Archive for the ‘Books’ Category

What Pediatricians Can Do About the Autism Epidemic

Saturday, June 27th, 2015

Pediatricians are the first line of defense against childhood conditions that have lifelong effects. Traditionally, that has included the Denver Developmental Exam, frequent doctor visits in the first few years, and vaccinations to prevent childhood diseases.

News Flash
There is an epidemic of childhood conditions that include ADHD and ASD, conflicting opinions notwithstanding. That means that pediatricians ‘stand at the door’, and are responsible for prevention and treatment, no matter how much they resist this reality.

Stay up to date on pertinent literature. As the HIV epidemic began to emerge, medical science experienced a quantum leap in our knowledge about the immune system. Similarly, the increasing volume of parents who are concerned about their children’s delayed speech, lack of focus, and hyperactivity, demands more research and knowledge and less kindly reassurance, which is based on the experience of the previous century.

Carry a high index of suspicion. Five or ten minutes spent with a parent and child is not enough time to perform a thorough physical examination and elicit pertinent clinical information. The visit should include a documented nutritional summary.

Make a presumptive (if not definitive) diagnosis. Parents need information, and the child’s pediatrician is the expert. It’s fairly simple – delay in communication, repetitive behaviors and lack of socialization demand an explanation and exploration. Loss of language, lack of eye contact, and poor tone are red flags to be explored, not ignored.

Do a proper workup. At least check the blood count, thyroid, liver and kidney function. What is over-kill about exploring vitamin and mineral deficiencies in a picky eater? Then, the doctor could evaluate whether appropriate intervention makes a difference in the signs and symptoms that concern parents.

Make appropriate consultations as early as possible. In a recent UC Davis study, six of seven high-risk children who received therapy alone lost the presumptive diagnosis. Parents will be more upset with the pediatrician who says, “Let’s wait,” and improvement does not occur, than one who advises, “Let’s err on the side of caution,” even if symptoms could have abated without intervention.

 Advise parents to try the gluten free – casein free diet for a few months. What is there to be afraid of? Uneasiness about creating a nutritional deficiency can be easily checked with laboratory evaluation and documentation of proper growth.

Perform an appropriate evaluation for associated signs and symptoms. Explore the cause of frequent infections, rather than responding with the knee-jerk reaction of prescribing antibiotics. Miralax® should only be given for brief periods and for occasional constipation, and isn’t even approved in children. GERD that is treated with antacid preparations can lead to vitamin deficiencies. Steroids may reduce skin rashes, but do not address to the root cause.

When a child has the diagnosis of ASD, the doctor should explore safety issues. Elopement is not uncommon, so family plans should be devised. Although learning to swim is no insurance against a tragedy, acquiring that skill helps provide some peace of mind. Incongruous laws notwithstanding, discussing gun security is a must.

Provide parents with a reading list. is a good start, where discussions are presented to address the polarized world of autism diagnosis and treatment. When possible, the essays have hyperlinks to the original research. The Newsworthy tab includes the most recent and pertinent literature.

Become knowledgeable about the variety of protocols. The doctor who has read the literature (both pro and con) about alternative treatments is the only one qualified to give advice. Practitioners who assert, “I’m not aware of this or that treatment,” may be highlighting their ignorance, rather than providing up-to-date info. Therefore, unless the pediatrician knows about a therapy, the patient will surf the ‘net, and listen to the professional who does.

Aspertools for Asperger’s Spectrum

Sunday, May 31st, 2015

There is a great deal of medical information to be learned about the autism epidemic of this century. Aspertools: The Practical Guide to Understanding and Embracing Asperger’s, Autism Spectrum Disorders, and Neurodiversity is a useful book to read and keep in our growing libraries.

It’s an interesting story in it’s own right.
The author is an orthopedic surgeon, professional heavyweight boxer, writer and film maker. That background, plus his life as the loving father of a special needs child, weaves a fascinating thread throughout the text.

This book is helpful for many parental challenges, not just Asperger’s Syndrome.
“Everyone… should be encouraged to discover their passion and then pursue it. If you can make a living at it, and if you can help others while you do it, so much the better.” Dr. Reitman talks about behaviors that get “amplified” in an Asperger’s patient, so many of the insights could work with ADHD, ASD, and oppositional behaviors, as well.

It’s best read by both the Asperg-er and the Asper-gee (those interacting with an Aspie).
Each chapter is presented from multiple points of view, including an expert teacher and the author’s daughter, who has the condition (and more), and provides helpful hints and useful action plans.

It’s a great place to start for a family looking for answers.
Patients with Asperger’s Syndrome have some common challenges, for sure. However, on closer examination, there is a great deal of diversity.
Dr. Reitman covers topics such as anxiety, meltdowns, sensory issues, transitioning, repetitive thoughts and “hyper-interests”, and socialization, with common sense techniques that deserve a trial.

The book also provides insights for experienced parents.
Aspertools contains information that makes sense and is easily applied to real life situations. Understanding that video games provide (virtual) socialization and an increased level of control, provides food for thought. Additionally, there are tips for limiting choices “to avoid ‘No!'”, practical concepts, such as breaking larger tasks into smaller ones, and the importance of time management.

Historically, the difference between Asperger’s and Autism was the age of language acquisition (later in the latter). The DSM 5.0 has subsumed the diagnosis under Spectrum Disorder. The delay in typical socialization is now being recognized as a common factor.

Autism expert (and patient) Jim Sinclair first spoke about the concept of neurodiversity in 1993. Aspertools contains informative vignettes, insightful humor, pathos, and practical ways to chart a successful course for an ‘Aspie’. In short, Dr. Reitman emphasizes the need to look at the world through another’s eyes.

In some ways, being less obvious than their ASD cousins, Asperger’s patients get the short side of research and successful intervention. This text paves the way for a better life for affected families.

The Autism Wars: Frank Bruni vs. Jenny McCarthy

Friday, May 2nd, 2014

Perhaps to mark the end of Autism Awareness month, but seemingly out of the blue, New York Times op-ed contributor, Frank Bruni, decided to weigh in on the vaccination-autism non-connection issue with this April 21, 2014 article. He accused Jenny McCarthy of being an “agitator… the intemperate voice of a movement that posits a link between autism and childhood vaccinations and that badmouths vaccines in general, saying that they have toxins in them and that children get too many of them at once.”

In this corner – Foodie Frank
Who is Foodie Frank to attack Gorgeous Jenny? His bio in the Times describes, “Over his years… he has worn a wide variety of hats, including chief restaurant critic… Rome bureau chief…  also written two New York Times best sellers: Born Round (“as in as in stout, chubby, and always hungry”), and Ambling Into History, (about George Bush)… coauthor of A Gospel of Shame: Children, Sexual Abuse and the Catholic Church.” Wikipedia adds that he “… became the first openly gay op-ed columnist…” of the Times.

Nothing in Mr. Bruni’s curriculum vitae points to any learned knowledge of science, biology, immunology, ecology or child development. The only extant association between Mr. Bruni and autism is this vacuous article that he penned. There is no evidence that he possesses any special information. Oh, that’s right, he did say that Yale’s autism expert, Dr. Fred Volkmar, told HIM that the vaccination controversy “diverts people from what’s really important, which is to focus on the science of really helping kids with autism.” A diversion from the important stuff, huh? As in, this bullshit op-ed story.

And, in this corner – Gorgeous Jenny
And what role does Jenny McCarthy play in this complicated, emotional and misunderstood quagmire that is the present autism epidemic? Her pediatricians didn’t even know what she was talking about when her child was diagnosed with autism. The conventional medical community says that, “Autism is what it is… you got what you got… deal with the situation and get (really expensive and difficult-to-find) therapies. Good luck.”

Parents are admonished not to listen to anyone who says that they can help with medical treatment, other than the standard psycho-stimulant meds. Even if Mom witnesses a change (from a GF/CF diet, e.g.), professionals warn that “It’s probably just a coincidence, like that disproven vaccination theory.”

Ms. McCarthy warned the country and the world that a storm was coming. Regarding ASD, doctors have displayed ignorance at best, and have even caused harm, due to delays and misdiagnosis. And, while we’re on the subject, if it turns out that her son, Evan, has one particular version of autism, that hardly constitutes some sort of fraud for the purpose of gaining visibility. Smack of bullying, Frank?

The child’s complicated diagnosis – made by the doctors –  doesn’t make McCarthy someone “who sows misinformation, stokes fear, abets behavior that endangers people’s health.”
Only the CDC, FDA, and AMA are allowed to do that.

I have been witness to the miraculous improvements served by childhood vaccinations. I recommend them to our patients; perhaps more diligently than might serve the ‘herd’, however, in susceptible individuals, doctors need to be very conservative. It shouldn’t be so complicated for the medical community to produce independent, prospective studies about the present vaccine schedule with 3 year follow-up aimed at developmental outcome, especially as it applies to higher risk infants.

No Winner is Declared
My advice is for Mr. Bruni to go back to his core competencies, Ms. McCathy to continue to fight for her child and help raise money for autism awareness-treatment-and-prevention, and for medical science to work on a better explanation(s) for this epidemic.

An agitator produces lots of heat with little light.
What a desperate mother does, is search for answers why her perfect, beautiful toddler became non-responsive and stopped talking.

Two Hundred Child Development Stories

Sunday, March 16th, 2014

This is my 200th official blog. Yay.

There were several reasons that I started writing back in 2011, and why I continue to produce these stories.

  1. To aid the constant Internet search that families go through in order to assist their developmentally-affected children. The reader’s ability to scrutinize the authority and basic science of medical information is proportional to the knowledge gained by “seeing it on the web.” Surfing is not research. I hope to provide a venue where readers can trust that the material is well researched and presented in a palatable form. Hyperlinks to the original articles are provided whenever possible. “Don’t argue with me,” I tell my skeptical colleagues. “Discuss it with the professors who wrote the paper!”
  2. My competition is the Internet. “My esteemed neurologist colleague,” who hasn’t changed his views on autism in the past 20 years, is still a respected professional. So, I write to enlighten and, hopefully, entertain, while making sure that is accurate and up-to-date. If you can’t beat ’em, join ’em.
  3. Producing this blog is homework. Days, and sometimes even weeks, are spent thinking about, researching, writing and editing each story. I am encouraged to organize my thoughts and to learn about new subjects. To teach is to learn.
  4. I can refer to these discussions for patient questions and clarification. These stories can provide a valuable aid to understanding some very complicated subjects. Plus, I invite readers to ask their pediatrician and other medical specialists to examine this information.
  5. The Child Development Center is a single practitioner private practice. With a small, but interesting and interested support staff, we are busy taking care of the patients, not studying them. This is an effective setting to tell our stories.
  6. Through this website, families from all over learn about this enigmatic epidemic and explore effective treatment options. reaches a worldwide audience. More than 150,000 visits have been recorded, there are now nearly 10,000 views per month, and the site remains high in Google searches. Importantly, I have the honor of caring for patients from around the globe.

Personal Facts
My favorite posting is “Joe the Plumber“, one of my first literary attempts in this digital venue. It was an attempt to convince parents that there were doctors willing to assist in the recovery of their affected children.

The most difficult work was the HBOT series. Such a complicated topic cannot be understood by advertising, testimonials or word of mouth.

My most emotional stories are on Mothers and Fathers Day. One Dad told me that he keeps a copy of the 2011 posting by his desk whenever he needs a healthy reminder about how lucky he is.

The busiest single story is not even mine! I’m not sure how she does it, but this mother warrior tells a great tale and has attracted many readers.

The most popular over time is the information about methyl B12 injections. I continue to refine and update that page; as well as to report that, under professional direction, this is one of our most effective medical therapies.

I am rarely at a loss for words about the epidemic of childhood developmental issues. Loyal readers, have no fear: I have over 60 blogposts ‘in the can’, ready to be fleshed out, awaiting more information, and/ or more interest. There will be more conferences to report about, and new research to be presented and explained.

To me, these are more than just stories.

Book Review – Ido in Autismland

Saturday, January 18th, 2014

Because autism is such a mystery, reading about it from the first-person point of view can be extremely instructive. That is why the story, Ido in Autismland, is so important to this medical professional.

There are similar recent books and videos, authored by affected individuals who convey their thoughts and feelings, so that neuro-typical readers may better appreciate underlying difficulties that lead to their unusual behaviors. What makes this different are the insights provided by penetrating and descriptive prose that transports the reader into Ido’s conflicted mind. It’s like The Reason I Jump on steroids.

Often, the issue of facilitated communication – another person involved in the download of information – is a key sticking point to establishing that such writing represents the actual thoughts that were being put forth. The teenage author makes a concerted and convincing effort to assure the reader that the information does, in fact, come from his mind alone.

Notable insights
The ability to communicate, and the lack thereof, has been the dominating force in his development. The subtitle is “Climbing Out of Autism’s Silent Prison”.

Ido emphasizes that his receptive language far outpaces his expressive language. Even if he believes he knows the correct answer to a question, it sometimes comes out of his mouth incorrectly (or not at all), due to his severe speech apraxia. This is mind bending.

Stimming is helpful, anxiety reducing, euphoria producing, embarrassing, nearly impossible to control and sometimes results in disruptive behaviors that even Ido can’t explain.

In addition to spoken language, the young author complains that generalized apraxia – the inability to move a variety of his muscles correctly – also interferes with his affect, hand movements (sign language and even pointing were a challenge), and the ability to interact properly in social situations.

Lack of empathy, or a sense of humor is not a sign of autism. That is merely how it appears. This kid has got soul, and he’s funny.

Ido’s exhortations to medical science give me help and hope.

If you are the parent of a young child who has been newly diagnosed with ASD, or suspect it, and you are seeking further information, this may not be a helpful read. Parents will do better to investigate medical problems, such as; G-I signs and symptoms, allergy related conditions, sleep disturbance, or other specific developmental concerns. As particular disorders are successfully identified and addressed, many atypical behaviors can be ameliorated and even prevented.

If you are an observer of this epidemic, AutismLand is an interesting read. Everyone can learn something from this journey through the mind of such a unique child.

If you are a professional who works with people with autism, you need to read this twice. The first time will be disturbing and challenge many of the basic beliefs. The second time, understanding will creep in and you will think of ways to incorporate such knowledge into your practice.

If you are an affected individual, or the parent or family member of an older child, this is a must-read. Ido discusses a variety of topics that will educate, enlighten and even entertain those who are trying to understand AutismLand.

Books About Autism cont’d

Sunday, December 1st, 2013

Occasionally, texts appear that are so compelling, they are assigned to my Official Autism Library. The scientific stuff can be found in medical journals. These are stories about how people think, what they think about, and about their lives. What makes them really special is when insights are provided that assist our understanding about why affected children exhibit unusual or repetitive behaviors.

The Reason I Jump has been at the top of my list, lately, because it tackles perplexing questions about atypical actions. Written in 2005 by a 13 year-old Japanese boy with autism, this short story presents his insights regarding many such enigmatic gestures. There are several drawbacks, leading to controversies that surround the book, however.

First, is the issue of facilitated communication, the method by which challenged individuals are able to confer their ideas to the outside world. This is accomplished via another person, the facilitator. A subcommittee of the American Speech-Language-Hearing Association has issued detailed reports about this form of translation. There are a number of criteria that are utilized to ascertain whether the final product accurately reflects the author’s thoughts.

Another question concerns the complicated journey that the autobiography has taken from the Far East, 8 years ago, to the West, this year. The author, David Mitchell, is a fiction writer, best known for Cloud Atlas. As a child, Mr. Mitchell suffered from a severe stutter, and he has a child with autism. With his Japanese wife, Mr. Mitchell ‘discovered’ and translated the story, without apparently ever having met or spoken to the boy.

In the book, the child responds to 50 or so questions about “Why do you…?” Some are simple, “It may look as if we’re being bad out of naughtiness, but honestly, we’re not.” Other explanations, “What makes us smile from the inside is seeing something beautiful, or a memory that makes us laugh,” are even elegant. Many of the answers appear to be coming from a teenage mind, but statements such as “… and that saps the spirit we need to soldier on,” are not consistent.

Currently in his twenties, Naoki Higashida, the actual author, participates in this blog. There is much more that he could tell us now.

In autism, behaviors that appear to represent a given emotional state, such as anxiety, are often misinterpreted. For example, to call I’m-pushing-my-fist-on-my-chin when I am angry/happy/sad/confused/hungry/excited, an obsessive-compulsive personality disorder is surely and sorely inaccurate. Children who begin experiencing additional muscle tone and sensation in the area around their tongue and mouth may be demonstrating improvement in their speech apraxia, rather than suffering from a psychiatric condition.

Facilitated communication, etc. notwithstanding, I am a fan of this book.

  1. It adds to my repertoire of possible reasons that patients display unusual behaviors.
  2. The accounts are not inconsistent with those of other patients, such as the teenage girl featured in this video.
  3. Many explanations make sense as I observe patients’  downstream signs and symptoms.
  4. The information makes people affected with ASD appear so much more LIKE US than we think.
  5. Ultimately, what difference does it make how such knowledge becomes disseminated?
  6. Discussions about this book raise autism awareness.

This is only my second book review, so far, but it prompts the addition of a Recommended Books Section to the website.

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Brian D. Udell MD
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