Posts Tagged ‘diagnosis’

Neurodiversity and Autism

Sunday, April 3rd, 2016

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

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

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

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

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

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

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

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

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

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

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

There is neurodiversity. And, there are autisms.

Reading, Texting, and Arithmetic for Special Needs Children

Sunday, February 14th, 2016

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

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

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

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

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

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

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

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

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

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

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

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

Seeking More, Better Autism Updates

Monday, August 17th, 2015

Every day, there is more information about this enigmatic epidemic. The Newsworthy tab on this site is useful for keeping up with some of the more controversial or confusing topics.

There never seems to be enough reputable, understandable, and useful news for families seeking help for a loved one affected with autism.

As of August, 2015, here is a representation of the most salient research:

Diagnosis
There are multiple reports that the increased number of patients with ASD is mostly the result of diagnostic changes. It’s difficult to understand WHY this is so important to the media. Cancer of the colon and breast is recognized more, as are autoimmune diseases, such as thyroid disorders. Plus, there are many medical diseases, such as chronic fatigue and restless leg syndrome, which weren’t even discovered until this century.

Though such information may be of some importance epidemiologically, it leads to confusion by affected families and skepticism by the general population. At The Child Development Center, there is a steady stream of patients who have no idea about DSM IV or DSM 5.0 criteria. Parents come seeking a trained physician who is willing to assist their non-typically developing child.

Genetics
This is where some of the most important discoveries should appear. It’s not like the ‘olden days’ when ASD was thought to be due to a single, as-yet-undiscovered mutation, infectious or toxic agent.

A myriad of possible genes, on a variety of chromosomes. previously unknown or thought to be of little significance, appear to be related to increased susceptibility in higher risk populations; including males, prematures, or children with immune problems. That situation, plus a toxic environment, creates the perfect storm for our little ‘canaries in the coal mine.’

Treatment
There is woefully little in the way of true new therapeutic interventions for children already affected with developmental delays such as speech apraxia, sensory processing issues, or aggressive behaviors.

Moreover, in spite of recent research indicating improvement with early intervention, the US Preventive Services Task could not recommend routine screening by pediatricians.

Prevention
The variety of studies that link advanced maternal and paternal age, increased maternal weight, and various other conditions of modern life, do little to ease the concern of prospective parents.

In fact, there are NO GoogleScholar.com entries on this subject in the present year.

Conclusion
Scientists can’t help but study this mysterious condition, in order to better understand not only ASD, but neurotypical behaviors, as well.

In spite of all the controversies that surround an autism diagnosis, medical researchers continue to make (slow) progress.

Docs, Glocks and Autism

Thursday, July 30th, 2015

gunMiami Herald
July 28, 2015
Appeals court upholds doctor-patient gun law

According to the article, “The law subjects healthcare providers to possible sanctions, including fines and loss of license, if they discuss or record information in a patient’s chart about firearms safety that a medical board later determined was not “relevant” or was “unnecessarily harassing.” The law did not define these terms.”

The law did not define these terms
It has been reported that U.S. Circuit Judge Gerald Tjoflat, the author of the majority opinion, understands that, in a patient at-risk for suicide, this might be a valid medical concern.

How about this case?

A fifteen year-old male who suffers from moderate-to-severe autism (or any other medical – psychiatric condition), takes Zoloft for aggressive behaviors, perseverates on violent video games, and doesn’t seem to grasp the line between fantasy and reality.

Would it be fair to say that a discussion by the physician with the parents about weapons in the home is appropriate?

The risk factors

  • The patient’s sex.
  • The person’s age.
  • Medication(s) use. There is even a ‘Black Box’ warning on SSRIs about the increased possibility of suicide.
  • The predilection for violent video games related to behaviors.
  • The teen’s inability to discern reality vs. fantasy. When asked, “Who is your best friend,” for example, one patient responded with the name of person who he had never met.
  • Constant bickering with parents over school.
  • A loaded gun in the house.

Discussion
Such a situation might be equally as valid when a patient experiences conditions other than ASD. Indeed, people ‘on the spectrum’ are probably less likely to act with outward aggression. Certainly, a discussion about elopement is absolutely a necessity in the face of autism, as are questions about a pool safety and the ability to swim.

Surely, there are a gaggle of gun-toting attorneys who can poke holes in my case. After all, I’m just a healthcare provider.

The lawyers representing the doctors got it wrong. This is not about the first amendment rights of physicians to discuss the issue of guns. This is about public safety. And, let’s face it, when it comes to vaccinations-for-all, as an example, there’s no problem protecting the herd.

Perhaps just as certain, is the possibility that, should a shooting death occur in this scenario, a lineup of litigators would appear on the radar screen, accusing the (ir)responsible doctor of not taking the obvious and necessary steps to prevent such a tragedy. “An Accident Waiting to Happen,” might be the headline.

Conclusion
This is an insane law that supports the NRA’s unyielding position about the rights of gun ownership. It is proof of how corrupted our system has become, due the superabundance of lobbying money.

Gun control is what we need, in the face all the senseless shooting deaths by too many young men, who obviously have mental challenges. However bizarre, it is a standing law that has now been upheld by the Florida Court of Appeals.

More information will be required to illuminate the holes that are created by this imprecise lawyer-speak.

Addendum:

http://www.aol.com/article/2016/07/27/two-thirds-of-americans-ok-if-doctors-ask-about-guns/21439181/

https://www.nytimes.com/2017/02/16/us/florida-doctors-discuss-guns-with-patients-court.html

 

Ten Noteworthy Observations about People with Asperger’s

Monday, February 2nd, 2015

reitman1Recently, I had the honor and pleasure of being interviewed by Dr. Hackie Reitman, an orthopedic surgeon, ex-prize fighter, and now author and producer. My role was to provide additional clinical information about his newest endeavor to address the difficult challenges met by people with Asperger’s syndrome.

The eclectic doctor has written and produced a soon-to-be-released movie entitled The Square Root of 2. Plus, he is in the process of publishing his enlightening book, “Aspertools: The Practical Guide to Understanding and Embracing Asperger’s, Autism Spectrum Disorders, and Neurodiversity,” to assist patients, families, and the public in understanding what it is like to live with Asperger’s, and helpful strategies for success.

Notwithstanding the official demise of the oft-used moniker describing a like-group of individuals, this compilation covers some frequent questions and observations:

10. As with autism, which is due to a variety of causes with varying presentations, there isn’t one kind of Asperger’s syndrome.

9. The appearance of any lack of cognition or empathy often does not reflect the affected individual’s reality. They experience emotions, like the rest of us, but do not necessarily exhibit them in a typical manner. Sometimes their frustration can boil over into extreme anger.

8. People ‘on the Spectrum’, who are able to communicate and aren’t aggressive, are considered ‘high functioning’. When Dr. Asperger described the first cases, however, earlier cognition and language differentiated his patients from ‘regular’ ASD.

7. Everyone who doesn’t get a joke doesn’t have Asperger’s, and many Asperger’s patients have a sense of humor.

6. Eye contact can be fairly difficult in Asperger’s. Patients often complain, “Do you want me to talk-listen to you, or look at you?”

5. Sensory issues are a major problem, and difficult for the neuro-typical individual to appreciate. Fluorescent bulbs are a distraction, certain sounds can be like chalk-on-a-blackboard, perfume may be nauseating, taste can be very picky, and just the thought of touch may become frightening.

4. Individuals can learn from a trusted friend, family member, or teacher.  However, many educational environments produce a distracting cacophony of sensory issues. Knowing that a highly social situation will be very anxiety producing makes the sufferer easily distractible and leads to poor focus. It’s not necessarily ADHD.

3. A narrow range of interests and repetitive behaviors are not always obsessive-compulsive behaviors, they are part of the condition. That is why the usual psycho-schizo-antianxiety medications are often ineffective in Asperger’s patients.

2. This is not a diagnosis ‘du jour’. People who experience this condition know it, and are usually relieved when they find out the reason(s) for their differences.

1. As with other ‘Spectrum’ patients, there are often additional somatic issues involving the gut, allergies, and nutritional deficiencies. A thorough medical workup with appropriate medical intervention is frequently quite helpful in relieving some core signs and symptoms.

Dr. Reitman, who is the father of an Aspie, is helping to design a better understanding and treatment of this mysterious condition. It’s comforting to know that, like Dan Marino, Ernie Els, and Jim Kelly, the autism community has another true champion on our side.

Autism, ADHD and Circumcision

Sunday, January 18th, 2015

New information has been forthcoming from a Danish database lately, specifically involving autism. This study represents data involving more than 1/3 million children, entered from 1994 to 2003 .

As might be expected, an eye-catching array of media headlines followed the paper entitled, “Ritual circumcision and risk of autism spectrum disorder in 0- to 9-year-old boys: national cohort study in Denmark”.

The Results:
In both the older and younger groups of circumcised boys, there was an increased relationship to ASD. Some adjustments (birthweight, APGAR score, etc.) were accounted for, while other known, possible associations were not (pain relief, living near pollution, diet, e.g.).

Additionally, circumcised boys in non-Muslim families were also more likely to have an ADHD diagnosis.

Other Research:
A 2013 study looked at the increasing incidence of ASD since acetaminophen (Tylenol) has been routinely used for pain relief during circumcision. The authors suggested “… the need for formal study of the role of paracetamol in autism.” In other words, they looked at the problem from the other direction; and when pain relief was provided, autism increased.

Discussion:
The Danish investigation contains a most glaring conclusion that makes the data-in-question eminently quotable, “We confirmed our hypothesis that boys who undergo ritual circumcision may run a greater risk of developing ASD.” I wrote to ask the principle author, Dr. Morten Frisch, about this.

The doctor took the time to respond to a number of questions about the information. He seemed to be somewhat sensitive that such controversy has surrounded these (admittedly) two highly emotional topics, and he is taking plenty of outside criticism. Furthermore, Dr. Frisch has assumed an “I’m-just-the-messenger” attitude about the conclusion.

For me, a major sticking point is a design anomaly which brings the entire report into question. Specifically, children who hadn’t been circumcised but were autistic were considered as not autistic until they got the operation, for the purposes of the data analysis.

For example, a seven-year-old who already had autism didn’t get classified that way, until he was circumcised at 7, (which is clinically impossible).
My question, “If a study shows that I am an architect, not a doctor, isn’t the study flawed?”
Dr. Frisch’s response, “No, in your example the methods would not be ’flawed’, but ‘imprecise’.” Either word – it’s inaccurate. The product only represents a mathematical reality.

Conclusion:
Male circumcision and autism are both very controversial issues. Supporters for various points-of-view will use self-selected segment(s) of the data to fit their particular pro or con argument.

The practice of male foreskin removal is decided according to family, friends, folklore, culture, customs, and cosmetics. The present medical evidence is far from conclusive.

Regarding the cause and prevention of autism, the more significant medical information is that vigorous scrutiny and intervention in a young infant’s nutritional and developmental status is the most successful means to fend off possible delays.

As for the present study? “There are lies, damn lies, and statistics.” (Mark Twain)

How Many Doctors Does It Take to Screw in a Light Bulb?

Sunday, December 14th, 2014

As seasonal changes come into full swing, too many moms are visiting too many physicians, and getting too few answers.

Children with immunologic difficulties who suffer conditions such as asthma, severe food sensitivities, eczema,or frequent infections are more likely to exhibit an increase in signs and symptoms under periods of increased metabolic stress.

The patient’s underlying situation may become more chronic or recurring. Or, there could be subsequent problems; the consequences of energy depletion and additional inflammation. So, parents wishing to hasten improvement, seek professional assistance.

Here’s where it gets tricky.
While traveling through an allergist’s territory, for example, the topic of recurrent or persistent ‘attacks’ may arise. The ‘allergy shots’ probably haven’t changed anything. Antibiotics are prescribed.

The doctor suggests that, perhaps an immunologist could figure it out.

Enter the doctor merry-go-round.
When another consultant is suggested (or, sometimes requested), there should be a realistic expectation about effects and side effects.

In this case, the typical response is a battery of tests that reflect immune functioning, according to that doctor. Results only represent the patient’s state of ill-health. A proper evaluation requires comparison to the child’s healthy state. Furthermore, by the time the tests become available, the clinical situation has probably already changed.

Often, steroids are added to the medical soup. The child feels a bit better, so returns to school and catches a cootie from another student.

More specialists are added.
Perhaps a different virus, a sinus infection, or an underlying allergic condition appears. Typically, a pulmonologist is the next stop. Another battery of labs and tests. Another confusing data set.

More steroids are added – inhaled, through nebulizers, and breathing treatments. Sustained improvement may not be achieved. Nowadays, the diagnosis of gastroesophageal reflux (GERD) is offered as a possibility, perhaps explaining the chronic and recurrent nature of the child’s condition.

A gastro-enterologist is then consulted. More tests add to the confusion. Prilosec or Zantac, potent stomach acid inhibitors, are prescribed. What is the concerned parent to believe?

Back to the Pediatrician.
The child who hasn’t improved by now is given a different, more powerful antibiotic. A discussion takes place about whether a New York specialist can offer better advice. In the meantime, academics and socialization have taken a back seat as families seek solid answers.

The primary doctor appears as confused as the parents about the next step. By this time, the patient is taking multiple, potent biologicals that may interfere with each other, or even make things more serious.

There is a solution.
Modern medical care is under scrutiny for the multitude of consultants, rarely resulting in better health care. There are often medication errors, with anxious and baffled patients who display little improvement – or worsen. The specialty of Pediatrics has been customarily exempt from such criticism, because of fewer medical complications.

As a mother recently exclaimed, “Do you think that I want to spend all of December traveling from one doctor to another? It takes a lot of work!”

One well-trained pediatrician, willing to consult with the specific specialists, who takes the time to understand what all those tests and medications represent for this individual, is the best answer. The professional who has the knowledge to interpret and clarify the picture offers the best opportunity for measurable improvement.

When the medical helm is steered by an effective professional, Mom has a lot more time to enjoy the season.

Autism, Broccoli and Cures

Sunday, October 19th, 2014

Sulforaphane treatment of autism spectrum disorder (ASD) made the news this week. According to Johns Hopkins’ researchers, an as-yet unavailable chemical derived from broccoli “…substantially (and reversibly) improved behavior…”

This is great news for parents and professionals who, for decades have been so deprived of clinical studies that are well – designed, performed, documented and published. Many families are now searching for the best way to get sprouts and seeds into their child with ASD.

Importantly, the proposed mechanisms behind the treatment lend mainstream credibility to the concepts of oxidative stress and the work of Jill James, who has published since the beginning of this century. “Sulforaphane, which showed negligible toxicity… upregulates genes that protect aerobic cells against oxidative stress, inflammation, and DNA-damage.”

The Good:
Supplements containing some of the chemical are for sale. There are ~1mg tablets, for example, that sell for ~30¢ each.  Broccoli seeds (the sprouting kind) are available for five bucks, though I’m not quite sure what to do with them.

One virtual vitamin shop advertises sulforaphane as AVMACHOL®, and that website is no longer available. It listed “365 mg of a proprietary substance made of 25mg of glucorapharin (the desired gluconsinolate form), broccoli sprout and mushroom extract.” One per day, @$ 1/per pill. Another lists Sulforaphane (From Broccoli), 0.4mg pill for only 4¢, but they were out of stock at this time.

The Bad:
There appears to be uncertainty regarding the bio-availability of the over-the-counter products. At it’s molecular weight (177 g/mol), and an average 100 uM dose (50-150 reported by researchers), it seems to represent a much larger dose (?~ 18 mg) than a broccoli side dish, or even the aforementioned supplements.

The Ugly:
Two of the authors in the study have explicitly rejected any claim to financial remuneration from sales of the expected product, due to “conflicts of interest.” Righteous! However, the son of one of those docs is the CEO of the new company.

Johns Hopkins University has U.S. patent applications and has licensed “… broccoli sprouts and seeds rich in glucosinolates… to Brassica Protection Products LLC.” That ought to raise the price.

Conclusions:
There are hundreds of patients who have been receiving reduced, (sulfur containing – cysteine boosting) liposomal glutathione for over 6 years, with great results. It turns out that the food with the highest known levels of glutathione – broccoli – works!

Parents who are already administering DMG, TMG, NAC, methyl B12, or reduced glutathione, should be alert for possible increased stimming with this added antioxidant.

At the very least, this information gives new meaning to moms who plead with their child to, “Eat your broccoli!”

Addenda:
Another opinion here

Simplifying study of fever’s dramatic relief of autistic behavior
Peter Good

ADHD – What else could it be?

Sunday, September 7th, 2014

In medical parlance, the title = “The Differential Diagnosis of Attention Deficit/Hyperactivity Disorder”. However, a major stumbling block to understanding, treating and preventing this childhood epidemic is that it is considered a single organic entity, mostly of familial origin. Treatment usually involves strong stimulant medications, with serious side effects, in order to semi-successfully control a perplexing mix of imprecise signs and symptoms.

It’s not ‘just’ ADHD:
When I first encountered hyperactivity in the previous century, it was called ‘minimal brain disfunction’. After adjusting the name to reflect the ‘hyperactivity‘, the term ‘attention deficit‘ was added to streamline the diagnosis. Common difficulties include distractibility, poor focus, constant motion, immaturity, a ‘short fuse’ and frequent disruptive behaviors.

Combining two conditions that are poorly understood makes the problem more, not less, complicated. Other than naming it differently, I’m not quite sure that we have learned much about ADHD in the past 40 years, except for the recognition that it is increasing.

It’s not just ADHD if the child also has:
Some other chronic, concurrent physiological infirmity. Allergies, poor sleep, bowel or bladder problems are often not separate, isolated maladies. Importantly, as the associated medical conditions are successfully addressed, many of the base signs and symptoms may be ameliorated, as well.

Notably, behaviors such as aggression, anxiety and opposition may be coping mechanisms, not core deficiencies. That would explain why prescription medications are frequently ineffective, only work for short periods, or can even exacerbate symptoms.

As in all medical conditions, the diagnosis requires a ‘workup’:
This week, our practice evaluated a patient who was exhibiting aggressive and oppositional behaviors. At the start of the school year, with so many children who have similar issues, the diagnosis would probably have been ADHD, and the patient sent home with an Rx for Ritalin. Except, on laboratory workup and by physical examination, he has thyroid disease!

Conditions as diverse as ASD, dyslexia, prenatal substance abuse, and even chromosomal changes may be present. Such circumstances are frequently missed due to the lack of elucidating a differential diagnosis –  what else could this child’s problem be?

Diet is important:
The studies about the effects of diet on ADHD are often difficult to interpret. The popular Feingold Diet focuses on artificial ingredients and salicylates, and has helped hundreds of thousands. WebMD provides a useful framework: overall nutritional, elimination and supplementation. Such a classification highlights the need to perform a thorough medical evaluation to eliminate much of the guesswork. If you can see it, you have a chance to beat it.

All the confusing nutrition babble aside, vigilant parents may discover offending agents and helpful substitutes. The problem is getting your kids to listen.

There isn’t just one treatment:
Stimulant medications. Three major variations. Caffeine citrate and nicotine patches can substitute.
Anti-anxiety drugs. Three on-label listings (Intuniv, Risperdal, Abilify) and numerous adult versions.
Homeopathic, naturopathic, allopathic variations.
Neurofeedback, NAET, neuro-sensoryelectrical stimulation, detoxification, etc.

Such a multitude of treatment options leaves professionals throwing darts at a moving target. The process is not exactly experimentation, but it certainly is trial-and-error. It isn’t difficult to understand why parents search the Internet for safe, effective intervention(s).

Close followup is key:
The present gestalt of listening to a parent’s concern, observing an antsy child in the office, and handing out a ticket for more over-prescribed ‘band-aids’ seems unstoppable. It’s not only the type of intervention, but how the child is evaluated and what specific signs and symptoms are successfully addressed, given the myriad of side effects.

Importantly, children are constantly growing, evolving and experiencing internal and external changes. Dosing, frequency, timing, and type of successful therapy will change dramatically over time.

Conclusion:
When a medical professional announces that your child has ADHD without a detailed history, review of systems, physical examination and appropriate laboratory evaluations, the patient is getting short-changed. It can even be made worse by over-prescribing potent pharmaceutical agents.

Parents who research the ‘net will find the landscape quite confusing. The best advice is to find a doctor with the skill, experience and time to understand this complicated diagnosis.

Smartphone Rules for Autism

Sunday, July 27th, 2014

There are a multitude of programs designed to engage, and hopefully enlighten communication-challenged youngsters. A great place to start is Autism Speaks’ Autism Apps webpage. That site contains a preferences filter, research ratings, and nearly 600 choices, as of this story.

The most affected and youngest patients with ASD seem to easily learn to navigate to their favorite game or YouTube video. Their facility in this arena frequently exceeds neuro-typical peers.

Since the landscape changes so quickly, specific programs are really not the issue. We have observed a new phenomenon of persistent play in developmentally delayed children who have easy access to their parents’ iPads, iPhones, etc.

Here are some of the issues that parents might consider when the child grabs for that partially broken, heavily armored, totally smeared and nearly unreadable device:

Even 1-year-olds are able to navigate the system. Parents should make sure that children are not merely doing visual-auditory stimming. What appears so cute, at first, can become a major annoyance. For some, just the credits of a favorite video or a certain song may seem quite fascinating. That is just a digital version of watching wheels, or a ceiling fan, spin. It’s not really play, and the time spent with this entertainment should be kept to a minimum.

Metabolic abnormalities found in our patients include a number of nutritional deficiencies. Vitamin D activation comes from the sun, not an iPad screen. Children must go outdoors and exercise. As old-fashioned and paternalistic as that aphorism sounds, it should be heeded, if parents have a sincere desire to help their children enjoy good health.

Try to avoid allowing such a compelling device to become the babysitter. With all of the variety, every child can find one or more apps that tickles their fancy. Busy parents may see the activity as a short break in their day – time to cook, take care of the other kids, or just relax. Unless the child is moved to another endeavor, the pattern could become a preferred, fixed, repetitive action that is difficult to manage.

Watching a small variety of videos, or various games on a device is still playing on the ‘pad. A core deficiency in autism is the existence of a narrow range of interests, so therapies should be targeted at promoting a diversity of experiences.

Apps that encourage learning basic concepts, such as number, color, letter and word recognition, can be a great educational aid. Once those skills are mastered, communication, starting with pointing, and skills that lead to sharing would be ideal.

The ultimate goal as toddlers mature is to be able to learn in a classroom with human teachers and classmates. Electronic programs can help prepare kids for the academic environment, but do the stated gains of any app promote the skills needed to succeed in school; such as, attending to the teacher, following verbal directions, and playing with other children?

Take advantage of this learning opportunity. Help your youngsters to get some socialization out of their digital experience. Join them as they master the games, and try to work on understanding how the app is somehow connecting to your children’s brains.

Smartphone rule #1, is… don’t let the smartphone rule.

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Brian D. Udell MD
6974 Griffin Road
Davie
FL 33314
Office phone – 954-873-8413
Fax – 954-792-2424

Email bdumd@childdev.org
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