Posts Tagged ‘doctors curing autism’

Fecal Transplant as an Autism Treatment

Sunday, June 3rd, 2018

The prestigious New England Journal of Medicine recently published an article entitled, Fecal Microbiota Transplantation for Primary Clostridium Difficile Infection. It is likely that parents of children with ASD, who exhibit gastrointestinal difficulties, will ask, “Can we use this to help Junior recover?”

The answer is a complicated, “Maybe. But, more research is needed.”

The study looked specifically at ‘C. diff’ – one strain of bacteria, not to be confused with parasites, fungi, viri, or other nasty cooties. The follow up was a mere 70 days. In children with yeast or other such distress, recurrence may appear weeks, months, or even years later.

Recent Literature
According to the Fecal Transplant Foundation, the treatment, “was first documented in 4th century China, known as “yellow soup”… there has never been a single, serious side effect reported…”

2010
Pyrosequencing study of fecal microflora of autistic and control children
Dr. Feingold, “examined the fecal microbial flora of 33 subjects with various severities of autism with gastrointestinal symptoms, 7 siblings not showing autistic symptoms and eight non-sibling control subjects… The results provide… a compelling picture of unique fecal microflora of children with autism with gastrointestinal symptomatology.”

2012
This review concluded that FMT, “is now arguably the most effective form of Clostridium difficile eradication… potential value in ulcerative colitis… as well as previous unexpected applications, such as obesity, diabetes and several neurologic disorders.”

2013
Fecal Microbiota Transplantation: Indications, Methods, Evidence, and Future Directions
“Most institutions utilize fresh feces, have adopted an approach of using highly filtered human microbiota mixed with a cryoprotectant and then frozen… with dramatic shifts in recipient gut microbial communities noted after transplantation… The route of administration … can be naso-duodenal, transcolonoscopic, or enema based…”

2014
A research paper that summarizes, “FMT is a highly effective cure for RCDI (recurrent Clostridium difficile infection), but increased knowledge of the intestinal microbiota in health maintenance, as well as controlled trials of FMT in a wide range of disorders are needed before FMT can be accepted and applied clinically.”

2015
Fecal microbiota transplantation broadening its application beyond intestinal disorders
The authors covered earlier works and noted, “FMT is a promising approach in the manipulation of the intestinal microbiota and has potential applications in a variety of extra-intestinal conditions associated with intestinal dysbiosis.”

2017
Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study
A rather complicated 2-1/2 month protocol resulted in, “an approximately 80% reduction of GI symptoms at the end of treatment, including significant improvements in symptoms of constipation, diarrhea, indigestion, and abdominal pain. Improvements persisted 8 weeks after treatment… behavioral ASD symptoms improved significantly and remained improved 8 weeks after treatment ended. “

Discussion
Signs and symptoms of gastro-intestinal distress ought to be present when seeking such treatment. This may appear obvious, but oft-times the gut has already been addressed and healed. Or, the primary cause(s) of the autism may originate from elsewhere, such as metabolic, genetic, toxins, etc. This complicated intervention may be superfluous.

One potential harm of fecal transplantation is The Unknown. What might the tiny viri, of which we know little – other than their ability to transform cells (cancer, cell death, immunity) – do to the recipient as regards potential long term danger?

Another risk is The Known. Can transferring bacteria from one person to another cause harm (immediate or delayed), due to allergy or other incompatibility?

Prior to his untimely demise a few years ago, in a personal communication with the intrepid Dr. Jeffrey Bradstreet, he lamented that the process was extremely resource intensive (to assure safety) and subject to recurrences, after as little as 3 months.

Conclusion
Earlier, Dr. Feingold noted, “If the unique microbial flora is found to be a causative or consequent factor in this type of autism, it may have implications with regard to a specific diagnostic test, its epidemiology, and for treatment and prevention.” FMT research helps enforce the gut-brain connection that has been noted in autism since Dr. Leo Kanner described the condition 80 years ago (although his Freudian underpinnings seem to have obfuscated his patients’ GI issues).

Autism consists of a variety of mysterious signs and symptoms. In all of the studies performed to date, there is a relatively short followup period, not necessarily reflective of an affected child’s time frame. It is difficult to ascertain whether regression, aggression, poor sleep, diarrhea, constipation, sensory overload, etc. are due to a specific organism or a different mechanism. Accurate knowledge the intestinal microbiota is paramount to assess efficacy and prevention of recurrence.

As costs, resources and safety become established with other disease entities, and practitioners learn how to effectively administer the protocol, this type of treatment may take a more prominent role in treatment of Autism Spectrum Disorder.

* My previous article on this subject appears here.

Autism & MTHFR Explained

Sunday, April 1st, 2018

From the work of Jill James, Amy Yasko, and others

I have attempted to write this explanation – about the MTHFR gene – for more than a year now, often surrendering because it just gets so complicated (see diagram on right – and that is a simplified version)!

However, almost daily now, I need to explain the testing and interventions that revolve around the MuthrF#$Ker gene, which produces an enzyme that can assist in the brain’s ability to process (among many other important body reactions) in patients with ASD.

So, here is my simplified version, which covers the important steps for our understanding about testing and treatment for autism:

1. Folate (natural), folic acid (synthetic), Folinic acid (active) and 5-methyl folate (active) are not exactly the same a form of Vitamin B9.

2. There are several reasons why the levels of the B9 might be reduced:
Reduced intake. Picky eaters and kids don’t usually savor green leafy vegetables or lentils.
Problems with internal state of health will affect availability. Synthetic folic acid must go through the liver, natural folate is metabolized through the intestines.
Antibodies that bind to, or block the active compound. This is why doctors check the Folate Receptor Antibody Test (FRAT). The presence of such inappropriate barriers implicates reduced activity, so administration of additional vitamin should help alleviate difficulties.
Any ‘weakness’ in the body’s inability to convert the vitamin – that includes the MTHFR gene that regulates the enzyme called methylene tetrahydrofolate reductase.

3. The most studied and concerning genetic variations are often designated as C677>T, A1298>C. Hieroglyphics aside, we  inherit a ‘C‘ and an ‘A’ from each parent, and each deviation yields a less potent enzyme, so the implication is that giving the active forms of the vitamin can be beneficial. (Dr. Google, and many labs will report variations as pertains to the risk of hyperhomocysteinemia, a medical condition observed in approximately 5% of the general population, associated with an increased risk for many disorders.) For ASD, improved communication is the goal of treatment.

4. The supplements include L-methyl folate, available as a prescription under Deplin®. A web search of this product will often result in a call from parents, “My child doesn’t have schizophrenia or depression!” Marketing. Improved outlook is just one of the treatment outcomes. As noted previously, in ASD the aim is more efficient neural processing.

5. Another intervention is available as folinic acid (<1 mg dosages) and as the prescription, Leucovorin. An Internet inquiry may stimulate a call, such as, “My child doesn’t have cancer or get chemotherapy.” Different market. At a recent MedMaps.org conference, I asked two top researchers whether they prefer one or the other active form. Each doctor replied with the opposite answer. Availability and cost help determine choice, and sometimes we try both.

Conclusion
The various forms of folate appear to be safe, effective interventions that can address weaknesses in the area of oral-motor functioning in individuals with ASD. In practice, agitation is the principle side effect, and too much ‘stimming’ or aggression is reason for discontinuance.

The gene controlling MTHFR production is important, but not the only one affecting multiple enzymatic pathways that lead to successful data processing. We are already discovering other critical genetic steps (SOD, COMT, etc.) and there are thousands of other genetic crossroads that will improve our understanding and lead to successful interventions.

For our more advanced readers – please feel free to submit any corrections, etc. that you feel might be necessary.

Medical Academy of Pediatric Special Needs Conference – Spring 2018

Sunday, March 18th, 2018

The Fall 2017 conference was ‘hurricaned’ out, so it’s been a year since I reported on the semi-annual 3-day scientific meeting of the Medical Academy of Pediatric Special Needs. This post will focus on the two most controversial topics – one, a treatment, and the other involving a popular new diagnosis.

Medical marijuana.
The less psychoactive, and legal part of pot – CBD (cannabidiol) – has been available for a couple of years now. Our experience at The Child Development Center, and the consensus of the group, was that it may be helpful for seizures, but perhaps less so for aggression, stimming and sleep. With no serious side effects, however, except for price (for high quality, measurable concentrations), it could be worth a try.

Much more effective, according to Dr. Michael Elice, are products that contain a measurable amount of THC (tetrahydrocannabinol). The presentation covered his experience with CBD+THC = medical marijuana. Utilizing the Autism Behavior Checklist as a measuring tool, he noted significant reductions in irritability, ‘lethargy’, stereotypy (stimming) inappropriate speech, and hyperactivity for a small number of children. To be fair, he also presented a child whose symptoms worsened with treatment. Overall, Dr. Elice told the audience that this intervention can be quite helpful for aggression and negative behaviors, though not for the ‘verbal diarrhea’ that many recovering children exhibit.

I inquired about the paucity of literature supporting medical marijuana, and studies that describe abnormal brain development when administered to youngsters. Dr. Elice responded that 1) The affected children’s brains are already demonstrating problems in development, and 2) Compared to the conventional meds, cannabis seems more efficacious with fewer side effects

No protocol was offered… the correct form, concentrations of THC/CBD, timing, and best mode of administration have yet to be elucidated. For physicians in states where pot is not legal, this treatment is not a realistic option. Even where there are medical exemptions, the process is resource intensive and tedious.

PANDAS/PANS 
Auto-immunity that affects a young child’s brain in an acute fashion, has been a popular diagnosis of late. Participants were treated to a full day of discussion by the most famous clinicians and researchers in the field. The room was packed.

The first speaker of the day was Dr. Aristo Vojdani, an Israeli researcher who practically invented food allergy testing. In fact, he began his presentation by declaring that he has learned the weaknesses of his earlier work, and the misconceptions about those tests. His take home messages were 1) Group A streptococcus is only one of many environmental trigger that contribute to symptoms, 2) Many pathogens and food components cross react with brain cells to cause problems, and 3) Accurately defining such antibodies and which receptors are affected is necessary to remove the environmental triggers.

Dr. Madeline Cunningham presented her modern view of molecular mimicry – “the sharing of antigenic determinants between the host and invading organisms.” The heart, brain, and other tissues can become the targets of the body’s response to environmental pathogens or toxins. Identifying the reactivity of brain proteins – the Cunningham Panel – may not be specific to strep, and helps explain disparate results. Tics, OCD and other neurologic difficulties are the result of a weakened blood-brain barrier and cross-reactivity.

Dr. Tanya Murphy presented, Antibiotic Treatment in PANS, Panacea or not? The specific signs and symptoms of PANS and PANDAS were elucidated. The role of Group A strep as a precipitating agent was emphasized. Specifically the rise of ASO (antistreptolysin O) often precedes the rise AntiDNAse B, but a positive culture for the organism is the best evidence. The successful role of antibiotics in general, and which ones seemed to work best was covered in detail.

A panel discussion involving these esteemed experts completed this incredibly interesting day.

Conclusions
Practicing functional and integrative medicine nowadays, with insurance stipulations and conventional dogma, presents unique challenges. The pediatric version faces even more obstacles, due to uncertainty of diagnosis, non-conventional treatments, and the vaccination issues. Without this Pediatric Fellowship, such work would be even more frustrating. The sharing of our collective experience regarding the epidemic of children with ASD and ADHD has taken diagnosis and treatment to newer and more modern levels of understanding.

As in previous years, the most valuable part of these conferences is the esprit du corps and networking of experience and ideas.

Significant Autism Events of 2017

Thursday, December 28th, 2017

In the face of the exploding incidence of childhood developmental abnormalities, scientific knowledge is sorely lacking. These are my top picks for this year’s most useful human research and events that address our understanding about the cause(s) and treatment(s) of these conditions.

January
Disrupted prediction errors index social deficits in autism spectrum disorder
This BRAIN study which locates “… coding discrepancies between the predicted and actual outcome of another’s decisions…” provides, “a novel insight into the neural substrates underlying autism spectrum disorder social symptom severity… could provide more targeted therapies to help ameliorate social deficits in autism spectrum disorder.”

February
Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study
“This exploratory, extended-duration treatment protocol thus appears to be a promising approach to alter the gut microbiome and virome and improve GI and behavioral symptoms of ASD. Improvements in GI symptoms, ASD symptoms, and the microbiome all persisted for at least 8 weeks after treatment ended, suggesting a long-term impact.”

March
WORLD’S LARGEST AUTISM GENOME DATABASE SHINES NEW LIGHT ON MANY ‘AUTISMS’
There were several studies, this year, that implicated the genetic susceptibility of ASD. This one is from Autism Speaks’ MSSNG project. “The omitted letters… (pronounced “missing”) represent the missing information about autism that the research program seeks to deliver.”

April – Autism Awareness month
The Pesticide Action Network and the Natural Resources Defense Council filed a complaint against the EPA, led by Trump appointee Scott Pruitt, asking a federal court to make the agency follow through on an Obama-era recommendation to ban chlorpyrifos, a pesticide linked to brain damage in children. The Trump administration reversed that recommendation last week — even though the EPA concluded in November that the pesticide is associated with autism, lowered intelligence, developmental delays, and attention deficit disorders.

Injury Mortality in Individuals With Autism
Conclusions were that, “Individuals with autism appear to be at substantially heightened risk for death from injury.”

From the FDA, this warning – Autism: Beware of Potentially Dangerous Therapies and Products

May
Autologous Cord Blood Infusions Are Safe and Feasible in Young Children with Autism Spectrum Disorder: Results of a Single-Center Phase I Open-Label Trial
Not the most rigorous study design, and safety does not imply efficacy. Nevertheless, by utilizing the infant’s own stored umbilical cord blood, “Behavioral improvements were observed during the first 6 months after infusion and were greater in children with higher baseline nonverbal intelligence quotients.”

June
Intranasal oxytocin treatment for social deficits and biomarkers of response in children with autism
The Child Development Center has been finding this treatment somewhat helpful for eye contact and socialization.

Functional neuroimaging of high-risk 6-month-old infants predicts a diagnosis of autism at 24 months of age
Functional, not merely structural connectivity was tested at a very early age. Only in the research phase, “These findings have clinical implications for early risk assessment and the feasibility of developing early preventative interventions for ASD.”

July
Low-dose suramin in autism spectrum disorder: a small, phase I/II, randomized clinical trial
Dr. Naviaux reported the use of a 100 year-old medicine for African Sleeping Sickness on a small group of ASD patients. His unified theory of central nervous system dysfunction involves the ‘Cell Danger Response’ – a proposed common pathway leading to autism. This could represent the most promising research of the year.

August
Increased Extra-axial Cerebrospinal Fluid in High-Risk Infants Who Later Develop Autism
The MRI test may assist in identifying autism risk in susceptible infants and younger siblings of affected children. However, accuracy was not optimal. Additional studies will be required to suggest whether it is worth risking exposure to anesthesia for testing.

September
Some good publicity for Planet Autism. The Good Doctor, a TV show about an autistic professional appeared on ABC. Compared to Rain Man, it represents a quantum leap in the public perception of autism. Also, Julia, a muppet with autism, joined the cast of the popular PBS children’s show ‘Sesame Street’. Plus, debuting this year was Netflix’ new comedy about an autistic teen, Atypical. Finally, you may want to check out these two offerings: Keep the Change, a love story which challenges popular misconceptions about ASD, and the more serious Deejinclusion shouldn’t be a lottery.

Combined Prenatal Pesticide Exposure and Folic Acid Intake in Relation to Autism Spectrum Disorder
Folic acid is a vitamin given to pregnant mothers to prevent spina bifida. When taken in higher doses during the first trimester, “… associations between pesticide exposures and ASD were attenuated…” Should all younger women be taking vitamin B9, or could it be too much of a good thing?

October
Accurate Autism Screening at the 18-Month Well-Child Visit Requires Different Strategies than at 24 Months.
Comparison of Autism Screening in Younger and Older Toddlers.
Accuracy of Modified Checklist for Autism in Toddlers (M-CHAT) in Detecting Autism and Other Developmental Disorders in Community Clinics.
These three studies evaluated a popular screening tool for autism, and found that is more accurate in children at 24 months of age than at 18 months. Pediatricians and other specialists need a superior tool to test children younger than 20 months. At The Child Development Center, we have found that the Autism Evaluation Checklist, careful observation, and a detailed history will yield a more accurate diagnosis.

November`
Association of White Matter Structure With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder
By utilizing a specialized MRI technique researchers were able to discover, “ASD traits and inattention and indexes of white matter organization, particularly in the…” tissue that connects the two halves of our brain. This technology might also identify ‘Processing’ and ‘Executive functioning’ disorders.

Subcortical Brain and Behavior Phenotypes Differentiate Infants With Autism Versus Language Delay
By combining MRI information plus behavioral assessments, scientists might be able to predict which children are only experiencing ‘benign’ speech delay.

December
Tools and techniques to improve the oral health of children with autism
By offering these suggestions, there is recognition of the need for improved mouth care in children with sensory and oral-motor issues. It’s one of the most obvious places to reduce the body’s inflammatory load.

Differences in fecal microbial metabolites and microbiota of children with autism spectrum disorders
Confirming the stool testing that functional medicine doctors utilize, “… data in this study support that children with ASD have altered metabolite profiles in feces when compared with neurotypical children and warrant further investigation of metabolites in larger cohorts.” Evidence-based medicine.

Advances on the research of the environmental risk factors of children autism
Amid all of the recent genetic research is this reminder that documents, “risks of autism in children may increase following in prenatal exposure to air pollutants, heavy metal and pesticides.”

Conclusions
Another year of more questions than answers. Why does it seem to be taking so much time for useful human studies to appear? Dollars for basic research depend on funding agencies’ understanding of this enigmatic condition. Plus, it takes more than a billion dollars to develop any new medication, so ASD is a very risky proposition.

Then, there is the Bettleheim effect (he popularized the ‘refrigerator mom’ theory), the Wakefield effect (any new idea about autism becomes suspect), the vaccine effect (just talking about ASD leads to this controversy), and the continued debate about whether there even really IS an epidemic.

However, practically everyone, nowadays, knows some family that is touched by this developmental disorder. We must continue to hope that progress will accelerate in response to the reality of a condition that affects so many of our children

Ten Top Toys Not to Get Children Affected with Autism for the Holidays

Thursday, November 23rd, 2017

Maybe this list applies to all modern kids. Especially as regards offspring who are ‘on the spectrum’, our experience and perspective from The Child Development Center can assist gift givers with decisions about whether holiday offerings are consistent with recovering challenged children, as well as making them happy.

What Not To Get Junior for the Holidays

1. Toys that talk to your kid. It’s supposed to be the other way ’round. Imagination through a favorite dolly or stuffed animal, and self talking, represent practice in communication. If someone has to invent a robot that speaks, it should also prompt. Can you imagine that conversation?

2. Stuff that fosters repetitious behaviors. Scrubbing Angry Birds on a digital screen preys upon the fabric of the youngster’s repetitive behaviors. Similarly, devices that enable constant You-Tube video re-viewing foment restricted interests.

3. Most digital gadgets, unfortunately engender those problematic criteria previously listed (#1, #2). i-Things should be reserved for when the parents absolutely cannot attend to the child, rather than becoming a body appendage. And, whenever possible, use a timer to notify the child, “No more.”

4. Presents that are primarily intended for indoor use. There’s already plenty of entertainment throughout the house, and miniaturized for portable use. Encourage healthy outdoor play. That means added work for families of special needs children; but scooters, trampolines, swings and parks – even if your child just watches – are worth a great deal more than another box of Legos.

5. Too many items. While it’s important to promote variety, as witnessed through the oft-uploaded FaceBook album depicting an orgy of holiday presents, that superabundance cannot promote anything but indifference to a truly valued item. As many parents know, just getting a child who is affected with ASD to appreciate any toy is a victory.

6. It’s difficult to completely eliminate preferred playthings. We show our love by gifting pleasurable items. But, those who thoughtfully provide a child’s favorite Disney movie or Star Wars model (when they already have 4 that are similar) might find their special item tucked away for another occasion.

7. Pets that you, the parent, don’t want to take care of. Because, no matter what any other family member claims, the purchaser of the animal is the de facto feeder, caretaker and parent of yet, another ward.

8. Any toy that emits an annoying noise. Frankly, if it makes any noise, the buyer should listen to it, like, 75 times, to experience the real gift. And, ‘friends’ who insist on giving your child such an annoying offering, aren’t really your friends.

9. Even objects that you don’t think can become weaponized may turn into dangerous flying objects. But, those that start out that way are suspect. Sure, that lightsaber looks appealing and fun. But will little princess Leah be bonking brother Jimmy on the head with it?

10. Gadgets with an easily accessible battery compartment. Even when the power is kept in a secure section, Junior may figure it out, especially if reinsertion into a body part is their mission. But, as you are traveling to the ER, you will know that, at least you tried to protect the child.

Conclusion
The message is, think twice before plunking down your precious dollars that could be otherwise spent on valuable therapies, which are necessary to promote healthier development. As with neurotypical kids, the box may be as entertaining (and better play) as the toy inside.

Consider the child’s state of autism. Not unlike many other areas of a special needs child’s life, it’s not fair, but even purchasing gifts requires extra evaluation.

The Perils of Home Treatment for Autism

Sunday, November 5th, 2017

Were it not for a lack of knowledge or, frankly, interest on the part of most of the medical community, parents of children with autism would be happy to relinquish their quest for appropriate treatment.

Too often, I listen to stories about pediatricians who have declared, “Well, I don’t know much about that ‘spectrum’ diagnosis. Let’s wait 3 to 6 months and see what develops.” Or neurologists who, after observing a patient for less than 5 minutes arrive at what they think is an accurate diagnosis, followed by little in the way of explanation, and even less effort to provide relief, other that a ticket to, “find a good therapist.” Then, there is the peanut gallery of mildly interested observers who implicate over-diagnosis and link the epidemic to anti-vaccination conspiracies.

That being said, the families who are left to fend for themselves in this void must navigate a sea of dangerous waters in order to find safe, reliable and effective protocols for children affected with ASD. These are some of the issues that frequently arise for those warrior-parents.

No matter how ‘benign’ the intervention, what works for one child might actually make another child worse. There are many different kinds of autism, including boys (aggressive) vs. girls, early vs. late (language regression), immune (rashes, constantly sick and antibiotics), gastrointestinal (reflux, bowel problems), and genetic variations. Furthermore, at any one point in time, speech apraxia, social isolation, sensory issues, or aggression might define a child’s autism. So, Dr. Google’s therapy du jour may not even apply to the present status of your offspring.

Will Junior actually take a supplement that was suggested on the Internet? Compliance issues are a major challenge among our patients at The Child Development Center. Children are usually very picky eaters, sometimes refusing to chew, or preferring to smell everything, and not likely to ingest another yucky concoction. The ‘best’ fish oil won’t work if your child won’t take it, so a better tasting, less expensive, well-tolerated version may be the better choice.

Costs can spiral out of control. Each affected child may take between 5 to 10 supplements/medications per day, often exceeding $300 per month. And, of course, it is not covered by health insurance. Can you really afford to give another remedy on the advice of a friend-of-a-friend-of-a-person-whose-kid-has-autism?

Complicated, expensive therapies are compelling. Parents who seek experimental, untested, and/or potentially dangerous regimens are not foolish or ignorant, they are frustrated and desperate. For the most part, unless your family has unlimited resources, your money is better spent on proven, conventional behavioral interventions.

Parents may not be aware whether item #2 on the list of supplements is actually amplifying item # 7, or nullifying. For example, notwithstanding manufacturers’ claims, digestive enzymes digest stuff. Probiotics, proteins, etc. work best when they reach their intended destination in the natural state, so some products must be given individually.

Home therapies do not take the place of a thorough medical workup by an experienced practitioner who demonstrates reproducible results. Vitamin D, e.g., is great, but high doses could be harmful. The child’s blood count, liver, kidneys, thyroid, and other metabolic functioning should be documented and followed when a fragile toddler is the recipient of pharmaceuticals of any kind, with potentially serious effects.

Conclusion
Rather than eschewing novel treatments, I am eager to become educated about patients’ reactions – positive and negative – so that my advice applies to each individual child, at a particular point in their recovery, targeted at the therapies that will take the patient to the next level toward independent function.

I have learned useful techniques from naturopathic, holistic, Ayurvedic, and just plain Mom-medicine. Epsom salt baths, attention to nutrition, probiotics, essential oils, and the like, can be quite helpful. However if you are experiencing a 2 year-old who is not making eye contact, a 3 year-old who doesn’t speak, or a 4 year-old who is banging her head, sooner or later you will get the most tangible results from a practitioner who can accurately identify, and treat, such serious challenges.

About regimens and treatments that some might say, “How can it hurt?” the most important lost resource may be time.

When Mom and Dad Disagree About Autism Intervention

Sunday, October 15th, 2017

Undoubtedly, the most stressful challenge that any family might face is illness in their child. Even in cases where treatment is established, e.g. acute leukemia, there are bound to be differences of opinion about which doctor, or hospital will do the best job.

When it comes to ASD however, even the diagnosis can remain in doubt. One parent, or a sibling, may have experienced “the same” symptoms, such as late speech or inattentiveness. So, the ‘watchful waiting’ advice from the pediatrician appears most prudent. A neurologist who observed your toddler for 70 seconds may have declared a normal – or dire – outcome. Who to believe? Then, there is the conventional medical community that continues to debate the condition and the ability of earlier recognition to alter the course.

Differences about the diagnosis
 Take an online questionnaire, such as the Autism Treatment Evaluation Checklist or Modified Autism Checklist for Toddlers. Although ‘experts’ may deem such surveying as ineffective, it is certainly a start. And, parents shouldn’t bother quibbling over whether Junior should get a “1” or “2” for any single answer. Observing suspicious tendencies may help convince a spouse, or doctor, that there could be real reason for concern.

 Listen to the advice of grandma or grandpa. They have raised other children, even if it was a different century. Try not to listen to advisors who have no responsibility for their opinions.

 If a therapist is already involved, ask what signs and symptoms they view as worrisome. It’s not their labels that you seek, but another professional opinion regarding suspect behavior.

 Don’t be afraid to ask the child’s teacher, or the school personnel, what they think might be different about your child. Academic staff are frequently the first to postulate a problem.

 Take videos of unusual behaviors. One parent may simply not have gotten to spend enough time to have observed a ‘stim’, or recognize activity as repetitive.

 Have the child evaluated by a trained professional. Then, insist on a precise diagnosis. Children with sensory processing, executive functioning disorder, and speech apraxia have autism.

Discrepancies about the next steps
So much inertia must be overcome to establish that first step, simply embracing traditional treatments can offer parents glimpses of improved development. OT (occupational therapy), PT (physical therapy), S&L (speech and language therapy), and ABA (behavioral therapies), must be given the time to reveal results.

At the very least, however, ask your pediatrician to make sure to perform some basic laboratory testing. Even if there is disagreement, how could it hurt to obtain a complete blood count, evaluation of nutritional status (calcium, magnesium, vitamin D, iron), and thyroid screening?

Opposition about biomedical interventions
Although the pull of the Internet is great, children are best served by contacting a physician who is involved in The Medical Academy of Pediatric Special Needs. Unfortunately, there are too few to adequately staff the burgeoning number of affected children, but, we practice state-of-the-art, evidence-based medical intervention.

By continuing our education within such a medical fellowship, and achieving a thorough knowledge of the science that appears in peer-reviewed journals, doctors have developed protocols that have been proven safe and effective. Although the costs are rarely adequately covered by medical insurance, the investment will last a lifetime. Literally.

Conclusion
Denial and delay are not in your child’s best interests. Doctors who are satisfied with the status quo will achieve that end. Modern thinking is that earlier intervention results in improved outcomes.

At The Child Development Center, our experienced and knowledgeable Practice Manager, Karen, has observed that families who seem to have the most success, “May not be on the same page, but are at least in the same book!”

The Real Cause of Autism

Sunday, October 8th, 2017

Recently, these 3 headlines appeared on my iRadar Screens:

Genetics a Cause of Autism in Most Cases: Study
 Korean-American Professor Couple Identify Major Cause of Autism
 Could multivitamin use in pregnancy protect children from autism?

Yet, the research was entitled:

The Heritability of Autism Spectrum Disorder
Mum’s bacteria linked to baby’s behavior
Antenatal nutritional supplementation and autism spectrum disorders in the Stockholm youth cohort: population based cohort study

And, the papers covered the following data:

The examiners mathematically re-analyzed decades-old Swedish registry information that strengthened the association with genetic factors. About the findings the lead author has admitted, “our results do not give any information about specific genes or other direct causes. It only informs us that genes are important…. our study cannot shed any light” on the reason for higher rates.

This was published in Nature, entitled, Maternal gut bacteria promote neurodevelopmental abnormalities in mouse offspring. “The couple found that certain bacteria in the mother’s digestive tract can lead to having an autistic child. Furthermore, they found the exact brain location linked to autistic behaviors, which can be used to find a cure for autism.” Mice are not men.

Using a similar Swedish cohort as the first study, authors reviewed supplementation with multivitamins, iron and folate. They concluded that, “Maternal multivitamin supplementation during pregnancy may be inversely associated with ASD with intellectual disability in offspring.”

Discussion
All of the information first appeared in reputable journals. The stories took a turn through leading health and science magazines, and finally popular media announced theories as if they were dogma. Often, autism research is subject to the ‘telephone game’, resulting in overstated and oversimplified claims masquerading as explanations for complicated medical concepts.

Nevertheless, these investigations represent clues, directions to be pursued, possible new treatments and even prevention. It’s so confusing because they document only baby steps in this scientific puzzle.

Conclusion 
Rather than view these studies as disparate, an alternative perspective could be something like:
If autism is the result of a susceptible individual (genetic study) affected by an environmental stress (mouse study), then utilizing a metabolic intervention (third study) might make sense.

Recognizing The Signs of Autism Recovery

Sunday, August 20th, 2017

As the autism epidemic has grown, so too, has the knowledge of professionals who shepherd treatment, and our recognition of success. It is helpful to offer predictive signs that reflect steady improvement. Due to the variations in autism presentation, there is no authoritative information about how long recovery takes.

However, it can be quite useful and encouraging for a parent to know that it is great news when a child who, after 9 months of treatment, is finally repeating words. It is just as important to understand that the lack of questions, or comprehension, is not pertinent at such a stage.

Patience is key – all affected families have already learned that virtue. But proper acknowledgement that the chid IS getting better should reassure families, hopefully adding a touch more perseverance to their storehouse of solutions.

The journey begins as the ‘fog’ lifts. Wandering should become exploration. New diagnoses do not suddenly ensue, they rise to the top of parental concerns.

It’s not apraxia AND autism. The lack of verbal communication ought to define that phase of autism. Speech arises as sounds, often verbal tics or ‘stims’, teeth-grinding, or screeching, progresses to occasional single words, more consistency, then more dependable expression.

At first, merely hearing the speech therapist say that your child is trying is a very positive sign. There is a pattern. Speak to yourself. Speak to toys. Speak to family. Sometimes, it make sense. Juice. Want juice. I want juice. Observe other children. Speak to safe children – older, younger, more docile. Sometimes, inappropriate.

The same arrangement can emerge with shorter, then longer, sentences. During this phase, parents may fear that the child doesn’t doesn’t comprehend, or is lazy. “He can do it if he wants to!” I think of it as paving newer, progressively wider, neural roadways. The quantum leaps in the appearance of knowledge, such as letters or numbers, are a result of the newfound ability to perform expressive language.

Repetition of words or phrases (echolalia, scripting) seems to be part of the fabric of the acquisition of this ‘skill’. If a child is supposed to say 1000 terms, e.g., and only has 300, they may say the same thing 3 times just to make up the difference, or repeat the last words that were spoken. (Neurotypical adults often do this, as well.)

Socialization will rarely ensue if these milestones, in some form, haven’t appeared.

Children who have repetitive behaviors and restricted interests do not develop obsessive-compulsive disorder. Yes, a youngster may appear to have OCD, but it’s the same problem they exhibited at 2 years of age. And, no pediatrician called it OCD back then. Furthermore, adult drugs for this ‘condition’ are dangerous and rarely perform as expected.

Sensory processing issues that involve hearing, vision, etc., do not develop into SPD. They may become highlighted at various points in the child’s recovery process as the cause of distraction or aggression. Stimming is frequently a symptom. Occupational therapy and other appropriate neural interventions can be quite helpful.

Likewise, lack of attention and focus, overactivity, and distractibility aren’t really a newly acquired ADHD diagnosis. This represents the remnants of an earlier autism. Signs and symptoms are only as subject to pharmacologic remedy as the resulting, appropriate anxiety.

Proper recognition of the challenging behaviors is key.
Does anyone know of a drug that would enable a 5 year-old to perform in a 2nd grade classroom?

Immaturity, tantrums, and difficult transitioning do not warrant a separate condition. Oppositional Defiance Disorder is a description. Behavioral interventions have proven value.

Conclusion
Some might be confused by my use of the word ‘recovery’. It depends on the definition. Subject to the age at the initiation of therapies (and a million other factors), The Child Development Center generally aims for a 3-to-6 year window, in order for a ‘typical’ patient to enter the general educational environment. There may be plenty of leftover challenging behaviors, as occurs in many of the other students in this century.

My point-of-view is that, 10 years after a crippling auto accident, the appearance of normalcy doesn’t erase the prior event. Five years following, however, the patient may experience muscle weakness and/or ‘pins and needles’. Such is the state-of-being for many of the children experiencing recovery in Autism Spectrum Disorder.

Back to Back to School Issues for Autism and ADHD

Friday, August 11th, 2017

Forget pencils and notebooks. Here is my take on the most important items that children who exhibit signs and symptoms of ASD and ADHD really need to make it through the coming season:

10. A weighted vest, and other such functional products. Neural systems are on overload, so any/all sensory reducing strategies need to be dusted off and utilized. My son, a former Special Ed teacher, reports that one of his favorites was Chewelry.

9. A special request for an IEP meeting to review everything agreed upon in the last IEP, and how the child has progressed. This can be especially important for the children who are losing the diagnosis. Being placed with role models is preferable to being the ‘one’.

8. A written, visible schedule. The previous school year’s busy agenda needs a re-boot. With non-preferred activities about to consume more time, acceptance and self-control become paramount, so clear expectations are a good start.

7. Sleep. Likewise, the body’s internal rhythms have gone on a summer vacation. Warm epsom salt baths are great to pave the way at bedtime. Chamomile is fine, and more difficult problems may be ameliorated with the administration of melatonin. Essential oils on the soles of the feet can be quite effective without the use of medication.

6. Supplements and medications. Children with ADHD are often given drug ‘vacations’ during the break. Appropriate dosing and timing may have changed as the summer progressed, so try getting things started a week or so early.

5. Healthy food. Unfortunately, schools do not often assist in this endeavor. If junior has been slipping off the diet, or eating too much junk, get back to basics.

4. An app to disable the iPhone. Really. The time spent on iPads, computers and video games needs to become severely limited.

3. Playtime. It is very difficult to transition from a season of freedom to one of academic drudgery and endless therapy sessions. Going to the park, ballgames, and other outdoor athletic activities is a basic part of being any kid. Even though physical activity is not as preferable as that smartphone, try to make it happen.

2. Soap. Stress cleanliness and get the child into the habit of washing their hands. To the extent that the school will cooperate, tissue dispensers, hand sanitizers and bathroom etiquette could provide some barrier to the onslaught of cooties.

1. A big dose of time and patience. As students fit into the new school year, so do teachers, administrators and other professionals need time to understand each child’s strengths and weaknesses.

VACCINATIONS?
For parents who are confused about administering childhood vaccinations, consider drawing blood ‘titers’. For those who have already had some inoculations, this is a measurement of how immune the child ALREADY IS to measles, mumps, rubella, varicella, etc. Your doctor can order levels of IgG directed against those diseases. High levels will not be accepted by the Public Health Department, so families will still need a ‘personal’ exemption. However, the already-immune child can be proven safe – as well as protecting their classmates.

Everyone remembers that first day back at school; anxiety, fear, excitation, and dread. The assault on the senses, social stresses and academic expectations are an even more tremendous hurdle for students with challenges in those very areas.

Most of all, parents’ love and understanding gets us all through those first inglorious days and weeks.

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Brian D. Udell MD
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