Posts Tagged ‘diet for autism’

Environmental Toxins and Autism

Sunday, June 16th, 2013

Advancements aside, the 21st century is experiencing the perfect storm, as far as infant development is concerned. Minor genetic variations that would have gone unnoticed in a less toxic world have resulted in vulnerability to certain presumably ‘safe’ foods, materials and the environment. Sometimes, if the stuff is harmful enough, it apparently might not even take impairment in identifiable detoxifying mechanisms.

The possible offending substances are ubiquitous, and the myriad of potential deadly combinations is infinite, making specific identification difficult. Although such discourse often turns to childhood vaccinations, that controversy only plays a part in the complicated matrix of possible poisons that lead to ASD.

Some may appear benign, such as the artificial sweetener aspartame. A more obvious culprit could be prozac in the water, or medications taken during pregnancy. Studies in California and Texas warn of pollution and childhood developmental problems. Plastic is in everything now. Then, there are the consequences of antibacterial (mis)management that have led to resistance and an abnormal gut-brain loop. Steroids are administered to make the animals more productive.There are new electrical fields, more powerful old ones, and increasing reliance on such energy sources. There are local energy fields in our houses and our pants and our ears. Remember that nuclear thing a couple of years ago? It was across the world, but the world is round.

This past week, the journal Pediatrics published research implicating levels of lead that were previously thought to be innocuous “…were associated with lower reading readiness at kindergarten entry. The high prevalence of elevated <LEAD> warrants additional investigation in other high-risk US populations.” Additional investigation?

Here is some of what the CDC recommended 8 months ago:

  • Experts now use a reference level of 5 micrograms per deciliter to identify children with blood lead levels that are much higher than most children’s levels
  • … CDC is no longer using the term “level of concern” and is instead using the reference value to identify children who have been exposed to lead and who require case management.
  • … The new lower value means that more children will likely be identified as having lead exposure allowing parents, doctors, public health officials, and communities to take action earlier to reduce the child’s future exposure to lead.
  • What has not changed is the recommendation for when medical treatment is advised for children with high blood lead exposure levels. The new recommendation does not change the guidance that chelation therapy be considered when a child has a blood lead test result greater than or equal to 45 micrograms per deciliter.

There are so many disconnects between what we are told by government agencies, what we are fed by mega-food producers and big pharma, and what we experience as the ASD epidemic unfolds. Suspicions become heightened and less-than-scientific theories evolve and abound. The parents of children affected by developmental challenges continue to visit practitioners who appear clueless as regards their specific challenges. Often, doctors with broader points of view are derided and dismissed as kooky by those “in the know”.

Important information and treatment is available. Unanimity of opinions would be great, but there is a great deal more knowledge that needs to be achieved in order to make specific recommendations. “State-of-the-art” in ASD treatment has yet to be defined. Families are left discover the most useful course for their child suffering with an autism diagnosis. Parents can’t fix the outside environment, but they can do something about the internal one.

Food for Thought about Autism

Friday, May 17th, 2013

The goal of biomedical treatment is to optimize health in order to minimize inflammation, prevent disruptive behaviors, enable normal development, and allow the traditional therapies to take hold. This is the story of one of our parents who became a believer after getting rid of the offending nutritional fare.

After our son was diagnosed with autism spectrum disorder, I spent about two weeks in a very dark place. As soon as I stopped feeling sorry for myself, I knew I needed to try to be as strong as I could so that I could help our son. About six weeks after our first visit with Dr. Udell, we received all of the test results for food sensitivities. My son had been a great eater (this is a story for another time) until we found out he was highly allergic to peanuts; then, after experiencing anaphylaxis at 17 months due to eggs, food became a MUCH bigger problem. He had pneumonia for the first time in February 2012, which was frightening. We were told that he suffered from Reactive Airways Disease and that he would be sick for quite a few years. I had such a difficult time just accepting this news, so I researched solutions. He was on a regimen of Singular, Xoponex, and Pulmicort in the nebulizer and, if it got severe enough, oral steroids. Our son was always ill. Sick so much that people did not believe us. This year, my son was on steroids (either oral or inhaled) from October until March, but he was still not better. One of the fill-in pediatricians proclaimed, “He is on too much medicine to be this sick!”

This past March, after our follow-up appointment for biomedical treatment, we started our son on a high dose probiotic and Diflucan. At that visit, we received a long list of items for our son not to eat. My husband and I decided to dive head first into this and get rid of his beloved bananas and Lorna Doones (cookies). I was skeptical about the food changes because any time you hear the word autism, GF /CF diets are soon to follow. I am not sure if the food, the probiotic or the Diflucan changed our son but something did and he has not had any more respiratory issues. I am not a Dr. but as we noticed our son changing with all of the new protocols, he became a healthy 3 and a half year old little boy. No steroids for 7 weeks and counting.

Back to my son’s food issues. He never got back to eating fish and chicken, as he did in his infancy. He eats a lot of pouches from Earth’s Best or Plum Organics. He drinks a smoothie in the morning but, since we had to change to rice milk, we provide Silk protein drink and soy yogurt. I went to my local health food stores (the big box ones are so expensive) and found Annie’s Gluten Free Bunnies, Crunch-master cinnamon sugar crackers, Enjoy Life sugar cookies and Home Free little sugar cookies. We had to bribe him with toys to get him to try new foods, but it worked. Now, we have a few items to take when we go out, so he can feel like a normal kid.

Quick tips for giant food changes. Talk to your local health food stores and see if they can order selected products for in-store purchase. Often, they will offer a discount if you order a case or more. Check out Amazonmom.com (it’s free) where you could get discounts on baby and kids items, make sure to sign up for their ‘subscriptions and save’ programs. The pouches from Plum Organics are $1.79 at Babies R Us and they are shipped to me for $12.46 per dozen, a savings of $9.02. The Enjoy Life cookies list for $4.69 a box, but through Amazon they are $2.84. Not everything is cheaper at Amazon, but with the expense of a GF/CF/egg/nut etc. diet, every little bit helps.

Cranial, Sacral, Vagal and other Pathway Therapies for Autism

Sunday, April 28th, 2013

In the previous century, I had occasion to train in Philadelphia, where I became acquainted with the treatments provided at The Institutes for the Achievement of Human Potential. The disorder that attracted my interest was cerebral palsy and the neurological outcomes of various protocols were the pursuit of my personal investigation.

At the time, I believed whatever the Hippocratic elders declared to be true, so I sided with the AAP on the issue of efficacy. “On the basis of past and current analyses, studies, and reports, the AAP concludes that patterning treatment continues to offer no special merit, that the claims of its advocates remain unproved, and that the demands and expectations placed on families are so great that in some cases their financial resources may be depleted substantially and parental and sibling relationships could be stressed.” When I interviewed parents who sought those services, I simply thought of them as unfortunate families who were desperate, but ignorant of medical facts. I no longer think that confused families who get relief wherever they find it are just misguided. Their experiences add to my knowledge, and patients deserve my appropriate support.

In one fashion or another, the aim of such therapies is to re-invigorate dormant, damaged, or otherwise under-functioning or unused neural pathways, so that they will/can wake up, grow, mature, lay down proper connections and so function properly. This usually involves physical input of one sort or another; from massage, to acupuncture, to electrical stimulation, to sound activation, to visual excitation. Similarly, there seems to be a consistent requirement for practice (as in, more parental work & time and/or practitioner visits) in order to solidify progress.

One of my earliest severely affected ASD patients was a great kid who suffered speech apraxia and experienced the best relief from CranioSacral therapy. “How can I believe in that stuff?” Well, in one case there was a parent and child who claimed improvement. I recently cared for a 6 year-old who was prescribed prozac for obsessive compulsive stims. Which therapy is safer? Which is harmful? Effective? (eyes of the beholders). Which treatment advertises to actually address the core problem, and isn’t just a weak Band-Aid, at best?

I am no expert on the many treatments that excite the spine, spinal cord, associated nerves and ultimately the whole CNS. Certainly, some of the various “alternative” treatment centers may take exception to comparisons because of ‘this or that’ technicality. I don’t have an issue with their services, however. Parents hoping to help their developmentally challenged offspring will continue to seek such treatments. Doctors who scoff at such thinking can’t really understand their dilemma. Pediatricians, neurologists and psychiatrists wishing to lead the medical team that helps to recover function in children should consider all reasonable treatment protocols. Programs can be checked for safety, documentation of efficacy (if possible), be performed by practitioners in good standing with their community, who keep records of their services, have referrals from other patients and don’t experience outrageous complaints.

To the extent that all traditional therapies, biomedical evaluations and treatments, and other alternative protocols are safe and do not deplete the family’s resources, they can play a part in the puzzle that assists problem children. As in all other medical epidemics, as the scientific community becomes more precise in diagnosis and effective protocols, the ones that work will take hold and others may be retired or find their way address other enigmatic conditions.

United for Autism?

Saturday, February 9th, 2013

“The teacher said that my child doesn’t listen… The Speech and Language therapist said to use only one language… The DAN! Doctor wants my child to take… The OT said that the child needs practice… My in-laws say that nothing is wrong… I read something on the Internet about… Somebody-I-know-who-knew-someone-with-autism-who-got-better said…”

AutismSpeaks keeps telling us about genetics. Alternative doctors continue to offer chelation. NAET practicioners say that they can get rid of a child’s allergies and help autism. Chiropracters. Neurofeedback. Neuromuscular Reflex Integration. Hearing therapy. Hyperbaric Oxygen chambers, hard and soft.

Have you heard about the study on stem cells? Is that the same as IVIG? How about the research on Bumetanide, Spironolactone, Actos, Secretin, Namenda, Baclofen, Biotin, Folinic acid, NAC, DMG, TMG, SAM-e and B12 ‘shots‘? Do I know about MMS for autism?

The pediatrician wants to keep putting the child on antibiotics. The neurologist suggests Risperdal to improve behavior. The psychiatrist is thinking Abilify. The teachers think that Adderall would do the trick. Intuniv is touted as a helpful medication. The dermatologist says that the rash is eczema. The allergist advises steroids. The gastroenterologist wants to do an endoscopic examination, and give Miralax in the meantime.

Parents are often counseled that stims should be ignored. The Son-rise program advises joining the child’s unusual repetitive behaviors. There are numerous supplements to address symptoms; including taurine, GABA, CoQ10, carnitine, carnosine, vitamins and minerals. Speak™ for speech. True Focus for focus. There are protocols for immune system support, G-I system support, and brain support. Want more? Treatments have been advocated using fecal transplants and even parasitic worms.

Then, there are the diets. GF/CF, The Some-Other-Food-Specific Diet, Low Yeast DietThe Blood Type Diet, Low Oxalate Diet, Specific Carbohydrate Diet, The Feingold Diet, Organic foods, and Dr. Udell’s diet. Oy vey.

Studies have shown that ASD patients can get better, and we know people who have. Older literature indicates that individuals don’t really lose the diagnosis, a self-fulfilling prophecy that explains such a belief. The cause has been ascribed to inflammation, the environment, mercury, lead, aluminumplastic, etc. Research indicates that the problem is mostly in the brain, while distinguished professor Martha Herbert teaches that ASD is a whole-body disorder.

Hello! Is it any wonder that parents are so confused about what to do with a non-typically developing child? We can’t even agree on a diagnosis. Is it Asperger’s, ASD, Severe, High Functioning or PDD-NOS? Parents come to our practice all of the time with developmental problems that you just can’t put your finger on. It isn’t the ADHD of the olden days, or the speech delay, or just oppositional behavior. The broadest category is “non-typical” – not what you would expect. For now, anyway. More precise diagnoses among the various professional organizations and disciplines will only serve to hasten effective intervention(s).

There will be additional theories offered, and sometimes treatments may work. But others may make patients worse. And some children who could have improved – even on their own – may deteriorate because of the wrong line of thinking, whether intervention is conventional or alternative. At a juncture so critical as this, in the thick of the most important childhood epidemic of the 21st century, physicians need to lead and assist an increasingly learned public on how to proceed. If pediatricians do not investigate and practice new protocols, the families will proceed without them.

Parents and patients need guidance through such a complicated maze of opinions and treatments. A united front on autism will emerge as parents, educators, physicians, therapists, and other practitioners agree about their role in recovery of function. Doctors should be more knowledgeable and speak honestly with the families about how much we do not know, what doesn’t work, what could be harmful and what is just too expensive without acceptable statistics proving benefit.

All treatments need to be assessed with scientific scrutiny and with empathy. That doesn’t mean alternative and complementary treatments should wait. Sometimes, physicians have to prescribe pretty strong medications to very disruptive children in order for the family (and the unfortunate patient) to get relief. On the other hand, let’s not get too upset with parents who try a GF/CF diet when there exists the myriad of treatments such as those listed here.

Parents need to find honest practioners with lots of experience who can analyze and properly utilize all of the possible protocols and recommend a reasonable and safe course for each affected individual.

Gluten Free / Casein Free Diet for Autism – Short Answer

Monday, December 3rd, 2012

Although I have previously written on this topic, an email request from one of my young readers prompted me to write the shorter version for her project:

Dear Dr. Udell,

… I am a senior at Buffalo High School in Buffalo, MN. I am researching gluten-free products and the trend in the increase of people going on gluten-free diets. Through research I have discovered a gluten-free diet may be an effective treatment for autism. I was hoping you could help me by answering the following questions.
     1. Research on the effectiveness of the elimination a gluten-free diet is minimal at this point. Though the research done proves the diet could help autistic patients, do you think the little evidence is enough to place patients on a life changing diet?
     2. Do you believe placing autistic patients on a gluten-free diet is helpful?

Thank you for taking the time to answer my questions.

My answer:
One diet (GF/CF, for example) shouldn’t be helpful for hundreds of thousand of people.

I believe, and my practice has demonstrated, that a person-specific diet can be quite helpful. Modern Western medicine handles inflammation by the use of strong anti-inflammatory drugs such as steroids or non-steroidal anti-inflammatory medicines (celebrex, others). Such compounds have lots of side effects, so physicians cannot give them to young children for more than a few weeks at a time. The best way to decrease inflammation is to avoid it – so I test for food allergies (94 different foods) and avoid those foods to which the child is most allergic. Sometimes, gluten and casein are the culprits, often they are not the ONLY foods to cause problems.

So, if a child is more allergic to soy, e.g. than casein, and drinks soy milk products, the diet won’t appear to work.

Or, if a child is allergic to peanuts, and is eating lots of peanut butter with the GF/CF diet, the diet won’t appear to work.

Or, if a child is not allergic to gluten or casein, the diet won’t appear to help.

Another problem with gluten and/or casein is that the large protein molecules sometimes “leak” into a patient’s bloodstream, after which the liver tries to rid the body by attaching morphine-compounds. I test for those compounds (urine), and when affected patients avoid those foods, they appear less ‘stoned’ and their attention improves.

Finally, if a “life-changing diet” helps change a person’s life (makes them talk or think better) umm… isn’t it worth it?

Thanks for asking!

Regards,

Brian D. Udell MD FAAP
Medical Director
Child Development Center of America
2751 Executive Park Drive #201
Weston, FL 33331
Phone 954-873-8413
Fax 954-384-228
www.childdev.org

What to Do About Autism and the Flu

Thursday, November 22nd, 2012

Rotavirus

Parents often complain that their very young ASD-affected child 1) Gets sick pretty often, 2) Stays sick for a pretty long time, 3) Gets lots of infections in a row, and 4) their behaviors seem to be more concerning during such illnesses (either too “tantrummy’ or too docile), the Pediatrics  article noting improvements in some patients notwithstanding.

It’s flu season. What is the flu?
It’s a respiratory infection caused by an RNA virus.
Signs and symptoms are temperature elevation, stuffy/runny nose, coughing, flushed skin and behavioral changes specific to each ASD patient. Appetite is usually decreased, sometimes problems keeping solid foods down and diarrhea may occur with, or shortly after the onset of symptoms.

What is a stomach flu?
It’s a G-I infection, mostly caused by a (different) RNA virus.
Signs and symptoms are temperature elevation, appetite is usually decreased, often problems keeping solid foods down and diarrhea may occur with, or shortly after the onset of symptoms. There may also be a runny nose, coughing (especially if there is reflux), flushed skin and behavioral changes specific to each ASD patient.

What we learn from these two well-established facts is that an autistic patient can easily get one and then another and then another – gastrointestinal or upper repiratory virus – throughout the ‘flu’ season and
NEVER REQUIRE ANTIBIOTICS.

I have previously written my thoughts concerning the overuse of antibiotics. So, in this article, I plan to help patients through the present bout of illness, and hopefully even prevent future occurrences.

What do I do about the fever*?
Autistic children are generally more resistant to pain and less verbal than others. I believe in treating the fever fairly aggressively. First, it will help ease their suffering, specifically the headache (?head banging?) and stomach ache (?hyperactivity?). Liquid ibuprofen (MOTRIN®) without food enhancers would be best, and stay away from acetaminophen (TYLENOL®), which interferes with glutathione production and aspirin, of course.

Also, especially since many ASD patients don’t drink enough fluids anyway, increased body temperature leads to more fluid loss, so encourage fluid – not food – intake. The children don’t need soup, or smoothies, or especially over-the-counter cough and cold remedies which could make symptoms such as stims or sleep disturbances worse.

It would be great if I could recommend products such as Gatorade or Powerade, but they contain high levels of HFCS and artificial ingredients. Products such as this seem to fit the bill. Finally, any difficulty handling your child’s fever with both adequate fluids (~1-2 oz per hour) and antipyrretics should be reported to the child’s physician and may necessitate the doctor visit.

What do I do about the symptoms?
Many of the child’s symptoms will calm down with fluids and fever abatement. For parents who remain concerned about upper respiratory symptoms, I find that the homeopathic remedies offered by Boiron are about as effective as anything else and they don’t cause more symptoms than they help (as is the problem with almost all the other cough and cold preparations).

Often, diarrhea responds well to the Bananas-Rice-Apples-Tea diet (as allowed) in your child. At the onset, stay away from solid foods as much as possible. Again, adequate fluids are important. You can check how hydrated your child is by feeling for some moisture in the mucus membranes and noting the amount and color of urine. Very little and very yellow are signs of poor hydration.

The use of medications containing loperamide (IMODIUM®) is not a good idea, especially in ASD patients. The chemical slows down gut motility without really fixing the problem, and dehydration is even more difficult to ascertain. I usually ask our patients to double their dose of probiotics until 3 days or so after the diarrhea stops. Bismuth containing agents (Pepto-Bismol®) are generally not recommended because they contain aspirin-like substances which are not to be given to children. If you see black stools after giving it, however, it’s from the medicine, not the child. If the diarrhea persists for more than a few days, the child should be seen by a physician.

Vomitting is a different story. If the child is simply bringing up the food right after eating, and it is only a small amount, just stay with clear liquids as suggested above. If the child is vomitting persistently or for no reason, you should definitely speak with the pediatrician and may need to have the child examined. Again, stopping the vomitting with anti-emetic medications (e.g. Compazine) is not a good idea in ASD patients because it may be the only way to tell what is going on.

I took the child to the pediatrician and was told that the tonsils, adenoids, lymph nodes are enlarged and I need to give an antibiotic. Is that OK?
ANY infection is handled by the glands in the head and neck. The surest sign that bacteria might be involved is a persistently high fever that is difficult to control. Pediatricians are more likely to be aggressive with children under the age of 3 because of the chance of a febrile seizure. It is not the job of practitioners such as myself to put the parent in the middle between two (or more) doctors. The practitioner who sees your child bears ultimate responsibility, so listen to them.

Children who keep pulling at their ears or hitting their heads might very well have (or also have) otitis media, which, although usually caused by viruses, is generally treated with antibiotics.

What should I do about giving the other medications/supplements that my child is taking?
It is probably prudent to stop most meds/supplements if a child is experiencing vomitting and/or diarrhea. The sole exception is the probioitcs, which could hasten recovery. For upper respiratory symptoms, continuing the supplements is probably a good idea in order to keep the immune system in the best shape possible, but again, increasing the probiotic until 3 days after the child is improved can be helpful.

Why don’t doctors such as myself recommend the flu shots?
We are trying to decrease the patients’ total inflammatory load. Presently, there are very few medications which actually kill viruses and they are only for serious infections. My counsel is that, at the onset of our biomedical intervention, let’s get the kid  better and not cause inflammation, which is what vaccines are supposed to do. BTW, such circumstances do favor the opinion that siblings and family contacts should be vaccinated in order to decrease the affected child’s chance of becoming infected or re-infected.

*DISCLAIMER… see the doctor if you have any medical concerns about your child.

Five More Frequently Asked Questions in Autism Treatment

Sunday, November 18th, 2012

Signs and symptoms of ASD are the most common ailments that I treat. Often, autism is the primary diagnosis, but there are many patients who have some other essential problem; either named (e.g. Down Syndrome), descriptive (Congenital hypotonia), or no diagnosis (PDD-NOS), whom I help as well.

I’m not boasting when I write that almost ALL of my patients benefit from treatment, since that is what a doctor should do. Our results are no false prophecy. Better health leads to improved quality of life for patients and their families. When affected individuals achieve a well-functioning G-I system, sounder sleep, softer skin, fewer allergies and less frequent illness, improved behaviors and more communication often follow. Combined with the traditional, proven therapies (including, S&L, ABA, OT, PT and others), their ‘autism’ improves.

Here are some of the most common questions that arise (AFTER we get through Q’s#1&2):

Q: “How much autism does my child have?” or some other variant, including, “He’s very high-functioning.”
A: In our practice, we have four ways to document the diagnosis:
1. Thorough History and Physical examination, including a family interview and review of all previous documentation
2. Accepted objective measuring tools, such as ATEC, or others as provided
3. Video documentation
4. My opinion

After each visit, the family is informed about progress, current skills, challenges and expectations.
As in any other medical condition.

Q: “What can I expect about recovery.” “How soon will we see a change in the child?” “My biggest concern is whether my child will be able to be like other kids and grow up and be able to take care of him or herself. How long will this take?”
A: Whatever the medical condition, including autoimmune conditions such as asthma, eczema or rheumatoid arthritis, it should be the same answer. “We will perform the most appropriate medical tests, then follow the most likely, safe and reasonable interventions based on how the child responds. Age and degree of involvement are important when evaluating response to treatment. To the extent that there is improvement, or at least a change, we will better know the type/degree of difficulties your child has and then that answer will become clearer.

The short answer is, “Let me see how things unfold over the next few months and I’ll be able to give you a better answer.”

Q: “Do you do chelation (administering chemicals by intravenous, oral or rectal routes to remove heavy metals)?
A: Even conventional scientists now agree that the toxic environment is at least as important as genetics as the cause of the increase in autism. While lead and mercury continue to be ubiquitous as neurotoxic agents, the plethora of pollutants – known and unknown – in the air, food and water may have overtaken the ‘common’ offenders as more likely culprits in the epidemic.

The body’s natural antioxidant, glutathione, appears to be a safe, inexpensive and effective way to clean up the mess. The oral preparation that is used in our practice appears to be reasonably well-tolerated and works quite well.

Q: Have you heard about… this or that… new study treatment/supplement that I saw on the Internet?”
A: This specialty is presently fraught with numerous remedies that are merely the anecdotal experiences of non-medical personnel. To be sure, the failure of the medical profession, and pediatric neurology specifically, to adequately and accurately approach the epidemic is one reason why individual research and treatment options have emerged.

Although various treatments appear on the web, the more exotic, experimental and expensive, the more their appeal, but unanswered is their efficacy or true long-term safety. Find a good developmental practitioner and leave most of the research to us.

Q:  My husband (mother, mother-in-law, father, father-in-law, neighbor) thinks that the child is OK, and it’s just how I’m raising him that is the problem. They said that I (my husband, in-law, etc.) was the same way when I was a kid.
A: The first sign of The Plague is a flu-like upper respiratory infection. If it were the year 1300 and you went to the doctor with a cold, he should be thinking The Black Death, not a URI.

It’s 2012. When an infant today presents with Red Flags such as loss of words, problems with eye contact, or repetitive behaviors, we should be doing everything possible for that child to make sure that autism does not develop.

The common thread is my belief that I’m treating a medical condition and therefore the usual workup and course of action applies. We could go all over the world, seeking cures that are unproven, because we believe that medical science has failed. But, having experienced thousands of visits and tens of thousands of patients over 4 decades, I believe that we can still stick to reasonable science.

 

MAPS 2012 Autism Conference

Tuesday, October 2nd, 2012

It is exciting to report that this past weekend I attended the First-Annual-Second-Level training sessions for the newly forming Medical Academy of Pediatric Special Needs, in Orlando. I won’t describe each presentation, as I have done in previous posts, other than to report the highlights.

For more than eight hours per day, for three days, we were immersed in everything from basic science, to research, to charting, to legal issues, to diagnosis, workup and treatment. The participants are a part of a truly elite group of medical professionals who are willing to work together to help parents find the correct medical care for their special needs child.

As I listened to some of the lectures this time, I was familiar enough with the information to think about how the material applied to children in my medical practice; specifically, who might respond better to some particular medications or supplements. Then, I would consider other patients who might benefit from particular blood and/or urine testing. Occasionally, I was alerted to possible negative reactions that I hadn’t heard about or procedures that I wanted to experience. After several years of attending similar seminars, I could pick out the other doctors who had similar philosophies, and we traded clinical information.

The most talked about topics were:

1. Memantine. This is a drug used to help people with Alzheimer’s disease to think and perform daily activities more easily. There was a fair amount of clinical experience among the participants, so trying this medication in selected patients seems to be worth a try. Additionally, there is apparently a more rigorous soon-to-be-published study that will give valuable information about its use.

2. Oxytocin. It’s getting more buzz, and it appears to be safe. It’s efficacy in this condition remains to be seen, however.  I heard various opinions on whether its use resulted in any real improvement, especially in eye contact and socialization.

3. The most common topics throughout the conference were inflammation, gut health, how the central nervous system is affected in ASD,  mitochondrial dysfunction, diet and the environment.

Networking with the other members is always a key factor to our enjoyment at such seminars. Lecturers included such autism luminaries as Drs. Dan Rossignol, Martha Herbert and Arthur Krigsman. It was great to meet Sandy Haines, our executive director, who used to work for Microsoft (and you could tell by the way she has organized and tidied up this nascent organization).

Earlier, I overheard a prospective society member inquire about the rigors of joining MAPS, including whether there might be formal testing in the future. I later told Sandy that she didn’t need to waffle about her response. “The answer should be ‘hell yes,’” I said. I’m proud to have taken the time to master the basic sciences and learn from from the experience of really smart medical professionals. We should be taking this opportunity a couple of times per year to discuss these enormous problems and all possible medical solutions. I’m proud to take a test to prove my knowledge.

It helps separate me from the Internet.

School Started – How to Help Your Children with Autism and ADHD

Monday, August 20th, 2012

One of our busiest times of the year is October, actually. Four-to-six weeks into the school year, many issues arise which require some sort of attention, or else it feels as if everything is going to fall apart. Focus. Anxiety. Fear. Teachers. Schoolmates. Non-preferred activities. Recess (though, that is usually everybody’s favorite) can be problematic, since that is often pull-out or tutoring time, or bullying can occur. Even lunch can be an issue for the children on special diets.

Sleep, exercise and food – paying attention to these simple activities can make a huge difference in the new semester.

The first activity that often needs to be addressed is sleep. Throughout the summer, the children have gone to bed later and later, and now that schedule needs to be re-aligned. This is no small matter. Who wants to learn a non-preferred subject when they can’t concentrate? For students with a short fuse, lack of REM sleep adds fuel to the explosive power of a meltdown. For those with social issues, the inability to get along is furthered by poor circadian rhythm. There is no area of your child’s development which cannot be improved with a good night’s sleep.

For some patients who are on stimulant medication, parents and professionals might consider changing the timing of the medication so that the child can fall asleep at the desired time. Some children will just unravel by the time school is over and so evenings and homework are a unpleasant chore. Instead of increasing the dose or adding a second medication, it could be prudent to split dosages when possible and determine the best time to get the best results. For patients taking guanfacine or other blood pressure meds, giving the primary dose just after school or at bedtime could be helpful since the sleepiness could be worn off by the morning, but the anti-anxiety effects continue into the school day.

In any case, I have found that melatonin is a wonderful supplement that can get things going in the right direction. Although there is great concern about the hormone (especially on the web), it is safe and effective. Compared to all of the other ‘real’ medications that may have to take, there are rarely any side effects. Vivid dreams may be an indication that the child has not been getting enough REM sleep, so don’t give up if that symptom ensues. One of the most important elements in this strategy is the development of a ‘normal’ daily rhythm by administering the supplement ~ 30 minutes prior to the desired sleep time, every night, including weekends.

Optimizing nutrition for children with developmental challenges is another important factor for a smoother Fall. I write lots of letters asking the school’s assistance by paying attention to students who require special diets. Junk and pre-processed food have been reported to affect neuro-typical children’s school performance and many parents have observed negative effects in their own children. Although it is controversial, many parents report learning and hyperactive problems when their children consume both natural and artificial sweeteners. In my experience with ADHD behaviors, it is the artificial coloring, flavoring and preservatives which can cause even more learning problems.

Proper exercise is the final key element that will help insure a better transition to the school year. The children have so many challenges during the day, then therapies and after-school (usually indoor) activities. Remember when we used to play outside until your mother called you to dinner? Even bouncing on a trampoline for a while can help get the jitters out. Physical activity helps focus during homework, getting sleepy at bedtime and feeling hungry at dinnertime. “There is simply not enough time for exercise,” is not an option. At least find the time to take the children out on weekends.

Appropriate  sleep, food and exercise. It’s not rocket science, but it is an effective strategy that can help your child achieve more success. It’s old advice, but, hey, I’m an old doc.

The Business of Autism

Sunday, June 24th, 2012

Several years ago, I was newly re-retired from a medical malpractice insurance company that I helped found and build, but I was not really ready to relax. Thanks to a bit of luck and lots of hard work in an earlier endeavor, I tried that route before, but my ADHD always kicks in. Plus, playing golf poorly all the time (which is how I play golf), is not a pleasant way to spend the last third of my life.

I volunteered at the Children’s Diagnostic Treatment Center in Fort Lauderdale, where I had been Medical Director of the High Risk Follow-Up Clinic many years earlier. I was able to observe and participate in the evaluation of children who were not developing typically and so sent to the Clinic by Child Find services. After witnessing scores of assessments by the psychologists and various therapists at the Clinic, I developed two important conclusions; 1) an epidemic of what we call ASD was emerging and 2) conventional medicine offered little in the way of etiology, accurate diagnosis, medical evaluation or treatment. I began to research about alternative interventions. There was the Internet, of course, reading books by CAM practitioners such as Drs. Ken Bock or Bryan Jepson, and attending conferences and lectures by organizations such as Defeat Autism Now! (as it was named) and the National Autism Association.

One day, as a child who clearly suffered from the ‘gut’-type of autism was leaving our Clinic with only some tickets to an hour or two of therapy and a bunch of consulting evaluations, I ran after the family to tell them that I thought that I could help. That was my last day at CDTC, because I was reminded, “we don’t diagnose or treat, we refer.” So began the Child Development Center of America.

In spite of my M.B.A. degree (University of Miami), embarking on this medical practice was quite a daunting task. If it were not for the incredible support and work of my beautiful and patient wife, Jackie, or my friend and super-capable Practice Administrator, Karen Vossen, I would probably have gone back to shooting 94′s every day (I only get to do that once-a-week, now). I opened a small office in a medical professional building near the Dan Marino Center, and simply started to see patients who came by word of mouth.

Previously, as a pediatrician and neonatologist, I cared for hospitalized children who were very ill and quite unstable. The back office particulars were handled by financial professionals. My new practice had to make an early decision not accept payments from insurance companies. It takes hours to observe and evaluate a non-typically developing child, and the insurance reimbursement alone could not cover expenses such as malpractice insurance, office overhead and staff (Karen). More problematic is the fact that the alternative methods that are useful for reversing autism are simply not recognized by the conventional medical community. That means scrutiny and oversight by medical personnel who believe that doctors can’t fix autism in the first place, any therapy that we recommend can easily be denied, and novel protocols even open the physician to reprimands and licensure issues.

Thorough evaluation and close follow-up are the best means to get the greatest number of patients to improve and even recover from this childhood epidemic. Doctors practicing this type of care need to not only make diagnoses and treat patients, there exists a paucity of valuable research and literature upon which to base clinical decisions. I’m not uncomfortable or unfamiliar with this position, but when we were taking care of tiny premature babies or HIV-exposed newborns, I was part of a larger infrastructure. Although the conventional medical community may not have understood what was going on in those days, they were at least cordial. Private and public payors were obliged to provide reimbursement.

Individual practitioners are a dinosaur in today’s medical marketplace. We are trying to figure out how to take care of patients, pay the bills, and keep costs under control so that our care is somewhat affordable. That’s a tall order. Some doctors sell products, services or supplements related (or even unrelated) to the practice. But, that creates a moral hazard, as in, “Is the doctor selling me this product because it’s really going to help my child, or to pay for his Porsche?” (BTW, most DAN! doctors don’t have Porsches).

Some doctors choose to speak and lecture to patients and other professionals. That takes valuable time away from the practice. And, for me, it’s not a preferred activity, especially since that choice involves extensive travel (except for ‘webinars’, I guess). Other physicians have chosen the ’boutique practice’ route. That’s when the patient pays an up-front cost to assure that the practice never gets too large and so the physician can afford to take personal call and be more involved in patient care. I haven’t seen that in Child Development, but it seems to be a possibility.

Books and fame can provide additional revenue to the charming, good-looking and personable few.

I’m working on the book, but the goal is to help families and children, not personal aggrandizement.

The best model that I have envisioned is a company such as Cancer Treatment Centers of America – where a network of experts diagnose, treat, make recommendations and follow the patient with a holistic approach. ASD patients could get multi-disciplinary care; including supplements, traditional therapies, alternative treatment modalities, nutritional and dietary evaluations and support, in addition to the medical care that should lead the process. Reimbursement should be provided through insurance and other funded programs that understand the SAVINGS that are generated by early, precise diagnoses and effective interventions.

Currently, insurance companies and the government are basically not paying for any real help. There is no pressure to provide such reimbursement, which is seen only as a cost, not a lifetime of improvement and savings. It will take a prototype program that has the resources to evaluate funding and outcomes, and a pubic outcry, in order for such a service to become reality.

The present state of the ‘Autism Business’ is that it is not a business. It is the practice of medicine in it’s closest-to-pure state. Doctors from all over the globe are noticing the epidemic, studying it, and treating patients. I believe that many important breakthroughs will take place in the near future. In the meantime, I’ll do everything that I can to continue to keep costs in line, see as many patients as possible and let the world know how we are doing.

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Brian D. Udell MD
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