Posts Tagged ‘autism puzzle’

Fish Oil for Autism and ADHD

Sunday, November 16th, 2014

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The War on Autism

Sunday, November 2nd, 2014

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Autism, Broccoli and Cures

Sunday, October 19th, 2014

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

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

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

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

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

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

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

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

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

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

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

Addendum:
Another opinion here

Why Don’t All Doctors Treat Autism This Way?

Sunday, October 12th, 2014

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Five Steps to Improving Vaccination Compliance

Saturday, October 4th, 2014

In a recent Wall Street Journal editorial, “The Anti-Vaccination Epidemic”, Dr. Paul I-never-met-a-vaccine-I-didn’t-like Offit whined about the ignorant public, The Wakefield Effect, “fringe” doctors, foolish families and the “inaccurate” media. The subtitle, Whooping cough, mumps and measles are making an alarming comeback, thanks to seriously misguided parents, sums up the position of Dr. He-ain’t-Jonas-Salk.

The mainstream approach to the childhood vaccination-autism controversy is that there is no blame on the part of the ‘experts’ or the doctors who follow the pharmaceutical industry’s dogma. The logic that says,”If you knew how bad those diseases were, you would believe,” doesn’t work on me. I have lived through many previous epidemics.

The major problem is trust. Confidence in the government is at an all-time low. More than half of the population doesn’t trust the FDA. That bureaucracy can’t manage to stop antibiotics in our food, even when there is evidence of negative effects.

The CDC has similar problems. The current whistle-blower incident, involving questionable data inclusion/exclusion affecting an association with MMR and autism in African-American males, hardly discourages vaccine skeptics. Furthermore, the present viral epidemics appear to reinforce public fear about the competence of that prestigious organization. It was media scrutiny that prompted investigators to secure the living quarters of the Texas ebola patient!

How to Improve Vaccine Compliance:

1. It is difficult to believe that an agency has ‘learned from its mistakes’ when they don’t even own up to them. There have been problems in the past. A neurologic illness has been related to some vaccines, and the Swine Flu ‘epidemics’ were debacles. Public trust would best be furthered by declaring, “We understand what happened and those issues are behind us,” if it’s true. If it isn’t, caution is warranted.

2. Pediatricians need to give better advice. Often, the doctor who professes vaccine safety also missed the child’s ASD diagnosis. Parents are not “bad”, “ignorant”, or misinformed. They simply don’t agree, and professionals should be armed with the facts, not paternalistic warnings.

3. Doctors need to listen. A previous sibling or relative with autism is cause for concern. Fevers or illness that followed other vaccinations should be highlighted in the chart, not dismissed. Co-morbidities, such as eczema or asthma need to be controlled, before adding to the immunologic load.

4. Research that challenges the norm warrants evaluation, not immediate dismissal. Instead of proclaiming the autism-vaccination question a dead issue, confidence would be elevated by experts who calmly declare, “That study deserves further attention.”

5. A practitioner’s willingness to agree to an individual family’s reasonable request to adjust the number and frequency of ‘shots’ will be met with more, not less, compliance. Furthermore, kicking an insubordinate family out of the practice is neither ethical nor helpful.

The present strategy of threats and intimidation is not working to decrease the number of families who either choose an alternative schedule, or the risky position of total noncompliance.

Further understanding and kindness is the best prescription for a more successful approach.

Hyperbaric Treatment Revisited

Sunday, September 28th, 2014

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

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

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

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

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

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

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

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

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

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

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

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

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

He’s right. We need to figure it out.

Early Intervention Reverses Autism

Sunday, September 21st, 2014

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

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

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

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

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

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

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

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

MAPS Fall ’14 Conference

Saturday, September 13th, 2014

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Day 3
Inflammation

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

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

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

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

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

ADHD – What else could it be?

Sunday, September 7th, 2014

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A Vaccination Booster?

Friday, August 29th, 2014

Regarding any association between ‘shots’ and the occurrence of ASD, the vast majority of accepted scientific evidence supports vaccine safety. Yet, for a great number of families, the term ‘vaccine safety’ is an oxymoron.

When childhood inoculation schedules light up the social media radar screen, there is often an increasing demand for my professional assessment.

"My child has made alot of progress.
 I have learned to pick my battles. So we have won some battles...
 What is your opinion on the current Vaccine CDC Controversy?...
 I feel soooo let down by my government!
 I need to hear from a Professional that is honest and caring...
 What would Dr. Udell Do? (Please say hello to Karen)"

The issue:
A now unavailable, already discredited, (formerly) published ‘study’ in the journal Translational Neurodegeneration, made claims about an increased risk of autism after MMR vaccinations in African-American males. Assertions surfaced about the validity of data collection and evaluation, implicating a government cover-up. That fueled online finger pointing.

The press loves a fight, especially when it involves those anti-vaccination kooks.

The light:
Well, there really was no light. The 10-year-old study in question was appropriately explained. Given design and outcome measures, the conclusions in that paper seem valid. As long as Dr. Thompson, the whistleblower, remains at lawyers’ length from public questioning, little ground is gained by explanations from anti-vaccination spokesperson, Dr. Brian Hooker.

Solid evidence is lacking about whether autism may be triggered by certain vaccinations, various dosages, schedules, in susceptible individuals, in the presence of certain physical findings, and depending on previous medical or family history, sex, age, etc. Then, there are external difficulties, such as the quality of storage and labeling, which have been brought into question.

NEVER? Impossible?
The government notes that ‘shots’ are responsible for fevers (up to 25%), seizures and neurologic disruption.
But not autism.

The heat:
CNN dredged up The Wakefield Effect; stories concerning any non-conventional point-of-view regarding autism should be assumed as false, and they could be dangerous.

Talking heads derided “those zealots” who are despoiling herd immunity with ignorant, self-centered beliefs. Still, in a highlighted measles vignette, the group-in-question was Amish! Such issues are extant in other religious organizations, as well. Autism outcome is not their primary concern, and that isn’t going to change with any CDC proclamation.

Admonishment from detached media ‘pundits’ further marginalizes affected families who are so baffled by what happened to their perfectly developing infant or toddler.

Conclusion:
We don’t even know what autism is, what causes it, or what has led to the increasing number of patients. Yet, the powers-that-be seem so sure about what doesn’t cause the problem. And often, about what doesn’t help, either.

Nothing has changed. I cannot get my head around the disconnect between public and medical opinion.
Two people get the ebola virus and we’re all running for the hills.
Autism as an epidemic? Not sure about that one.

This story is a tempest-in-a-teapot based on a decades-old study when the incidence of autism was 1/110. The rate has nearly doubled since that time. Rather than deriding those who question the gods of medical science, it’s time to delve even deeper into the factor(s) producing this modern epidemic.

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Brian D. Udell MD
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Davie
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Email bdumd@childdev.org
Website http://www.childdev.org

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