Archive for May, 2020

Notes on an Epidemic 2 – Not COVID-19

Monday, May 25th, 2020

Quarantine has led our practice down the road of virtual visits, in order to continue to assist the ever-growing population of developmentally different patients. At each interview, I have asked the parents and children what they liked best?, and what was the most challenging? during this bizarre period in human history.

The Good
No doubt, more time spent together as a family was the #1 response. Parents ‘forced’ to work from home, avoid travel, furloughed (or worse), closed businesses, first responders whose partner must remain with the kid(s), and… well… no one else to rely on! The nuclear family alone, together.
So, what did parents learn?
Renewed kudos for teachers, and appreciation for the multitude of difficult tasks they perform daily.
Renewed appreciation for the caretaker who has been at home, previous to this catastrophe.
Keener awareness about the child’s strengths, weaknesses and unfulfilled abilities.
First-hand observation of how the child responds to educational demands. Often, parents get to observe the reasons why teachers, and other professionals complain of poor focus, attention, easy distractibility and overactivity.
One-on-one interactions, when possible, may often result in more effective education.
Healthier meals for all, and those who require specialized diets are more likely to be in compliance.
Reduced stress and anxiety for the child, and often the entire family.
Fewer distractions when afforded appropriate space.
More exercise as permitted by outdoor exposure.

The Bad
Being cooped up in a relatively small space with only the ones that we love, highlights how much we must love them.
One child replied to the commonly asked, “How am I as a teacher?” question with, “Mom, you really suck!” Parents signed up for parenthood, and the skillset of teachers and therapists is just that – a learned and practiced art. You can’t just hand the job over to a Mac.
Consistency is a hallmark in successful treatment of behaviors. Every learned skill requires practice and repetition until the child understands the concepts. Quarantine has disrupted this process, so return to a ‘real’ schedule with professionals, feels like a MUST.
Acquisition of medications and supplements, and other necessary doctor visits have had to be postponed, adding to concern and frustration.
In such closed quarters, many ASD patients get to practice manipulation on their parents.
Online courses fail to grab many children’s attention – especially if focus is a basic concern. Parents’ constant need to redirect may become another learned behavior – by the parent!
Certainly not parents, but even siblings, do not represent the true exposure to socialization the patients must practice.
Schedules, with are such an important ingredient to assist children’s development, become relaxed or absent. Often, sleep can become disturbed, as well.

The Ugly
Behaviors in confined spaces can become extremely violent, disruptive, and may even require potent medications.
Resources have become stretched and so therapies, medications and supplements have sometimes had to take a back seat to more basic needs.
On-line special needs learning can be especially frustrating and become counter-productive if behaviors deteriorate.
Back-to-school, whenever that happens, is gonna be a bitch for many families.

Conclusion
Perhaps surprisingly, some parents have decided to stay home post Quarantine. That given this time, a more complete understanding about what the child can do- and can’t, what the educational system can do- and can’t, and how this new-found information can lead to optimal outcome for every child.

Others have said, “No, this kid needs to get the willies out, needs to get with other children, has to learn to follow a schedule, and get back to the therapies that were getting Junior on the right track.” Okay, that’s helpful to know, as well, especially if families were wondering, “Was any progress being made?”

Given that there is no next ‘normal’, perhaps parents will discover a more fitting new ‘normal’ experience for special needs children.

Notes on an Epidemic – Not COVID-19

Tuesday, May 5th, 2020

What is the best way for medical experts to get ahead of this modern pandemic? This very website, TheAutismDoctor.com, has provided my most fruitful research since opening The Child Development Center of America over a decade ago.

As in previous epidemics, such as ‘Cocaine Babies’ or ‘HIV Babies’, conventional medicine is slow to recognize, slower to study and, therefore, even slower to treat. So, how is a curious pediatric fellow with a particular interest in an emerging medical event supposed to learn how to help affected patients?

Modern allopathic medicine does not provide a Pediatric Residency or Fellowship to address functional and holistic medicine for any malady, let alone ASD. Psychiatric, neurologic and pediatric specialists consider their role in autism as diagnostic, not therapeutic.

Although medical journals have been the traditional method for accruing necessary information, the choice is no longer the obvious Pediatrics, Neurology, or even Child Development publications. Such ad-supported literature seems to underrecognize, underreport and mischaracterize the ever-increasing number of affected patients (see CDC graph). The current issue of PEDIATRICS features 13 new scientific articles. Two studies report about weaknesses in vaccinations programs, two cover the dangers of e-cigarettes, and no mention of ASD in the cover sheet. In Utero Antidepressants and Neurodevelopmental Outcomes in Kindergarteners and Rates and Stability of Mental Health Disorders in Children Born Very Preterm at 7 and 13 Years ARE about autism, but you wouldn’t necessarily recognize it from the title.
The conventional approach appears to be overly concerned about proving that alternative methods are useless at best, harmful at worst; and safety first – at all costs – when it comes to diagnosis and treatments for autism. Sidestepping the “A” word impedes the rise of important studies when Googling “research in autism spectrum disorder.”

Valuable information can be researched in peer-reviewed publications such as Autism Research, Molecular Autism, Autism, Journal of Autism and Developmental Disorders, Developmental Medicine & Child Neurology, plus the all-too-few papers that appear in trusted periodicals, such as The New England Journal of Medicine, or the Journal of The American Medical Association, for example. Google Scholar and National Center for Biotechnology Information, are reliable resources when seeking specific information about a specific topic.

Presently, The Medical Academy of Pediatric Special Needs (MedMaps.org), whose goal is excellence through dissemination of scientific information and collegial interaction, represents both a useful starting point as well a valuable venue for the most seasoned practitioners from all over the world to learn and discuss our unique problems and practices. Our canceled semiannual March meeting was another notch in Coronavirus’ take-no-prisoners belt.

In the meantime, an offshoot, highly non-official group has coalesced. Our small band of pediatric specialists has dubbed ourselves as the ‘Havana Group’, because of our initial conversations at a similarly named restaurant in Costa Mesa, CA (remember the days when we met at restaurants?). New problems continue to arise, and complicated medical issues are discussed via video chats. So far, viri (of any type) have not interfered with our monthly meetings.

Experience being the best teacher, our families’ journeys and the children’s response to various protocols have become the most valuable resource for outcome success. Professional Fellowship enables members to gain knowledge exponentially, especially given the ever-increasing number of patients. In the face of sparse useful scientific research, many practitioners have developed our own database as another valuable tool to track progress.

Discussion
The Corona Virus Epidemic has forced everyone into a state of profound reflection and redirection. Certainly, parents who are at home have become de facto school administrators, nurses, teachers, and therapists, in additional to all the other parental and (hopefully) work duties.

This near-apocalyptic viral event has prompted a renewed journalistic inclination to spread the word about another medical catastrophe. COVID-19 represents complex, serious and vexing medical problem. However, it appears a great deal more solvable – with a lot more resources – than the epidemic that is affecting nearly 2 percent of our children.

Conclusion
Preparing stories for TheAutismDoctor.com, has proven an invaluable tool by forcing an organized approach to the successful treatment of a disparate but somehow related variety of signs and symptoms presently classified as ‘Autism’. Quarantine has afforded my practice the increased time to read and write about the most important childhood epidemic of the 21st century.

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Brian D. Udell MD
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Davie
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Email bdumd@childdev.org
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