue this work will make a difference. Perhaps not one particular study or that trial, but by their dedication to becoming part of the solution, parents can be assured that you have champions on your side.

You can access the research abstracts here.

Assessing the Skills of Your Child with ASD and ADHD

Sunday, April 27th, 2014

How prepared is your child for school?
What is the best classroom for next semester?

Dr. Udell's Fish Tank

Dr. Udell’s Fish Tank

As the school year comes to a close, and plans are being made for appropriate placement next fall, these are the questions that parents of ASD and ADHD kids have to face. IEPs are generated to provide documentable services, and professional assistance is sought to understand choices that will best address your child’s situation.

The Examination
In order to help families evaluate these difficult choices, various points-of-view come into play. There is the school the child goes to, the one he is going to go to, the one that you want him or her to go to, the administrators, teachers, and all of the other professionals who interface with each child. At The Child Development Center, we have found that, by observing the actions of our children, the reactions of their parents, and the interactions with the staff as patients enter our playroom and gravitate toward the tropical fish tank, many of the skills that are under consideration may be appropriately assessed.

“Hi, did you see we’ve got baby fishies in the tank?” I ask. If mom or dad immediately interrupts, to prompt the child to listen to the doctor, there is a reason. Sometimes a parent will say, “Look at the doctor. What is his name?” Often, they will repeat my question – several times. It is the rare parent who, if the child doesn’t attend, let’s time pass to see what their child will do.
Symptom – The child doesn’t pay attention.

“Do you see the biggest fish?” Does the child look at me? At the tank? At the TV? “Do you see the rainbow fish?” “Do you see the treasure?”
Symptom – The child won’t focus.

“Where is the red fish… we have one red fish.” The child looks at the train table.
Symptom – The child is easily distractible.

If they point to the orange carp, that’s ok, but there are two of them.
“How many fish?” If they start to count, that is BIG.
Symptom – The child is really smart, and even though it LOOKS as if he isn’t listening, he actually does.

The Diagnosis
And, it’s not just the aquarium, of course. Many activities that take place in our playroom provide a framework about your child’s abilities and challenges. For many young children who do not seem to pay attention, can’t seem to focus and appear easily distracted, the diagnosis is immaturity, not attention deficit or hyperactivity. Stimulant medications and anti-anxiety drugs may not help the situation, and often make behaviors worse.

Making A Plan
Parents prefer their child to be with verbal, non-disruptive classmates. Often, special educational environments do not seem to fit their children’s needs. Here’s the bottom line for many of our recovering ASD patients: in the best of all worlds, each child would spend some time in a neuro-typical classroom for socialization, with pullouts for required therapies and academic challenges, and a shadow to redirect. Resource allocation will determine the combination that best fits each family’s situation.

Be realistic about what accomplishments you really want to see in the next school year. For the youngest patients, speech acquisition and play are the most important skills. Five and six year-olds need to get along with others and pay attention to the teacher; or at least, appear to pay attention. In elementary school, it is not in the child’s best interest to force too many academic challenges that affect self-esteem and create anxiety.

Therapies and homework need to be balanced with outdoor activities (golfing, swimming, martial arts, etc.). Do not force multi-player sports such as soccer, because of difficulty with eye contact. Importantly, find a way to limit video games and television stimming.

Conclusion
The world of autism evaluations includes tests such as the Autism Diagnostic Observation Schedule (ADOS), Psycho-educational Profile Exams (PEP), Modified Checklist for Autism in Toddlers (M-CHAT), the Clinical Global Impressions Scale (CGI) and many others.

Then, there is my fish tank.

Vitamin D for Autism and ADHD

Sunday, April 6th, 2014

One of the more common out-of-range laboratory findings in the children who come to our clinic is a low vitamin D level. Learning about the myriad effects of this important nutrient ought to encourage parents to ask their pediatric specialist to check the blood concentration when evaluating patients with ASD or ADHD.

Effects:

  1. Vitamin D enhances the intestinal absorption of:
    1. Calcium
    2. Iron
    3. Magnesium
    4. Phosphate
    5. Zinc
  2. It is involved with the immune system:
    1. Normal functioning
    2. Inflammatory response
  3. There are effects on neuromuscular functioning.
  4. Bone mineralization is influenced.
  5. The vitamin is involved with modulating genes that regulate cell growth, proliferation, differentiation and death.

Metabolism:
The sequential manner in which this hormone-like vitamin gets into the body, and becomes active, helps explain possible reasons for insufficiency, and observed effects.


 

Dietary Sources:
According to an interview on WebMD, “Surprisingly few foods contain vitamin D…” Dr. DeNoon lists “Super foods,” such as (wild caught) salmon, mackerel, shellfish and mushrooms. Mostly, though, humans were built to get our vitamin D through the skin, so foods are now fortified to make up the difference.
Based on bone health, and given acceptable calcium levels, dosages of 600 IU/d for non-seniors “meet the requirements of at least 97.5% of the population…” BTW, the RDA for vitamin D was derived based on conditions of minimal sun exposure.
There is apparently conflict among the experts, however, about the definition of standard levels. Recommended intakes for infants and children vary from 400IU to 1000IU per day, with unanswered questions about increases.

You can take too much:
This is a fat soluble product, meaning that it can accumulate and become toxic. That is why a doctor should evaluate and follow levels, especially in high-risk children.

Evaluation:
The laboratory evaluation is usually done by testing for blood levels of 25-hydroxy Vitamin D, which is NOT the active form. A calcitriol (1,25 di-hydroxy Vitamin D) level must be ordered separately. The results, and variation from the standards vary, depending on the laboratory. Calcium, zinc, iron and magnesium may be checked, as well.

Autism and ADHD
ASD patients do not represent a ‘normal’ population. RDAs are, in my opinion, the amount below which some neuro-typical people can get symptoms. It seems to me, “Low normal,” is “low.”
There are numerous reports of children spending less and less time outdoors in physical activity,
especially those ‘on the Spectrum’.
Many kids are picky eaters or have been placed on restricted diets
that might affect absorption and levels.

The dermatologists have warned about the dangers of ultraviolet exposure, so SPF 188 was invented and applied copiously.
Often, children have eczema and other skin conditions that
might interfere with normal metabolism.

The conversion of chemicals to the active form assumes a healthy circulation, liver and kidneys. Many of the patients do not appear in optimal health.
There are genetic disorders of calcium metabolism
that present with autism.
There is even evidence that maternal levels may play a role in ASD.

Mostly, however, I am not sure why
so many patients exhibit decreased vitamin D levels.

Treatment:
Children with values that are at, or below the low range of ‘normal’ (depending on the lab), are usually given”D3,” 1,000 – 2,000 IU extra per day.

Treated patients are re-evaluated by periodic testing, plus documentation of daily supplemental intake.
Positive effects, such as a healthier immune system, are usually noticed within a month or two of getting the correct dose. Sometimes, sleep improves (try giving at night). The other therapies appear to work more efficiently; there appears to be better cognition, focus, and eye contact as vitamin D levels are normalized.

Conclusions:
It is difficult to sift through, and pinpoint, the specific biomedical intervention that leads to healthier and happier children. “Documentation,” as they say, “is lacking.” It certainly feels as if adding vitamin D3, when it is low or deficient, helps practitioners achieve improvements in signs and symptoms of ASD.

Oral supplementation is inexpensive, usually well-tolerated by the child, can be followed by documenting the course of treatment and laboratory confirmation.

Autism Conference 2014

Sunday, March 30th, 2014

This conference represents a major opportunity for serious professionals who want to learn about state-of-the-art autism diagnosis and treatment. Other pediatric specialists should take note that the Medical Academy of Pediatric Special Needs is a formal, scientific forum for doctors who wish to care for complicated cases.

Day 1 – ADHD Sessions
Dr. Elizabeth Mumper (Rimland Center) reviewed neurotransmitters. Her focus then shifted to the pressure that Big Pharma has (openly and clandestinely) foisted upon parents, patients, and doctors to diagnose ADHD and prescribe medication. Plus, there is a lack of research demonstrating long-term improvement from these pharmaceutical products.
The disorder is better characterized as a network-communication problem, rather than focusing on one or two specific areas of the brain.
Dr. M then reviewed treatable, metabolic causes of behaviors that may be diagnosed as ADHD. Therefore, the signs and symptoms deserve an appropriate workup; not merely a knee-jerk Rx for stimulant medication.

Dr. Dan Rossignol summarized the most recent and pertinent literature about laboratory assessment for ADHD. A reasonable medical workup was presented, so that treatable conditions can be identified.

Dr. Nancy O’Hara followed with her interesting proposals about non-drug interventions, including dietary changes and addressing environmental issues.

Dr. Stuart Freedenfeld spoke about the forces that drive the diagnosis, many of them non-medical and more related to socio-economic status, especially as regards pharmaceutical intervention.

Case presentations and discussions filled out the rest of this first day.

Day 2 – Environmental Medicine Sessions
Dr. O’Hara reviewed detoxification physiology and the factors that might affect normal functioning, including genetic variation and the myriad of toxins in the air, food and water. Poisons have detrimental effects on mitochondrial operation, the CNS, and can lead to thyroid disruption, altering normal physiology. Various helpful interventions were offered.

Dr. David Quig reviewed laboratory assessment of metal exposures and the concept of body burden. Single toxins can be detrimental, but there are many environmental poisons that multiply negative effects, called the Multiple Hit Phenomenon. He discussed the issue of net retention of toxins, and various therapeutic modalities.

Dr. Stephen Genuis expressed his opinion that airborne pollution represents the most important source of toxic load, resulting in chronic illness for the mother, child, and future generations. He also introduced the topic of ‘nano toxicity’, new pollutants of very small molecular size, in bedding, for example. Evidence for direct and indirect effects of the ever-increasing burden of toxins on multiple body systems was reported.

Dr. David Dornfeld added to our knowledge about total body burden of multiple toxins. He also discussed various forms of detoxification, including chelation – the active removal of heavy metals with chemical compounds.

Case presentations and discussions followed.

Day 3 – Plenary Session
Dr. William Parker spoke about “Post-industrial factors underlying immune system destabilization and subsequent inflammatory diseases point toward dramatic changes for medical practice in the near future.” His discussion was about the manner in which modern society has disturbed our microbiology and the effects that has had on the immune system and created a whole host of auto-immune conditions.

Dr. Paul Schreckenberger gave a fascinating talk revealing that, contrary to common scientific belief, urine is NOT sterile. The take home point was thathere is whole host of new thoughts about the human microbiome (our micro-organisms and their genetic components). There is a need to identify new species and get a better understanding of good and bad bacteria.

Dr. Michael Cabana presented the evidence about the use of probiotics and the effects of ameliorating auto-immune conditions, especially asthma. Important variables are when the supplement is delivered and the requirement for high potency products.

Dr. Rossignol presented the evidence for HBOT to address gastrointestinal inflammation.

Dr. Bob Sears gave a lecture about thyroid disorders and the ‘workup’ to assess thyroid function.

Finally, Dr. Rossignol presented evidence about the newest therapies for autism.

Conclusions:
Coincidentally, this conference commenced even as the CDC announcement that 1/68 children are now affected with ASD. Each year, it seems, the numbers can’t possibly go any higher, but they continue to rise.

The professionals who attend this conference are serious about getting a better understanding about this epidemic and trying to help, and I am proud to be part of that group.

Autism Goals

Sunday, March 2nd, 2014

An important barometer in the current treatment of ASD is the creation of an IEP and the achievement of stated goals. While it is necessary to document progress, the present mechanism may not always engender enough of the kinds of skills that are needed in the real world.

As children improve from the conditions that surround ASD, IEPs notwithstanding, these age-appropriate activities of daily living must be achieved:

  1. The ability to get ready in the morning.
  2. Getting out of the house, into the car, out of the car and into the school, without a major meltdown.
  3. Following the directions of school personnel.
  4. Being able to sit, fairly still, for varying periods of time. Or, at least stand there. Or, at least not be disruptive.
  5. Learn a new activity, or practice a necessary skill.
  6. Transition to another exercise, which may be more difficult (or impossible), or less-preferred.
  7. Kids learn how to be kids from each other. So, children need to show and share.
  8. As development proceeds, children display a desire to watch others play, engage in play, and even initiate.
  9. Getting out of the school, into the car, out of the car and into the house, without a major meltdown.

Academic achievement is the standard for neurotypical patients. For the autistic child, socialization will bring the maturity that can create significant progress.

Does my child meet the following criteria?

Does the child turn to voices and especially their name? “Your son won’t listen,” or “Your daughter doesn’t pay attention,” is a common concern. That is especially frustrating for those amazing kids who hear and take in everything, but are believed to be ‘slow learners’. The IEP goal? “Your child will turn to their name most of the time, when they are called, without prompting.”

Do they make eye contact with other children, not just family members? This important social skill is a major first step in normal play. If you watch a group of 3 or 4 year-olds, they don’t ask, “Who wants to play chase?” There’s no memo or adult prompting; they just look at each other, screech, and start to run around. Finding social situations where your child can practice is so much more important than how well they play Angry Birds.

The ability to speak is paramount. That doesn’t mean hours and hours of Speech and Language Therapy by itself. The Child Development Center has seen hundreds of children who developed speech by utilizing a combination of therapies with medical evaluation and appropriate, effective interventions. Our older apraxic patients have different problems.

For children who can speak, do they use their voice at the appropriate times (naming, answering) or only when prompted? Is there a great deal of echolalia, saying the same sentence as the questioner? Does scripting seem to make sense and, at least, be in context, or does the conversation seem to be gibberish? These rituals are practice, not to be discouraged, but the child must generalize language to appropriate situations. Kids judge other kids.

Sensory difficulties are a major hurdle for many ASD patients. Sounds may be too loud, lighting to harsh, and experiences so stimulating that children exhibit repetitive motor behaviors (stimming). For both the student and the classroom, addressing these issues (e.g., sensory diet) will make things go more smoothly.

Aggressive behaviors will not be tolerated for very long in any educational situation. Rather than making excuses for why your child behaves in a disruptive or violent manner (whether SIBs or directed at others), gastrointestinal health and ABA intervention is more important than any academic effort.

We are talkin’ ‘baby steps’ here. Autism is not someone’s fault. It is a condition of the 21st century that requires appropriate medical and therapeutic intervention.

Autism Review 2013

Sunday, December 29th, 2013

Here is this year’s crop of stories (listed in Medical News Today) that I consider to be the most informative, interesting, and likely to change the knowledge base concerning the epidemic of childhood signs and symptoms presently called Autism Spectrum Disorder.

January
Can Children Lose Their Autism Diagnosis? - Uh, yes. And, many more than this group reports.
New Gene Variants Linked To Autism Discovered - The perfect storm of environmental toxins and susceptible individuals (genetic variation).
Epilepsy Drug Linked To Increased Risk Of Autism - The perfect storm of environmental toxins (medication) and susceptible individuals.

February
Feeding Problems And Nutritional Deficits A Significant Risk For Children With Autism - Ya think?
Attention Deficits Picked Up In Babies Who Later Develop Autism - The ‘Spectrum’ diagnosis involves a combination of signs and symptoms, not just the ‘core’ deficits.
Help Needed For Youths With Autism Spectrum Disorder Transitioning To Adult Health Care - Transitioning in general, don’t you suppose?
Autism Study Finds Behavioral Therapy For Children Can Impact Brain Function - So, the autistic brain can exhibit plasticity. Just like every other human brain.
Brain Connections Differ In Kids With Autism - There were lots of brain connection articles this year. The problem is understanding WHY the brains work that way, since it’s pretty obvious that some circuits are crossed and/or missing.

March
Study By Kennedy Krieger’s Center For Autism And Related Disorders Reveals Key Predictors Of Speech Gains - This is why it’s so important for kids to play with others.
Suicide Ideation And Attempts A Greater Risk For Autistic Children - Why doctors shouldn’t put teenage patients on anti-psychotic medications.
Old Drug Offers Hope For New Autism Treatment - This article covers it all; inflammation, immunity, the environment, mitochondria, stress and recoverability. It’s just in a mouse model, but offers a unifying theory.
One In 50 Kids Has Autism In U.S., CDC - And, we’re still arguing the ‘E’ word (? epidemic ?)
Gaze Shifting Delay Has Potential To Diagnose Autism At 7 Months - Plenty of research about earliest diagnosis, not much about how to intervene.
Multiple Vaccines Not Linked To Autism Risk, CDC - So they keep telling us.

April
Link Between Autism And Increased Genetic Change In Regions Of Genome Instability - The perfect storm… you get it.
Minocycline Show Benefits In Children With Inherited Cause Of Intellectual Disability And Autism - Some assistance for patients with Fragile X syndrome, one of the known causes of ASD.
Study Shows Different Brains Have Similar Responses To Music - Love of music is universal.
Propranolol Could Improve Working Memory In Autism - Several of the older blood pressure medicines perform in some fashion to help affected individuals.
Taking Valproate While Pregnant Raises Autism Risk - Drugs taken during pregnancy may not be good for the developing brain. Well, at least it’s in print now.
A Newborn’s Placenta Can Predict Risk For Autism - Now, there’s an early predictor! Again, what to do about it?
Significant First Step In The Design Of A Multivalent Vaccine Against Several Autism-Related Gut Bacteria - Formal recognition that there is a gut-brain connection in autism.

May
Researchers Successfully Treat Autism In Infant - OK, so maybe you can do something about the earliest red flags.
Early Intervention Program For Children With Autism Found To Be Cost Effective Through School Years - More documentation such as this is needed so that governments, insurance companies, and the like will take notice.
Link Between Epilepsy And Autism Found - The literature reports that 40% – 80% of patients have seizures (much lower at The Child Development Center, however).

June
A Third Of Autism Cases Also Have ADHD Symptoms - It’s not ALSO, it’s an integral part of the picture for some children.
Autism Discovery Offers Hope For Early Blood Test And Therapeutic Options - One of the reasons that I prescribe tryptophan (5-HTP) to address some ASD signs and symptoms.
Racial And Ethnic Disparities Found In Gastroenterology, Psychiatry Or Psychology Care For Children With Autism - Yeah, professionals need to get on the same page.
Air Pollution Raises Autism Risk - The environment. Again.
Single Mutation Can Destroy Critical ‘Window’ Of Early Brain Development - Genes. Again.
Autism In Children Affects Not Only Social Abilities, But Also A Broad Range Of Sensory And Motor Skills - Recognition of signs and symptoms that every parent of an ASD child observes. More such information was published subsequently.

July
The Gut May Offer Clues About Autism - By now, even pediatric gastroenterologists should be getting the message.
Autism Training Program For Pediatricians Meets ‘Critical Need’ For Earlier Identification - Until now, I don’t think that my fellow pediatricians are doing such a great job at early diagnosis.
First Full Genome Sequencing For Autism Released By Autism Speaks Collaborative - This kind of valuable information is why all of the parties in the autism community should work together, rather than criticize each other in public forums.
Early Intervention Benefits Young Children With Autism Regardless Of High-Quality Treatment Model - So, if early intervention helps, and we can make the diagnosis earlier, then the situation should be improving. Right?
Oxytocin not found to offer symptom relief in autism - A bunch of these articles this year, both pro and con. My experience is that it does help in a small percentage of affected individuals.
Fresh fuel reignites Asperger’s debate - Combining two conditions that we don’t understand – couldn’t that make us twice as ignorant?

August
Oxytocin, the ‘love hormone’ may have relevance in autism - This was one of the ‘pro’ articles.
New research sheds light on previously under-researched area of study – females with autism - We really need more information about the difference between boys and girls with ASD.
Induced labor linked to higher autism risk - Here is my advice (as a Board-Certified Neonatologist): Have the baby when the time comes. Sometimes, Mother Nature does know best.
Risk of autism in further children – study findings - This is the type of information that prospective parents frequently seek, and little is really known.

September
Young adults on the autism spectrum face tough prospects for jobs and independent living - This highlights why early diagnosis and intervention are so vital.
Genetic disorder 22q could be misdiagnosed as autism - Or, this could be just one of the causes of autism. No?

October
Improving understanding of brain anatomy and language in young children - This is the type of knowledge that needs to be elucidated as we try to solve this puzzle.
New cases of autism in UK have levelled off after five-fold surge during 1990s - Well, good for England (if it’s true). This is not the case in the U.S., or most other countries, however.
Autistic children look less friendly to peers - And, vice-versa, I would say.
Web-based autism intervention tool shows promise - Lots of tech stuff for autism appeared this year. I still like Proloquo2Go the most.
Link examined between pregnancy weight gain and autism spectrum disorders - An even EARLIER diagnosis. How about a fetal Speech and Language therapist?

November
Health-care changes needed to help adults with developmental disabilities - Much more information needs to become available to address the growing numbers of older individuals with autism.
Autism increases risk for synaesthesia - Maybe shedding some light on the sensory issues in ASD.
Relationship between bedroom media access and sleep problems among boys with autism - As if parents didn’t know this! Well, it’s official, now.
Gender differences in gene expression in male and female brains - I’ve described this clinical difference before. There’s the “girl kind”, and the “boy kind”.
Autistic children’s ability to perform everyday tasks improved by occupational therapy - This one should help with insurance reimbursement.

December
Genes and air pollution combine to increase autism risk - Circling back… genes and the environment.
Brain function in children with autism improved by a single spray of oxytocin - It works. It doesn’t work. Which is it?
Autism-like behaviors in mice alleviated by probiotic therapy - Human probiotics, by the way.
Research linking autism symptoms to gut microbes called ‘groundbreaking’ -  Well, it’s important, but groundbreaking? This association has been ‘documented’ since the “Refrigerator Mom” days.
Hospital infection in pregnancy tied to higher risk of autism - Perhaps it’s the antibiotics that are given, not the infection itself?

Hopefully, 2014 will bring more in-depth research with targeted treatments, so parents will have an increased number useful protocols to assist their developmentally challenged children.

Pediatric Special Needs Include Autism

Saturday, December 14th, 2013

Recounting events that take place over just a couple of days at The Child Development Center provides me with the opportunity to paint a picture* about state-of-the-art medical care for complicated pediatric development. This is a newly emerging specialty, which is now presented as a fellowship of the Medical Academy of Pediatric Special Needs.

It is of utmost importance that patients receive a correct and precise diagnosis. That should lead to the most specific treatment(s), presumably with the greatest chance of success. Autism, unfortunately, is not a precise diagnosis. There are multiple causes for the unusual behaviors or physical properties that bring concerned parents and their children to our medical practice.

AM Any_Day: This was the third follow-up visit for a 3-1/2 year-old boy who has “escaped autism.” What a patient set of parents! They have understood the difficult journey, taking their at-risk child to the next developmental level, without the use of stimulant or anti-anxiety medications. In this case, the child demonstrated an inability to tolerate oral glutathione (for poor muscle tone). Only a course of anti-fungal medication complicated our otherwise positive road to a resolution of the majority of behavioral concerns.

Then, there was the second follow-up visit of a moderately affected 2 year-old. Four months earlier, he spoke just a couple of words, demonstrated repetitive arm and body movements and appeared in a profound fog. Now, the child interacts with his parents and is speaking. G-I problems were his main initial findings that, when addressed, assisted in his improvement.

This was followed by the fourth follow-up visit of a 3 year-old girl who first presented six months ago. As an infant, there was GERD, and speech was significantly delayed. This child’s food allergy panel was especially unusual. With strong probiotics, appropriate vitamins and supplements, plus occasional anti-fungal treatment, she has been able to make great strides toward an optimal outcome.

That afternoon: 4- and 6 year-old brothers whose level of complications equals the most difficult patients in the practice, from a diagnostic and therapeutic perspective. The older boy is brilliant but has behavioral challenges that are responding positively to treatment. The younger one has yet to show much positive response in his communicative abilities. Mom is incredibly knowledgeable and, together, we explore reasonable strategies to address their continued delays.

Following that, there was a Central American family whose 3 year-old son presented eight months earlier with moderate-to-severe ASD, including speech apraxia. We discovered his significant gluten, casein and egg allergies, and vitamin D deficiency. He presently has more than 100 words (español, por supuesto), makes eye contact and plays with his parents. Mom and Dad do not care that, “There are no studies demonstrating the efficacy of dietary interventions…”

AM Next_Day: New patient, a preteen with P.A.N.D.A.S. This story needs a blog of its own.

Another new patient, a 5 year-old with mild signs and symptoms of his earlier autism, treated with conventional therapies. Socialization and other behaviors concerned the parents enough to seek interventions while hoping to avoid stimulant and/or anti-anxiety medications.

And, it’s not even ‘hump’ day. Plus, there are all the calls, letters, charting, emails, labs and support personnel necessary to assist these determined families.

Each of these patients presented with a unique diagnosis requiring evaluation and treatment protocols that were unknown to me, ten short years ago. From this pediatric specialist’s perspective, there is a whole new world of complex developmental problems, and they require very special consideration.

*To protect anonymity, the dates and names of patients have been randomly selected

Escaping Autism

Saturday, November 16th, 2013

With increasing frequency lately, this medical practice evaluates another child who displays a combination of signs and symptoms that can best be explained by the term, “Escaping Autism.”

There appears to be some common connection involving the parents’ chief concerns, physical examination findings, laboratory results, response to treatment and residual behaviors. It is something that you just can’t put your finger on.

There may be sensory difficulties, problems with focus, heightened anxiety, ADHD, ODD, G-I issues (from GERD to constipation), allergies (from asthma to eczema), repeated ear infections, low muscle tone, poor sleep, very restricted diet, or decreased eye contact – in some combination that doesn’t seem to be supported as a separate diagnosis in the present scientific literature.

The condition is not “classical” autism because the patient lacks symptoms in one or all of the 3 key global domains (social isolation, repetitive movements or restricted interests, and the inability to communicate). Why not call it PDD-NOS? Actually, such a diagnostic assignment probably represents the present, most accurate classification. However, there are so many conditions included in that “waste-basket” category; it begs to be picked apart as more precise situations become apparent.

“Escaping Autism” represents a more simple, unifying proposal (Occam’s Razor). Such a diagnosis adds to the modern pediatricians’ toolbox by documenting identifiable signs and symptoms that may be amenable to effective medical interventions. This is a newly described association.

A “Spectrum” of difficulties that are now considered separate childhood disorders may also be viewed as a unified picture of multi-system involvement. This clinically distinct syndrome may change and evolve as the interplay of behavioral and/or functional changes mature in the individual patient.

Some good news is that, as in other medical disorders, the less severe the presentation, the smoother the clinical course. After all, mildly asthmatic patients who can be treated with inhalants and kept out of the hospital are a lot easier to manage than those requiring frequent therapeutic alterations. The professional workup should include routine blood tests and more, depending on the symptoms and practitioners’ findings. Appropriate interventions, based on clinical and laboratory data, would follow.

Such information is not well-accepted in the conventional world. There might be a great deal of pushback from allergists, neurologists and other pediatric subspecialties. Negative initial responses may be misinterpreted as a sign that treatments are not proceeding on the correct path. Should there be a rocky course to recovery, families are less likely to remain patient, especially in a ‘higher functioning’, non-autistic individual. Plus, there is the chance that the child will continue to improve, with or without intervention.

Could these patients who have “Escaped Autism” represent the tip of the iceberg involving an emerging additional developmental diagnosis? Are such children the next “canaries in the coal mine“? Considering that ASD may represent the perfect storm, comprised of modern environmental stressors acting upon genetically susceptible individuals, one more genetic variance, or one more toxin, could result in additional parents who find their offspring have gone ‘over the fence’, so to speak.

As far as taxonomy goes, a clearer nomenclature will unfold as increased numbers of children demonstrate this cluster of symptoms and successful treatments come to light.
One of our patients has suggested that we call it NAUTISM!

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Brian D. Udell MD
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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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