Posts Tagged ‘vitamins and ASD’

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.

Hope and Understanding the New Autism

Sunday, May 5th, 2013

Stories describing new relationships occurring within the autism epidemic appear every day. Families wonder about their significance; whether they, in some way, can better understand why their children are affected by the condition (? older fathers, overweight mothers, living near highways, premature births, anxiety, copy number variations, etc.) and the significance of new treatments appearing on the horizon as it applies to their situation.

For example, the report of a “vaccine” FOR autism attracted attention recently.
The good: The thinking goes that killing Clostridia (an especially nasty cootie) with this anti-biofilm product could reduce autistic behaviors in many patients. Importantly, it validates “complementary and alternative” medicine’s insistence on the gut-brain connection in autistic behaviors.
The bad: It’s only been tested in rabbits.
The ugly: “The vaccine might take more than 10 years to work through preclinical and human trials, and it may take even longer before a drug is ready for market…”

Regarding treatment, UC San Diego recently reported “Antipurinergic Therapy Corrects the Autism-Like Features in the Poly(IC) Mouse Model”.
The good: The drug, suramin, targets a cell messaging system that produces a metabolic response to stress. “According to a new theory, autism is strongly linked to this pathway… Scientists in the U.S. found that the drug corrected 17 types of abnormality linked to autism in genetically modified mice, including social behaviour problems.”
The bad: It’s only been tested in mice.
The ugly: Mice aren’t men.

At the SFARI conference this past week in Spain, research was presented that supported the environmental theories of causation.
The good: There were significant presentations reporting associations with air pollutants and insecticides. Also, the topics of proper prenatal and pre-pregnancy vitamin and mineral intake were popular offerings.
The bad: ”The new studies showed only associations and couldn’t prove causality, and each factor itself likely accounts for a small portion of the risk for autism, researchers say.”
The ugly: ”Genetics likely account for about 35% to 60% of the risk, many researchers say.” Genetics accounting for susceptibility is not that helpful until the downstream abnormality is identified.

The report of placental changes signaling an increased association with later autism got a fair bit of press this week.
The good: The test “…yielded a 92% specificity rate for predicting ASD risk status — and …yielded a 99.9% specificity rate. The differences between the 2 groups were amazingly, awesomely different.” The earlier the red flag, the better.
The bad: “… this test will not be able to identify all individuals who might develop autism.”
The ugly: If we don’t do anything about the red flags that we see already (“Let’s wait until he’s older…”), is this information that helpful?

Another recent article that points to early involvement was Deviance in fetal growth and risk of autism spectrum disorder in the American Journal of Psychiatry.
The good: ”… poor fetal growth was more strongly associated with ASD with intellectual disabilities than without. Regardless of fetal growth, preterm birth increased ASD risk.” I repeat, the earlier the red flag, the better.
The bad: In my many years caring for high risk premies and diabetic babies (the very small and very large), when I was Director of our Follow Up Clinic, ASD was not being recognized/diagnosed.
The ugly: Ditto to the last ugly.

The most important points that we can glean from such literature are:

1. More recognition of the epidemic, and therefore more research that will lead to treatments – eventually, even if it’s just avoidance of the toxic offenders.

2. Earlier recognition of red flags that a child may be at-risk, with earlier diagnosis, instead of “he’s a boy – they talk late.” Hopefully that means earlier interventions.

3. More recognition of the medical nature of the condition.

 

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.

MAPS Spring 2013 Conference

Sunday, March 24th, 2013

This past weekend marked the third Medical Academy of Pediatric Special Needs Conference, which was held in Costa Mesa, CA. I have made sure to attend every one. This time, I had the added challenge of traveling on my damaged and recently repaired left foot. But, thanks to the help of my beautiful and patient wife, Jackie, I managed to fly, hop, crutch and wheel across the country.

What started out as the “Defeat Autism Now!”(DAN!) movement, then morphed into the Autism Research Institute (which continues to support autism research and provide needed information and support for families and individuals with autism spectrum disorders), has finally become a full-fledged medical society “for the treatment of children with autism spectrum disorders and chronic special needs.”

These courses provide the required CME credits to attain a MAPS fellowship certification. This educational experience prepares practitioners from all over the world to deliver state-of-the-art care. Qualified and experienced doctors and other professionals offer detailed scientific evidence and clinical information in order to further understanding and treatment. We review older therapies, some of which may still have value, the most common protocols that the participants presently utilize, and the emerging technologies that could lead to better treatment.

The advanced courses that I attended included the following discussions:
(Day 1): Hormones & Neurodevelopmental Disorders, led by Dr. Anju Usman. Covered subjects included the CNS, HBOT and treatments such as galantamine, phosphatidyl serene, propanolol, cortisol, oxytocin, secretin, the endocrine system, calcium, the adrenals, and hormones. We also learned about remedies from plants, foods and other cultures.
Evaluation & Treatment of Older Children was presented by Dr. Dan Rossignol, who gave one of his stellar presentations thoroughly reviewing the scientific literature that helps support our various treatment protocols. Case presentations with enthusiastic audience participation rounded out the afternoon.

(Day 2): Gastrointestinal & Nutrition. Dana Laake (Dietician-Nutritionist) reviewed Advanced Nutritional Assessment including labs, signs and symptoms, and special diets (all of them, I think). Dr. Elizabeth Mumper immersed us in G-I testing and discussed “clinical pearls” – what practitioners should look for to help patients with symptoms due to an unhealthy gut. Dr. Rossignol reviewed the pertinent literature and more clinical cases. Dr. Jeffrey Bradstreet taught us about testing and treatment options for autistic gastrointestinal disturbances. He concluded his talk with a thorough discourse about fecal transplants. No shit.

(Day 3): Cutting Edge & Novel Treatments. There were lots of experts, lots of treatment possibilities, and lots of opinions. Need I write more?

The MAPS conferences are no boondoggle. Classes go from 8-to-6 for three days, with formal testing at the end of those long sessions. The most important functions include networking with doctors from all over and discussing cases – just like your children – from the youngest, to the most challenging and complicated. This information adds immeasurably to our individual clinical experience.

What’s new is that your children – young and old, disruptive or spaced, apraxia or echolalic, unfocused and anxious, suffering from seizures or repeated infections – are being discussed, reviewed and considered as patients who deserve appropriate medical attention.

MAPS participation grew by a third this meeting, but that is still not enough personnel to address the burgeoning patient load. It’s a great feeling to know that each year we are getting closer to the causes and cures for this ever-increasing epidemic.

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.

On Preventing Autism

Sunday, January 27th, 2013

The disorder that we call ASD is treatable by various means, so is it preventable? For the time being, the most accurate answer appears to be, “It’s complicated. Maybe. Sometimes. But, it’s not how you think.” At the beginning of an epidemic, doctors are mostly looking at the trees, and the bigger picture is elusive.

A major stumbling block to better understanding ways to diffuse the epidemic is the abundance and predominance of research about genetic influence on the disorder. So, if it’s largely genetic, as has ofttimes and generally been believed, then prevention is less likely, because our genes are, sort of, fixed. However, if occasional-to-frequent, previously unrecognized, minor genetic variations have led to downstream abnormalities due to unforeseen environmental influences, that would be a situation that deserves further investigation. And finally, if what-we-call ASD is mostly not genetic, then the there exists an even greater possibility of preventability.

Can breast feeding reduce autism? One report of infants who received either breast milk or formula with similar supplements indicated a reduced incidence of ASD. Even if this finding is verified, correct formulation merely highlights that it’s the nutrition that matters, not the breast milk, per se. First, for most of the second half of the 20th century, when there wasn’t an autism epidemic, the vast majority of moms (in the US, at least) did not breast feed. Second, I treat many patients with autism whose moms are STILL breast feeding at 3 and 4+ years! (Yes, teeth and everything). Third, while there are many studies advancing the healthy consequences, there aren’t ones that target reduction of autism with breast feeding. Don’t get me wrong. I am a neonatologist and I firmly believe that human milk directly from the breast is the preferred method of feeding infants. It reduces allergies, otitis media and other respiratory infections, and some studies claim improvement in IQ. But, I want to assure any guilty moms that personal and scientific evidence indicates that THIS was NOT the reason that their child suffers from ASD. Many of the affected but as-yet-unrecognized newborns have colic, GERD, hypotonia and feeding intolerances in the first place, making breastfeeding impossible or impractical.

Would alteration of the present vaccination schedule have an effect on the incidence of autism? The answer from most experts, including a recent report from the IOM, is a resounding “No”. I have serious concerns about the plethora of childhood vaccinations and I am skeptical because of the dearth of prospective, randomized double-blind research assuring us that the present schedule is always safe for everyone. Furthermore, 5% of my parents report an absolute proximate association between vaccinations and autistic regression. However, I do treat many patients whose were never vaccinated and appear with autism. My biggest concerns are the overuse of antibiotics, and when pediatricians give vaccinations while a child is sick, even if the child had negative reactions to previous vaccinations, give extra ‘shots’ to make up the schedule, or do not take other comorbidities (such as diarrhea, asthma or eczema) into account. This is one area where we might see a reduction – if the experts would just listen to the parents.

The more recognition that the immune system triggers markers of ASD, the more we should be able to target and diminish that inflammatory reaction.The discovery about patients diagnosed with autistic symptoms who have antibodies to folic acid, which is an important prenatal vitamin for the prevention of other CNS abnormalities, may help identify the risk of the disorder and provide clues to treatment and prevention. Autoimmunity seems to play an important part in this disorder, as reported last summer in the New York Times. Dr. Judy Van Der Water has discovered another type of auto-antibody, specific to fetal brain proteins, a finding which could lead to a prenatal test for some types of ASD. She has recommended that women get the flu shot BEFORE they consider getting pregnant, and particular attention to cleanliness and avoiding inflammation. Additionally, she emphasizes the need for pregnant moms to reduce the risk of infection and illness during pregnancy.

Dr. David Berger, a pediatric colleague who practices in a similar fashion and has assisted many families, offers his experience regarding the issue of prevention in this publication.

Obviously, research is lacking. For the present, treatment focuses on patients who already exhibit symptoms. As we identify and appropriately address the younger siblings or others with newly-identified high-risk behaviors, it appears that we can prevent the diagnosis from fully-developing in such patients. If intervention begins at the earliest red flag – before an ‘official’ diagnosis – and leads to improvement in hypotonia, G-I issues, or poor health and the child never develops further evidence of ‘traditional’ autism, that is good start.

Addendum: A recent study in the Journal of the American Medical Association reported an association between the intake of folic acid and decreased risk of ASD in the offspring of mothers who started taking the supplement at least 4 weeks prior to conception. It has been known for years that this was an important nutrient for preventing certain CNS malformations, and this lends even more credence to a healthy maternal state influencing an optimal outcome. My advice on this supplement is that the recommended dose is 400 micrograms per day – more is not necessarily better (and could be worse).

Child Development Center’s Holiday Party

Monday, December 10th, 2012

This past weekend marked the 4th annual holiday get-together for the staff of The Child Development Center of America. I am writing because I am so proud of our staff and the work that the Center has accomplished in such a short time.

The only attendees at the first-annual party were: Karen Vossen, kind and efficient Autism-Mother-Expert and our Practice Administrator, her husband John, my beautiful and patient wife Jackie, and myself. By the second year, we had a new ‘intern’, Ryelle Seymour, who has since gone on to the University of Central Florida and is working towards a law career. Last year, we taught  even more young students who were interested in working with, and learning about, developmentally-challenged patients.

This year’s staff also included:
Kelsey Bragg, who was recently accepted to a prestigious Physician’s Assistant program. Her patient skills will be well-served as she studies for a Master’s Degree at Drexel University – Hahnamen Medical College in Philadelphia.

Bianca Gabbara, who graduated with a BS from NOVA University, and is a planning a career in Applied Behavior Analysis. She has great organizational skills, which is a plus in such a chaotic specialty.

Julian Guzman-Ballen, a former patient, who is a graduate of Lynn University, and is presently performing post-graduate studies at FAU. He is a fast, pleasant and efficient worker, and we learn from each other every day.

Daylin Benguria, our Spanish-speaking Assistant Practice Administrator, and big sister to a beautiful ASD little girl. Her understanding and patience enhances our work, and she has one of the best memories of anyone that I know.

Lisa Martindale, our loyal bookkeeper and experienced mother of 4, including an improving ASD son. Her know-how has been passed on to many of our parents.

This past year, we saw over 800 patients in our practice, from all over the world. I believe that we have helped almost all of those patients toward improvement, at the least, and recovery at best. Dr. Evan Mehlman, our resident psychologist (soon to be moving to his own office) remarked, “This is the hardest working, most interesting group of people that I have ever worked with. It has been a great learning experience that I will miss a lot.”

I know that each one of the young people who work with us will go on to help countless others in the future. It may be in autism; but even if it isn’t, the people with whom they come in contact will receive great service. I am lucky to have their enthusiasm and bright minds. When asked if I would miss one or another staff as they move on, my thought is this: I am happy to have been exposed to their passion and inquiring minds, and that is good enough for me. I am sure that we shall continue to grow and have other new ‘interns’ to take their place, with their special knowledge and skills.

Even though we do not have much time to socialize at work, this party made us realize that we are truly a family. We cover each other’s backs. When one of the staff’s children is sick or having problems, the rest pitch in – never missing a beat – and patient care continues a the highest level. We are very close, we all have special strengths, and we work together to help address this new epidemic that is affecting our world.

Happy Holidays to all of our readers, patients and their families. Thank you so much for letting us be part of your lives, and your child’s recovery.

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

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.

 

What is Stimming in Autism?

Monday, October 29th, 2012

DSM-IV version

DSM V

Some medical professionals who read this blog might even scoff at the question. “Stimming? That’s something that you guys made up, like some of the other stuff you say about autism.” It’s as if sensory processing disorders aren’t real, ’cause the AAP decreed it so.

Regarding the term ‘stimming’, critics might have a point. Even wikipedia only provides a brief explanation. Let’s take a look at what it is, how it might be addressed, and what the prognosis is for this sometimes-annoying sign that so often identifies abnormalities in the movement domain (the others being social and speech). For many parents, such behaviors represent a sign that their child looks different when playing in the park, or that they may be bullied as they get older. It is a key symptom for inclusion in the proposed 2015 criteria change (pictured).

1. Stims are not one thing, they indicate various activities. For this reason, the psychiatric equivalent, “stereotypy,” which indicates purposeless movements, would be imprecise and incorrect. Furthermore, they do not only represent ‘self-stimulatory’ behaviors responding to sensory input; ‘stimming’ is expressive in nature, as well.

Many parents can become quite versed in Stim-lish. “Oh he loves that video,” or “She flaps that way whenever she is nervous.”

2. Some are purely verbal. Ever hear that high-pitched, repetitive cry? That’s a verbal cue to get some kind of attention. It works really well. Screeches are also very effective at attaining an adult’s attention, if not affection.

3. Given a narrow range of expressive verbal behavior, more generalized body movements are often the only way to display fear, anger, frustration, sadness, joy and excitement.

4. Repetitive behaviors are not obsessive-compulsive disorders. They are repetitive behaviors, until proven otherwise. Therefore, most anti-OCD drugs don’t work, or can even exacerbate symptoms.

5. Several ‘stims’ that have the common factor of responding positively to restoring G-I health. Those include: severe, prolonged tantrums, self-abuse behaviors, aggressive behaviors, constant activity, and repetitive bending at the waist or pushing into objects.

6. Sometimes, they represent the affected child’s bodies’ appropriate response to really loud frequencies or incredibly bright lights that their altered sensory systems percieve. That assault on their senses may frequently become an issue as children recover and are even more keenly aware of the environment. Sudden onset of unusual behavior may indicate that the individual is experiencing a very annoying or new perception. Such a change in behavior is not always a negative that requires strong medication, or that medication would effectively treat, anyway.

7. Also, a child exhibits repetitive behaviors as a result of boredom. I spoke to one Mom who re-directs her child to empty the clothes dryer. She said, “It may take 45 minutes, but he’s not stimming while he’s doing that.”

8. Stims evolve. Some morph into other oft-repeated behaviors, and many just disappear over time. For the most part, the majority of my older patients have become rid of these activities. As children get older, they may be mistaken for tics, and treated in that manner, which is usually not effective, and may even be counter-productive.

9. As increasing numbers of neural pathways for speech become enabled, children often exhibit echolalia and scripting. These are forms of verbal stimming in a patient who is becoming more proficient. Such speech patterns are sometimes practice, so  they wouldn’t always be an activity that needs to be corrected. The child’s level of cognition can be much more accurately assessed by the quality (not the quantity) of repetitive speech. Over the years, parents have repeated words and phrases so frequently that children are often merely imitating the constant reiteration that parents expressed as they have sought to get through to their affected offspring.

10. Some recent literature may indicate that seizures, or seizure equivalents, may be represented clinically by repetitive behaviors. This may be especially true if the child seems to ‘flake out’ at repeated intervals, or displays alterations in gross motor movements such as jerking or clenching.

What stimming actions have in common is that they provide communication and are not always a negative that can or should be fixed. ‘Self-stimulatory’ activities are signs and symptoms that require examination and evaluation, not just behaviors that should be brushed off as part of the autistic condition.

Finally, in my experience, the ability to re-direct (rather than admonish or punish) such unusual behaviors serves as a measure of medical involvement, an insight into the cause, and a therapeutic intervention.

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Brian D. Udell MD
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