Posts Tagged ‘autism puzzle’

Medical Academy of Pediatric Special Needs 2016 Spring Conference

Sunday, May 1st, 2016

Practitioners, such as myself, find that it is necessary to attend the bi-annual Medical Academy of Pediatric Special Needs conference for two important reasons. First, to listen to experts from all over the world present their knowledge and latest research. Second, to network with, and learn from, other like-minded practitioners.

What I Liked Best
This year, I chose the ADHD path. The workups that were presented tended to be somewhat complex, and perhaps unattainable for many patients. The bottom line was to get a medical evaluation. The differential diagnosis ranges from thyroid to PANDAS. Mostly all agreed that stimulant and psychotropic meds should not be the first line in treatment. One professor spent some time questioning the diagnosis, itself, and how the modern world has contributed to the epidemic.

What I Liked Least
Traveling all the way to Costa Mesa, CA. Course work is 8 hours per day, so no time for Disneyland, etc.

This Year’s Major Focus
Mitochondrial function continued to play a big role in the presentations. The advanced courses involved lots of methylation, detoxification, and energy production diagrams. The newest twist has been the addition of genetic testing to better determine the cause(s) of inadequately functioning biologic pathways. Single nucleotide polymorphisms (SNPs) and ‘epigenetics’ were the buzzwords – how individual genes interact with the environment and within the individual leading to dysfunction and downstream signs and symptoms.

Topics That Were Discussed in Passing
Microarray genetic testing, covering multiple genes, did not play a big part in this year’s talks. Discussions about childhood immunizations underlie a great deal of the members’ conversations; specifically the lack of solid scientific evidence for safety in high risk populations. Attendees are not against vaccinations, by the way. Lyme disease was discussed in general, and as that inflammatory process relates to other infectious-metabolic conditions.

Subjects Not Formally Presented
GcMAF and nagalase levels. Some patients have indicated that a useful, safe supply may become available, so that will help determine future use. As well, chlorine dioxide, hyperbaric oxygen treatment, helminths, medical marijuana, and stem cell therapy were not offered by this year’s presenters.

Conclusion
It is disappointing to return from such conferences without that ‘magic bullet’. Just standing around, listening to Sid Baker speak about how he got interested in autism, or asking him how the ‘ion cleaning’ footpath worked, is worth the price of admission, however. This science started with Dr. Baker, and he continues to be an inquisitive, gentle force for hope, 40 years later.

In the absence of a sufficient population of scientists who are willing and available to address this modern epidemic of childhood developmental problems, this meeting stands as a bastion against the current state of ignorance.

The Autism Diet

Sunday, April 24th, 2016

There are specialty diets for just about every situation, including specific medical conditions. They developed as humans evolved and discovered nourishment that promoted longer, healthier lives.

Some address a particular population; the Feingold diet could be a godsend for ADHD parents. There are plenty of cancer treatment regimens. Paleo is popular. How long did cave men live, about 30 years? Copious cholesterol lowering protocols. And just plain diet diets for people to lose weight. They tend to be trendy like the Coffee Diet or The South Beach Diet.

The Autism Diet(s)
There isn’t really ONE diet that has been shown to work for all, and there are patients who do not respond to any nutritional alteration.
The variety includes:
Gluten Free / Casein Free Diet (GF/CF) – is one of the most popular and often successful. Parents frequently report that eye contact improves, the fog lifts, and some toddlers begin to speak.

Specific Carbohydrate Diet (SCD) – has many success stories. This fairly restrictive protocol makes it difficult to sustain, even for parents who see improvement.

Gut and Psychology Syndrome Diet (GAPS) – an offshoot of SCD. As in other therapies, the aim is detoxification and reduction of inflammation, leading to a abatement of signs and symptoms.

Dr. Udell’s Child Development Center Diet – Blood and urine testing is done first, looking for 1) a significant IgG antibody response to 90+ foods, and 2) the production of morphine from incomplete digestion of gluten and / or casein (leaky gut). Identification of offending fare is explained to the family, which often leads to a successful appropriate dietary intervention.

The Evidence
The diagnosis of ASD is imprecise, confounding the evaluation of any treatment modality. Lack of biomedical markers to identify patients’ level of involvement and response to change represents another significant challenge to the ‘evidence-based-medicine’ crowd.

Solid scientific scrutiny is lacking. However, there have been lots of coincidences where children improve. At least, the child’s stooling patterns may normalize, or toilet training becomes more successful. What’s the harm?

Discussion
There isn’t a great deal of evidence to support the notion that ingesting large amounts of Monsanto’s Round-Up could hurt us, but it is probably not a great idea. There are antibiotics in our food – proven to cause harm –  and the government has failed to respond.

It’s not proof that families seek, it’s change in their child. When a parent says that “After we started the diet, he seemed to wake up and words started coming,” anyone would stop and take note. To the conventional medical community, that is just another nut who probably doesn’t believe in vaccinations.

The criticism that such diets are nutritionally insufficient is spurious. Accurate documentation of somatic growth, plus pre- and post- laboratory testing confirms sufficiency. For those doctors who seem so concerned about this issue, why aren’t you already checking the nutritional status of your picky eaters?

Conclusions
Compliance is paramount for restricted diets to really work, so family resources and the patients’ age need to be considered when the professional recommends. 7+ year-olds (especially male) tend to cheat, lie and steal the yummier, forbidden fare. Likewise, preparing separate meals for a family of 6 can present a major obstacle.

Improvements are generally incremental; so diets might take time, perhaps months, and may need to be kept up for years. Children with ASD are usually sensory diners in the first place, so change is challenging.

Even in the absence of large, perceptible improvements, your healthier child can respond much more efficiently to the other therapies that assist in the journey towards recovery.

Vaccination Redux

Sunday, April 17th, 2016

TheAutismDoctor has been asked to weigh in on the recent media attention regarding the film Vaxxed, which was scheduled, but not shown, at this year’s Tribeca Film Festival.

Robert De Niro, who helped organize the exposition, announced that he has an 18 year-old son with autism, and felt that the point of view presented in the documentary was important enough to explore. However, he decided to pull the film because the controversy is so heated that it deterred the public’s enjoyment of the rest of the event.

Do Vaccinations cause Autism?
The topic has been covered in this venue over 35 times, so I’m fairly certain that another protestation will confer little additional sanity.

Regardless of the volume and frequency with which Jenny McCarthy, Robert De Niro or Dr. Udell voice the opinion that we are not against childhood inoculations, ‘anti-vaccination’ is usually the way that the information is characterized. Opinions are either, “All or none, for or against, pro-science or anti-vaccination, educated or ignorant, healthy or dangerous.” Such points of view offer no middle ground and so this dispute won’t go away any time soon.

Discussion
I posed the following question to the ‘pro-vax’ father of a 6-month old, “You are asked to enter your baby into a formal study in which there are two groups.”

Group A – Present Schedule

Start at birth (Hepatitis B in hospital)
Fever OK (give Tylenol)
Mild illness OK
9 or more components at once OK
Negative previous reaction OK
‘Make up shots’ (for missed doses) OK
Other medical conditions OK
Development not on track OK

Group B – Other factors considered

Wait to begin until infant is clearly healthy
No shots if child is sick
Fewer components at each time
No pretreatment with Tylenol
Medical evaluation if previous problems
Appropriate testing if medically unstable (e.g. frequent infections, premature, GERD, eczema, asthma, abnormal stooling…)

Dad’s answer? “The safe one!” Really? Is that the one that the ‘scientists’ and government say is all right? And by the way, even if a physician might answer the hypothetical by responding, “Group A is perfectly fine,” their partner would probably protest, “Are you crazy? Not my kid!”

When that scenario is too cumbersome to recite, I pose another question. “Which is a more reasonable statement? ALL vaccinations are good for ALL children ALL of the time,” or “SOME inoculations might not be good for SOME toddlers in SOME situations?”

If the answer is the latter, it begs the question, “Which ones, when, under what conditions?”

Conclusion
Childhood vaccinations have been a true victory for modern medicine. They have prevented a variety of devastating diseases suffered by so many for millennia.

This movie, subtitled, From Cover-up to Catastrophe certainly stokes the controversy, as does its outspoken lightning rod, Andrew Wakefield.

No matter how frequently, dogmatic or pedantic the ‘Vaxxers’ pontificate, this polarization will continue until we understand more abut the present autism epidemic. Once that diagnosis is accurately understood and described, ‘real’ science demands independent, prospective, randomized, controlled, double-blind crossover studies of each and every component of the modern protocol to prove safety and efficacy.

Echolalia in Autism

Sunday, April 10th, 2016

Among the variety of perplexing signs exhibited by patients with autism is speech repetition. Increased understanding of the genesis and purpose of reiteration of words or phrases assists in our knowledge of ASD, and in developing useful therapeutic interventions.

Definition
As applied to autism, echolalia is the immediate or delayed repetition of vocalizations. In our electronic world, sounds don’t only come from other people. Imitation is common as toddlers start to speak, but persistence beyond the age of three continues in 3/4 of children ‘on the Spectrum’.

Representative literature:
1969
Research described echolalia as a contrary language-related rationale emanating from the study and from the literature.

1981
It is argued that researchers who propose intervention programs of echo-abatement may be overlooking the important communicative and cognitive functions echolalia may serve for the autistic child.

1984
The diversity of delayed echolalic behavior is discussed in reference to its conventionality, the presence or absence of communicative intent, and its status as symbolic communicative activity.

2013
Utilizing Behavioral therapy:
… Stimulation and echolalia decreased during treatment, and appropriate behaviors increased.
… Spontaneous social interactions and the spontaneous use of language occurred about eight months into treatment for some of the children.
… IQs and social quotients reflected improvement during treatment.
… There were no exceptions to the improvement, however, some of the children improved more than others.
… Follow-up measures recorded 1 to 4 years after treatment showed that large differences between groups of children depended upon the post-treatment environment (those groups whose parents were trained to carry out behavior therapy continued to improve, while children who were institutionalized regressed).

The Autism Doctor’s observations about the condition:
lightbulb littleIt is not uncommon to observe parents who repeatedly prompt, possibly providing a template for that speech pattern. “Tell the doctor your name. Tell the doctor your name.”

lightbulb littleWhy does the behavior occasionally seem to arise out of nowhere? By observing children who are finally healthy enough to produce vocalizations, they are practicing – singing songs over and over, and stuff that just pops into their heads.

lightbulb littleThe core symptoms of autism include restricted interests and repetitive behaviors. Speech recurrence sometimes appears to represent those issues. Echolalia is not merely, “Not getting it.”

lightbulb littleWith the frequent use of digital media and the ability to observe and listen to scenes over and over, imitation follows naturally.

lightbulb littleSpeech delay, another common sign, results in paucity of language. Children who wish to communicate, but who only possess 30% of ‘normal’ vocabulary, may be repeating each phrase 3 times, just to make up the difference.

Conclusions:
Even today, echolalia is sometimes noted as non-functional at best, or possibly annoying at worst. After all, what parent hasn’t been driven crazy but the oft-repeated phrase, “When we gonna get there?”

As a clue to the deficiency of productive communication in ASD, this sign is important for our understanding of the bigger picture.

Strategies aimed at reduction ought to include expanding useful communication, rather than extinguishing, that vocal activity.

Neurodiversity and Autism

Sunday, April 3rd, 2016

Hands2We are not going to cure cancer. Eventually, medical science will successfully treat melanoma, breast cancer, or lymphoma. One disease at-a-time, with discovery and experience along the way. Likewise, there will come an understanding of the underlying causes, treatments and prevention for all the types and conditions that appear with signs and symptoms now considered ASD.

Calling the epidemic ‘Autism Spectrum Disorder’ is, paradoxically, both accurate and imprecise. It is valid to the extent that, given our present state of ignorance, there exists an array of individuals who fit a common diagnostic category. However, it comprises too many people with a myriad of conditions. Under the present state-of-the-art, there are those who are just, well, neuro-diverse!

Maybe it’s Asperger’s syndrome (OK to say, before DSM 5.0). Perhaps, it’s extreme ADHD, with a bit of sensory issues. There is oppositional behavior disorder, visual and/or auditory, sensory processing and executive function disorder. How about social processing disorder?

The A Word
A new BBC series entitled ‘The A Word’ was recently reviewed by the New York Times. While it’s admirable to expose the public to the challenges of families who are affected by this modern malady, as a pediatrician who has been practicing for over 40 years, the comments by one reviewer (who co-authored an article with his autistic daughter) gave me cause for concern.

“Years ago, black people or gay people were on telly purely as black people or gay people. Autistic people still are — they appear on programs purely as autistic people,” he said. “It would be great to see autistic people in TV dramas who are just there, like any other character.”

ARE YOU KIDDING ME?
Who ever said, “We need to hear more tuberculosis patients on the radio?” Or, “People with polio don’t appear enough on TV.” The scientific community astutely researched, understood, and successfully treated those emerging medical conditions.

It’s not just neurodiversity
This is why a more precise diagnosis is needed. So far, I see speech apraxia and oral-motor dysfunction (including extreme feeding disorders) as THE LINE. It impedes even the brightest and most talented of individuals.

In addition to the lack of communication, aggression (against self or others) is the most perplexing and difficult-to-treat feature of ASD. In toddlers, negative behaviors usually emanate from discomfort, pain, or unmet needs. It is the discovery and treatment of such co-morbidities that enables clinicians to successfully address those youngest patients. As children age, that lack of contact and the frustration that accompanies loneliness and isolation often result in tantrums or other negative behaviors.

Discussion
By the way, the difficulty is with speech and communication, not S&L. Patients are not ‘confused’ by multiple languages, ‘spoiled’ by grandparents, or ‘isolated’ by numerous siblings. In our multi-cultural world, the most incommunicative children can follow directions given by a variety of non-English-speaking caregivers. Additionally, even sign language is difficult for those who are most affected.

I’m all for embracing the neurodiverse universe. Its inhabitants are interesting and have provided the horsepower for imagination that has helped change the world. When people who are different require special instruction or more understanding, popularizing their plight makes sense.

Conclusion
Doctors are not seeking to  ‘cure’ neurodiversity. On the contrary, we ought to learn about different brains and embrace their uniqueness. However, to the extent that autism is considered “Locked in autism silent prison,” practitioners need to understand and treat this enigmatic medical condition.

There is neurodiversity. And, there are autisms.

Speech, Apraxia and Therapy

Sunday, March 20th, 2016
Cortical Humunculus

Cortical Homunculus – Large areas of brain map to oro-motor function and hands

Two major problems facing the youngest patients who are most affected with signs and symptoms of Autism Spectrum Disorder are aggression and speech. These factors shape socialization, the final step in ‘normal’ communication. Therefore, achieving self control and enabling speech is key to reversal.

Aggression
Often, combativeness appears to come from pain. Sensory overload, sinus problems, gastrointestinal discomfort (from reflux to abnormal stooling), infections and headaches can produce a variety of stimming behaviors; including lashing out against self and others. Combined with a short fuse protruding from accompanying sleep difficulties, the resulting picture is often misunderstood by conventional specialists who invoke potent CNS medications, only meant for adults.

So, the first step to successful intervention is the achievement of better health. Modern therapists who recognize this, and refer the children for appropriate diagnosis and intervention, will be rewarded with more attention and compliance.

Speech Apraxia
There is no other more perplexing condition associated with ASD. Almost all vertebrates exhibit the ability to utilize vocal communication. In humans, articulated speech should be a pre-wired state. Parents don’t teach Junior to speak at 12-18 months. He just talks.

Apraxia’ refers to the inability to perform a desired ‘natural’ motor activity, presumably due to difficulties with central nervous system processing. So, neuro-typical individuals do not have ‘trombone apraxia’ because there wouldn’t be a preexisting neural pathway for that activity (unless the person is a prodigy). Research must be targeted at unravelling this mystery. For the great majority of patients, it’s not Autism AND Speech apraxia. It’s autism. Furthermore, I don’t think that those newly minted Autistic Japanese monkeys are ever going to speak.

A scholar.google.com search for medical treatment of speech apraxia in autism returns few specific, well-proven, evidence-based choices. It appears that modern medicine does not understand the cause, or even the site of verbal malfunction in ASD patients, let alone pharmaceutical interventions.

Discussion
By the way, language does not appear to be the problem. It is common to hear parents exclaim that, “Grandpa (from Romania) and Grandma (Haiti) can tell him to do anything.” Additionally, there are patients with speech difficulties who spend hours on the Internet learning other languages, including those not even spoken in the home. Jake, our Practice Administrator’s son, was found practicing Japanese one day!

There is little doubt that the child’s ability to respond to the therapists’ prompts is directly related to the success of intervention. Parents have frequently observed children merely staring into space while the professional works, and may go years without improvement. Or worse, the child becomes belligerent as the S&L person approaches the front door, often leading to violent behaviors.

Conclusion
Biomedical intervention is available for the modern patient to address problems with muscle tone, fog, and processing, in order to better address oro-motor function, and therefore increase chances of successfully addressing this very symptom.

The experience at The Child Development Center of America, and with the doctors who practice under the auspice of Medical Academy of Pediatric Special Needs, has been consistent as far as the ability of methyl-B12 injections, to engender useful speech. When combined with good health and traditional therapies, this could be the best possible advice for confused but determined parents.

A Letter to Autism Researchers

Sunday, March 13th, 2016

The title of a recent article in the Journal of Pediatric Gastroenterology and Nutrition was Evaluation of Intestinal Function in Children with Autism and Gastrointestinal Symptoms. The headlines featured by most of the lay press, “Tests Show No Specific Gastrointestinal Abnormalities in Children with Autism.” Big difference.

The Study
According to the authors:
• There was no difference in the activity of the enzymes that break down key sugars in autistic vs. non-autistic children who are evaluated for gastrointestinal disorders.
• Specific biomarkers of intestinal inflammation were elevated equally in autistic vs. non-autistic children with GI signs and symptoms.
• Biomarkers of a ‘leaky gut’ were not found more frequently in autistic vs. non-autistic patients with similar symptoms.

Discussion
A scholar.google.com search for gastrointestinal problems in autistic children returns >24,ooo results. There are reports of poor oral-motor function, sensory issues of taste and smell, GERD, eosinophilic esophagitis, abnormal gut flora, chronic constipation, chronic diarrhea, alternating constipation and diarrhea, and delayed toilet training.

The authors noted that, “Common problems such as gastroesophageal reflux or constipation may present with atypical symptoms such as stereotypical behaviors, aggression, or self-injurious behaviors. Consequently, gastrointestinal problems that might be easily recognized in a neurotypical child may go undiagnosed in a child with autism.” They concluded, “There is no evidence to support that gastrointestinal disorders cause autism.”

This crystallizes what’s wrong with research in the ASD universe.
There isn’t one kind of autism. Addressing the individual co-morbid conditions frequently allows traditional therapies to take hold.

The diagnosis itself is a collection of signs and symptoms categorized in this manner, especially since the DSM 5.0 has included PDD-NOS and Asperger’s Syndrome under the Autism Spectrum. There are conditions that present primarily with aggressive or disruptive behaviors, genetic variations – large and small, immune system regulation difficulties, central nervous system abnormalities and seizures, significant skin rashes, and probably many more.

It is only a matter of time until a colleague announces to me, “Well, I heard/read/thought that it has nothing to do with the GI system.”

Conclusion
Even when respected professionals, such as Dr. Buie, et.al., research and document important information, it is frequently misunderstood by the general media to dismiss the tragedy of this epidemic.

Evidence-Based Pediatric Special Needs Medicine

Monday, March 7th, 2016

EvidenceAt an autism fundraiser lately, I took the opportunity to speak with one of the leaders in our local treatment community. I felt that his understanding of complementary and alternative protocols was limited at best, and looked upon with suspicion and even derision at worst.

When I stated to the Director that I was a pediatrician who treated children with autism, he exclaimed, “Well, we do evidence based medicine. What’s with that Wakefield fellow?” “Ummm,” I replied, “that was, like, over 15 years ago. Why am I responsible for that stuff?”

“And, what about that Bradstreet guy? I went to hear him speak once, and the information about secretin was already in, and he was still lecturing about it’s value? What makes you different?” asked the gentleman.

“Well, we do a suitable medical workup, and, depending on the findings, treat patients with safe and often effective interventions.

Perhaps we could go to lunch and talk about the manner in which doctors, such as myself, practice? And by the way, what about that decision by the AAP that early autism screening isn’t supported? They claim that more evidence is required. Do you subscribe to that?”

Evidence Based Medicine
Certainly, the goal of modern treatment is to follow best-practices protocols, which have been documented as safe and effective, and evaluated with scientific scrutiny. The gold standard for medications has been a repeatable and repeated, double-blind (examiner not aware if drug is med-in-question or placebo), crossover (give real med to one group then reverse), randomized (who gets, who doesn’t), controlled (follow specific protocol) trial of sufficient number of patients (determined and crunched by statisticians).

A noted expert has written in the British Medical Journal, What it is, and what it isn’t:

It’s about integrating individual clinical expertise and the best external evidence.

The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.

Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough.

Evidence based medicine is not “cookbook” medicine.

May raise rather than lower the cost of their care.

It will continue to evolve.

As noted in Wikipedia, “A 1994 study concluded that 58% of life science companies indicated that investigators were required to withhold information pertaining to their research as to extend the life of the interested companies’ patents… A major flaw and vulnerability in biomedical research appears to be the hypercompetition for the resources and positions that are required to conduct science… seems to suppress the creativity, cooperation, risk-taking, and original thinking required to make fundamental discoveries. Other consequences of today’s highly pressured environment for research appear to be a substantial number of research publications whose results cannot be replicated…”

Discussion
This past week, a mom reported that her 5 year-old child with signs and symptoms of autism was taking “some type of sleeping pill” given by a respected local psychiatrist. The medicine was Buspirone – an antipsychotic. Where is the evidence for that? Another child had just gotten a sleep study – from another physician – with no history of any sleep problems. Antibiotics for colds, Tamiflu for upper respiratory infections, and anti-seizure medications, are all routinely prescribed with less-than-solid evidence. Not to mention the complete lack of a laboratory investigation.

For several years now, the Medical Academy of Pediatric Special Needs has stressed that conventional therapies combined with a proper medical evaluation and appropriate intervention results in better ASD outcomes. There is a large body of evidence to support the protocols that are so successful in reducing unusual behaviors and prompting communication. Dr. Dan Rossignol has led an organization that stresses the use of evidence-based research and applying that knowledge to patient care.

Anyway, it’s not simply complementary and alternative medicine that we practice. Nor is it holistic, integrative, allopathic, osteopathic, Western or Eastern. It’s the provision of safe and effective interventions that ASD families seek. It’s medicine.

High vs. Low Functioning Autism

Sunday, February 28th, 2016

MeasureAfter a thorough history and physical examination, if there is an autism diagnosis, parents frequently ask the question, “So, do you think that my child is high or low functioning? How much autism does my child have?” They are especially thinking, “Will my child be OK?”

The answer depends on the underlying cause(s), the child’s age, developmental trajectory and skill set at the time of diagnosis, the response to therapies so far, and how they go on to respond to the various treatment regimes.

Screening validity
According to the CDC, “Research has found that ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable. However, many children do not receive a final diagnosis until they are much older. This delay means that children with an ASD might not get the help they need. The earlier an ASD is diagnosed, the sooner treatment services can begin.” The webpage even provides a detailed algorithms for parents and professionals to follow.

The site also provides links to the various tools that families and diagnosticians can access. The CDC even displays an Autism Fact – Myth Table, with references, at the bottom of the page. Begging the question, is how accurate the tests are, as far as assessing and predicting the future course of a patient’s autistic involvement.

Discussion
Presently, there are no practical biological markers to measure and follow the ‘level’ of autism. There are certainly tests, such as chromosome and abnormal metabolic laboratory findings, that carry more predictable courses.

In my experience, the important predictors of a more positive outcome are:
• Initial score less than 50th% of top possible score.
• Scores that are higher in speech.
• Scores that are lower in negative behaviors.
• Scores that continue to improve over time.

Conclusions
The good news is that many of the negative behaviors attributed to autism are often gut-related. As the astute clinician diagnoses and successfully treats that co-morbidity, children often respond with improved communication skills, including the difficult-to-treat speech apraxia problem.

Likewise, accurately understanding and treating the lack of interaction with the environment – lifting ‘The Fog’ – with biomedical intervention, goes a long way toward lowering the bad scores and improving the child’s ability to attend to the traditional therapies.

Attainment of the skills that are required to join a general education classroom is more important than any score – developmental, intellectual or academic. Perhaps sadly, the non-disruptive and compliant child is more likely to remain mainstreamed than those with more advanced abilities who are aggressive or less-responsive.

Finally, I like to point out that the term ‘high’ or ‘low’ functioning doesn’t just apply to the developmentally challenged. There are lots of low-functioning neurotypical individuals. We meet them every day.

Reading, Texting, and Arithmetic for Special Needs Children

Sunday, February 14th, 2016

While on summer vacation as a child in the middle of the last century, I would pass booths along the Boardwalk in Atlantic City, NJ, where hucksters would proclaim their ability to accurately evaluate any personality by examining handwriting. Sloppy or tidy text, large or small font, left- or right-leaning, dotting i’s and crossing t’s, for example, were alleged to represent telltale signs about the kind of person you were.

Today, ‘graphology‘ continues to be a skill offered by trained professionals who scrutinize calligraphy to expose weaknesses, point out strengths and certain personality traits. There are even computer algorithms that claim similar results. Information may be used by the legal system and employers to better determine veracity, aptitude, and job success.

History
According to Wiki, the earliest reference appeared in “The Confessions of Saint Augustine” AD 401… For those first lessons, reading, writing and arithmetic, I thought as great a burden and penalty as any Greek.” The original phrase “the Three Rs” came from a speech made in 1795.

Handwriting has thus been included in the necessary skill set that any educated person should possess. Well, it’s the 21st century, and we need to revisit that requirement.

‘Rithmetic
When calculators arrived, they were eschewed by an older generation, who claimed that, “If you were stuck on a desert island without a calculator, what would you do?” Of course, the answer was that, if you were so marooned, you wouldn’t need to cypher, you would need to survive! The point as regards mathematics, is that the concept needs to be understood – that 7 is greater than 5, and that 5 apples do not necessarily equal 5 oranges.

What about memorizing times tables? It’s basically the same issue; there is a larger concept that requires comprehension. If you don’t conceive of 12×12 = gross, you will have a difficult time ordering parts, making a budget, or figuring if you have enough money to buy a Big Mac and fries. Entire skill sets are based on math; from plumbing, to painting, to architecture, to all scientific pursuits. Understanding math is a basic necessary skill, handwriting is not.

Reading
An argument could possibly be made about reading being an archaic competency, as well. After all, computers can now read aloud, and podcasts and audible books are ubiquitous. Such reasoning will certainly rankle traditionalists. I am an avid reader, so believe me, I see holes in this line of thinking.

‘Riting
Most patients who experience fine motor difficulties, whether as a result of their autism, ADHD, dyslexia, dyspraxia, or various other physical challenges, find that they are terrible at handwriting. Practice, Practice, Practice. There is no pill for dexterity. If there were, we would all take them, and learn piano! But, what if you don’t want to learn to play an instrument? Should you be forced to, and will it make you anything but a terrible musician?

When my son taught Special Education to 5 and 6 year-olds, we would speak about the struggle that his students were experiencing as they tried to fit into a conventional academic experience. Later, while trying to instruct 10 and 11 year-olds, however, capitulating to the usefulness of typing became the logical choice. The child’s self-esteem would improve and the frustration of managing this skill would disappear.

Discussion
Watch people use a keyboard nowadays. Some use their thumbs, poke with one digit, stab with two fingers, utilize the old qwerty touch-typing method, point with a stylus, and even talk into a machine that turns voice into text. How well would a 50-something do on a job interview, if thumb-texting were the required skill?

The only ‘C’ that I received throughout my academic experience was for handwriting, when I was in third grade. My cursive was – and still is – nearly unreadable.

You know what? My mom said that I could still be a doctor. She was write right (no thanks to my spell-checker).

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Brian D. Udell MD
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