Adult ADHD

Arrghhh . . . .  Anyone see Dr. Hallowell on Good Morning America today talking about Adult ADHD?  I’ve read his books, and I’ve found him to be one of the few medical practitioners in this field that seems open to treating the disorder without medications, including the very methods we use at Spark, but you wouldn’t know it from this interview.

He says that (i) ADHD is “genetically transmitted, there is no doubt about it,” “95%” of the time; (ii) it is extremely under diagnosed in adults; (iii) medications – taken properly – are “very safe” and can be taken “indefinitely” because “when used properly,” these meds have “no side-effects;” and (iv) if you learn to adjust your life-style and develop new habits, you can wean yourself off these meds.

Also, if you watch the interviews with two adults who were diagnosed with ADHD and began taking meds for it, you’re led to believe these meds will enable you to have a novel published and earn huge bonuses at work (hmmm, maybe I should start taking Ritalin . . .).

I’ve said it before, and I’ll say it again.  I’m all for people getting help with attention issues – they really do exist -- and I believe that meds have their place, but only as a last resort.

I mean, really, if ADHD is genetic (and on that note, what about the research linking the disorder to, among other things, pesticide exposure (http://sparkdevelopment.blogspot.com/2010/05/pesticides-and-adhd-whats-next.html), too much television (http://sparkdevelopment.blogspot.com/2009/01/dont-touch-that-dial-literally.html), and artificial food additives (see, e.g., The Oxford-Durham Study: A Randomized, Controlled Trial of Dietary Supplementation With Fatty Acids in Children With Developmental Coordination Disorder?), and you need meds to deal with it, how can a change in lifestyle and habits cure the disorder?

Maybe, I’m missing something, but meds, in theory, affect a theoretical imbalance of neurotransmitter transmission and uptake in the brain.  Also, in theory, these meds do their thing in your brain and then they’re out of there.  Thus, you have to take them pretty much every day (in some cases, more than once a day).  So, I don’t think anyone believes that these meds permanently repair the hypothetical imbalance in your brain.

If that’s the case, how can a lifestyle change get you off these meds successfully?

What is actually going on?  Read between the lines.  Dr. Hallowell states that lifestyle changes can work.  And we know, and the research backs us up on this, that dietary changes, exercise, and sensory programs can quiet the internal “noise,” decrease the intensity of (and sometimes even eliminate) the “distractions,” and increase focus and attention.

Would one argue that a change in lifestyle is merely a coping mechanism, and the ADHD still exists?  If that’s the case, then aren’t the meds merely coping mechanisms as well?  And, if the two serve basically the same purpose, i.e., coping with ADHD, wouldn’t you want to do the one that is safer, and probably ultimately more likely to present a more permanent solution? 

Granted, drugs are quicker, but if the meds are not changing the biology, are we merely promoting the idea of taking drugs to enhance performance (http://sparkdevelopment.blogspot.com/2009/02/drugs-for-everyone.html)?

No one really knows how these meds work, no one really knows about the long term effects of these meds (see, eg, http://sparkdevelopment.blogspot.com/2009/01/finnish-study-questions-long-term.html), and it is simply and utterly untrue that these meds have no side-effects.  Like all psychotropic medications, they do have side-effects, even when taken properly, and while it is rare, there is documented proof of some very bad things happening to some people who took these meds (http://sparkdevelopment.blogspot.com/2009/02/on-subject-of-medications.html and http://sparkdevelopment.blogspot.com/2009/06/unexplained-sudden-death-and-adhd-meds.html).

Hey ABC, how about a story about people who cured themselves without meds?

Spark Development Centers Testimonials

We are deeply touched by the kind words of these parents.  While we realize that every child is different and that results will vary, we greatly appreciate our parents' eagerness to share success stories like these.  Most of all, we thank our parents for their continued support and for the opportunity to serve their families.


To view complete video testimonials, Click Here.


To read parent testimonials, Click Here.


We thank Joseph Eckardt for capturing these very special moments for us.

Video Editor:  Stephanie Lombardo

Production Coordinator:  Gordon Edward

Autism and Genetics

Did you see the article by Delthia Ricks, entitled “Scientists finding genes related to autism,” Newsday (12/5/10)?  It states that as a result of “combing the human genome,” “new gene discoveries . . . are helping to shape a narrative that autism spectrum disorders are largely genetic conditions.”  In fact, Dr. Eli Hatchwell, a geneticist and founder of a biotechnology firm claims that, "There may be a small number of individuals who are reacting badly to something in the environment, but I don't believe that to be the case for everyone. . .  Autism is 90 percent genetic in my opinion."  It should be noted that Hatchwell and his team are working on gene-based diagnostics for autism.

Sadly, I’m reminded of the old joke where a guy is intently scouring the ground under a street lamp one night.  Another guy sees him and asks, “What are you doing?”  The searcher replies, “Looking for my car keys.”  “Where exactly did you lose them?” inquires the second guy, to which the first points off into the dark distance, and says, “over there by my car.”  Incredulous, the second guy asks “Why on earth are you looking over here then?” “Because the light’s better,” says the first.

Millions and millions of dollars and research are being thrown at finding the “genetic” basis of autism, but really, are we looking in the right place?

Yes, the “light’s better” – if autism is truly an inherited, genetic condition, then autism is no one’s fault.  There is no one to blame; it’s just an unfortunate accident.  There is no need to change or go without what our society has come to accept as safe and normal.  Even from an economic standpoint, a genetic cause of autism would pretty much benefit everyone.  A proven biologically based medical condition would surely be covered under insurance (and don’t worry about the insurance companies – when and if the time comes for them to belly up to the bar, they’ll work the cost into our insurance premiums – they’re pretty good at making money no matter what), the medical practitioners will have a guaranteed stream of diagnostic/treatment-related income, the drug manufacturers will surely come up with a slew of drugs to treat the “medical” condition, testing companies will have a field day screening all of our kids, and no messy lawsuits from “those people” who believe it was some environmental insult that perpetrated the harm.

Consider the alternative, looking in the dark.  If something in the environment is causing autism, then is it really a medical condition?  And, surely, someone created the environmental condition, so maybe autism really is someone’s fault.  Can you imagine the consequences?  The lawsuits, the liability.  And, we’d have to change.  Maybe we can’t use so many pesticides.  Well, wouldn’t that hurt the farmers with increased costs of production?  Wouldn’t that hurt the vegetable and fruit eating consumers who would be forced to pay more for produce?  Maybe we can’t use scientifically created hormones and antibiotics on our farm animals.  That also hurts the farmers and consumers, and of course, the people who make the hormones and antibiotics.  What if it’s over exposure to EMR, cell phones, television/computer?  What if it’s vaccines?  What if it’s jet fuel?  Can we ever do without these ubiquitous items (yes, our parents did, and their parents did, and isn’t it interesting to note that even as late as the mid-1980’s, autism was thought to affect only about 1 in 2,500, not 1 in 100 like today?).

And, if autism is caused by something in the environment, and we simply eliminate that cause, who would turn a profit?

But, even though the light is better, is it really the place to look? 

First, and foremost, even if there is a difference in the genes of autistic individuals, the question that really needs to be answered, but apparently is not, is whether the difference is innate or the result of some external catalyst.

In other words, are different genetics the cause or the result?

Moreover, in order for autism to be a genetic disorder, unrelated to environment, one must assume either that (i) autism always existed to the extent it does today, that is in 1 of 100 individuals, and we just didn't notice it all these years, or (ii) the human race has undergone a spontaneous genetic mutation of staggering proportions over the last twenty to thirty years.

Otherwise, by definition, some external – i.e., environmental – factor must be to blame.

Now, I like science, I like math, I like facts, and I really do want to believe that autism is nothing more than a genetic accident, that no one is to blame for what happened to those affected.  I want to keep my cell phone, and watch too much TV, and not worry about the cell phone antennae and high voltage wires in my neighborhood.  I want to eat fish, and meat, and not worry about hormones or genetically modified foods.

But, I need proof.

So, if you want me to really believe that autism is 90% genetics, prove to me that ASD always existed to the extent it does today.

Show me that 1 in 100 of all 80 year olds, 70 year olds, 60, 50, 40 and 30 year olds have autism.

Explain the math that would prove that better diagnostics/different definitions could possibly account for the staggering increase in the incidence of autism.  Really, explain how you go from one in 2,500 in the mid-1980’s to one in 100 today.

Explain why there are classrooms dedicated to autistic children today that did not exist even ten years ago.  Explain why teachers are saying they see a fundamental change in our student population.

Or, terrify me, and explain how we can undergo such a dramatic, and damaging, genetic mutation -- without any external trigger -- in the span of a single generation.

Some Things Just Work Out In The Wash

You ever notice how life works out? I was training, really hard, for three races this past fall. I'm fairly competitive and hoped to win some awards. The first was the Warrior Dash - a three mile obstacle course. The second, a four mile run to support an autism foundation. The last, a 5K for a special needs school.

I convinced Robert to run the Warrior Dash with me. Of course, being young, and strong, and a high-school cross-country runner, he did no training whatsoever. He did, however engage in an awful lot of boasting about how well he was going to do while I wasted my time training.

We arrived bright and early for our run. Little did we know that it was about a mile and a half up a ski mountain, and then two miles back down.

Robert made it about 1/4 of a mile up the mountain before he had to stop, walk and be sick. Being a good daddy, I stayed with him. And, we walked, and ran a little, and walked some more, and ran a little. Robert looked green -- I was chomping at the bit to run. But, I stayed with him.

After forever, we got down to the last three obstacles at the bottom of the course. Robert went first down a 100 foot waterslide -- I had to wait for him to clear it. When Robert saw he had the lead, he took off like a bat out of hell!

I cursed him from the mud I was lying in at the bottom of the slide and took off after him at full speed. He had me, but fatigue caught up with him at the barb-wire trench we had to crawl through, and we crossed the finish line together.

Our times were pitifully slow. There was no award for me. But, I never had more fun running a race!

I was really ready for the 4 mile autism run, and I ran a good race. I improved substantially over last year's time and overall finish. Knowing that I had taken third place in my division last year, I was hoping with my much improved time, to place second this year.

Well, I didn't get second.

And, I didn't get third.

I came in fourth by 3.7 seconds. Son of a &*%#@!!

Yeah, I was ticked. I killed myself, done well (so I thought), and NOTHING!

On to the 5K. I ran it well, but not as fast as my last 5K. I hurt at the end, and was a bit disappointed with my time.

I thought maybe I might take third in my division, maybe.

Instead, I came in FIRST in the MASTER'S DIVISION! I never dreamed I'd ever take a Masters (and, I won FIFTY dollars, to boot!).

That's my youngest, Matt, running the 5K with me last year.

A glutton for punishment, I ran one more race. A four-miler near my learning center. I didn't expect much -- it's a very competive race, and runners come from all over the state to compete.  I didn't really train hard for this one -- I originally wasn't even going to run it, but something told me to give it a shot.

I was in pain from the second mile on, but I pushed through and did okay taking fifth place in my division. But, what was truly wonderful was hearing the name of one of my former students as he crossed the finish line!

I had no idea he was running, and never would have guessed it. When he started with our program, he had coordination issues, and no one would ever have accused him of being athletic. He was also a bit distractable. He did well by us. He grew stronger, more coordinated, better able to focus, and graduated the program about two years ago. We knew what we did with him would eventually bear fruit, but we had no idea this was coming.

There he was, crossing the finish line in under thirty minutes! His dad came to me beaming. "You should see him. Cross-country, basketball, honor society and straight A's!"

The best award I ever got at the end of a race.  And, to think, I almost didn't even run.

MRIs, Autism & ADHD

I may be wrong, but I think we have another “duh” moment. According to “Brain MRI may lead to early autism detection,” reported by Nicole Ostrow of Bloomberg News, researchers studying 60 children, half diagnosed with mild autism and half without autism, were able to identify autism 94% of the time using magnetic resonance imaging. Specifically, the MRI looked at water diffusion along the brain’s nerve fibers.

The article talks of “the disorder’s biological base,” and objective markers, and early detection.

While there is no doubt that early diagnosis and more objectivity are worthy goals, I have to wonder, if autism is a neurological disorder, and even subjectively, differences in behavior, intellect and communication are readily apparent, isn’t it a given that brain processing will be different? Isn’t this just objective confirmation of what we already know? (and why only 94% success?)

Also, this test does nothing to shed light on the cause of autism. When the article discusses “the disorder’s biological base,” is it suggesting that the differences found in the autistic brain are innate, and thus, the cause of the disorder? Or, is it merely finding changes in the brain caused by some external, environmental insult (which, combined with a genetic disposition of susceptibility to such harm, is what we believe to be the true cause of the disorder)? If it’s the latter, are these differences in brain processing really a “biological base”?

And, another thought, this one regarding ADHD. We’ve always maintained that disorders like ADHD are part of the ASD spectrum (and there are researchers out there who apparently believe likewise). That is, that whatever is causing the ASD epidemic also is causing the ADHD epidemic. It’s just a different degree of effect and a different manifestation. I’ll bet if the same MRI studies were done on kids diagnosed with ADHD, the researchers would find that the ADHD brains also process information differently.

If that’s the case, then you have to wonder. We were always told by Robert’s doctors that ADHD was caused by a brain chemistry imbalance with respect to certain neurotransmitters, and that drugs were the only way to address his issues.

If the ADHD brain, like the autistic brain, processes information differently, is that really the result of a “neurotransmitter imbalance?” And, more to the point, how can messing with those neurotransmitters, as the ADHD meds are theorized to do, really fix the problem?

Just a thought.

Autism, Mitochondria, Science & Parents

Came across a very interesting article in the paper today. Delthia Ricks reports in “New angle on autism,” that “[a]utism for some children may be related to defects in the mitochondria.” This “new” finding is reported in the Journal of the American Medical Association.

I write “new” because this theory has been around for a while. In fact, I believe there are practitioners here on Long Island that have been testing for these defects for several years.

And, Ms. Ricks notes that “[f]or years, parents on Long Island and elsewhere have argued their children diagnosed as having autism actually are affected by mitochondrial defects but the scientific work to support their claims have been scarce. . . ‘It always takes the medical and scientific community a long time to catch up with what parents are saying,’” noted Evelyn Ain, an advocate for children with autism.

Yeah, don’t we know that!

Oh, and there was one more quote that I particularly enjoyed. Dr. Eli Hatchwell, while commenting that the findings were “intriguing but not definitive,” stated “I have said it before and I will say it again: There is no single cause of autism.”

Funny, we’ve been saying that for the last ten years!!

But, maybe now that a doctor says it . . .

Don't the Needs of the Many Outweigh the Wants of the Few?

Is it just me, or is there something fundamentally wrong when you read in the paper about Long Island school superintendents who are making hundreds of thousands of dollars a year in salaries, pensions and benefits, and then two days later, read in the same paper, that services for special needs children are being cut?

One person wrote an editorial in which he was outraged that anyone should have an issue with the superintendents' pay because they "earned it," and the pay simply can't compare to that of private sector CEOs. I think this person is missing the point.

It's not really a matter of "earning it" (although others were quick to point out that city school superintendents', with far more children to account for, don't make nearly as much), and it has nothing to do with the private sector (our taxes pay for their jobs -- it's not a for-profit organization). What is at issue here, what should only really be at issue here, is what's best for our children. If the districts need money -- and remember, it's really our money in the form of ever increasing taxes -- the cuts should NOT come at the expense of our children. The schools, and the superintendents, exist for our children's benefit -- not the other way around.

Or maybe I'm just crazy to think that maybe the needs of the kids should come before those who have "earned it."

A Response to a Post on Dr. Rory F. Stern's Website

I came across a post entitled "How Do ADD/ADHD Medications Really Work" by Dr. Rory F. Stern. He asked for comments. You all know this subject has been addressed here many times. Here's what I wrote to Dr. Stern.


Wow.

I must admit I was a little upset when I saw the title of this post: “How Do ADD/ADHD Medications Really Work,” because NO ONE really knows how any of these medications work. We’ve all been told about the medical theory underlying ADHD, i.e., that ADHD is the result of a chemical imbalance in the brain involving certain neurotransmitters and that the medications help regulate such neurotransmitters.

However, this is only a THEORY. No one really knows what causes ADHD, and NO ONE really knows how any of these medications actually work. As most of you certainly know, ADHD is a symptom driven diagnosis – if you check off enough behaviors on the Conners sheet in enough environments, you will be diagnosed with ADHD regardless of what is actually causing the behaviors.

If you do the research, you’ll find studies that “prove” inattentiveness and impulsivity can be traced back to many different “causes” -- overexposure to media (including television and video games), poor diets and food allergies, nutrition deficiencies (including essential fatty acids), sensory integrations problems, sleep problems or emotional issues, to name but a few. I noticed that some of the previous posts mention such issues.

But, to Dr. Stern’s credit, he did not try to explain exactly how these medications work, nor did he take a stand on their use. The subject of medication is near and dear to me, and I have blogged about it extensively in the past. While I am certainly not a proponent of medication, I do realize that for some people it is a life changer. I only urge that you try other therapies and approaches, and use medications as a last resort.

Without getting into the gory details, our son was diagnosed with ADHD, borderline ODD, and PDD by the age of 7. We reluctantly tried medications, and unfortunately for our son, he got hit with nearly every side-effect you could get, from wild mood swings, to hyper anxiety, to facial tics. One med led to another, and to another, as his doctors tried to medicate his side-effects away and get his behavior under control.

He was a mess, and the cocktail of ever changing meds was only making him worse. When we mentioned trying alternatives ranging from dietary changes to homeopathy to sensory integration work, we were told by every professional that meds were the only proven therapy and the rest was a waste of time and money. However, our son’s downward spiral on the meds, the doctors’ insistence on more meds, and our desperation drove us to explore the alternatives.

We did, and we have never looked back. It took time and a lot of effort, but by the time our son entered sixth grade, he was completely off all medications and you would never have known there was ever an issue with this child.

Over that time, we learned a great deal about meds that the doctors never shared with us. First, nearly all studies show that over the long run, these meds lose their effectiveness. Second, these meds almost always have side-effects (although some may argue that the benefits outweigh the side-effects). Third, while rare, there are some serious issues with these medications that have led some to be banned in other countries. Fourth, the effectiveness of such meds is greatly over sold. You see, it depends on your definition of “effectiveness.” If you define “effectiveness” as having some “effect,” then these meds are very effective. If you define “effectiveness” as satisfactorily alleviating the issues for which the medication is given, you’ll find that these meds aren’t nearly as effective as promised.

In fact, during a Special Education PTA seminar, less than 30% of the parents who tried medications to regulate their children’s behavior thought the meds did what they were supposed to do, and 100%(!!) experienced side-effects. This number was interesting since a psychologist writing on the subject of the effectiveness of psychotropic meds, made a similar distinction, and stated with authority, that such meds had an “effect” 70% of the time, but only really worked about 30% of the time!

So, I was truly shocked to see how many people responded that their children were helped by meds. I was even more shocked by the apparent lack of those who had awful experiences with medications, like we did. I can only say to those who responded by saying that meds were life savers, I am truly glad that you were able to help your children, and be aware how lucky you are!

Spark Halloween 2010

Some More TV News

Can you stand one more blog about television?

An article posted at http://www.themedguru.com/20101011/newsfeature/long-hours-watching-tv-can-harm-child-s-mental-health-study-86140882.html by Silky Chandvani (10/11/10), cites a study that indicates that long hours of screen exposure at an early age might lead to psychological problems.

The study examined 1000 children, all around 10 years of age. Two measuring devises were used. The first was a questionnaire that covered: television viewing time, emotional difficulties, conduct problems, hyperactivity or inattention, friendships, and problems relating to peer groups. The second was an activity monitor that recorded the children’s sedentary time and moderate physical activity over a week’s period.

What did the researchers find?

The children who sat in front of a screen for more than two hours a day scored low on the questionnaires, regardless of how much physical activity in which they otherwise engaged. In addition, these children ran a 60% higher risk of developing psychological problems than those who racked up fewer viewing hours.

The study was published in the November edition of “Pediatrics” and was supported by the World Cancer Research Fund and the National Prevention Research Initiative.

Need I say more?

The Warnings Keep Coming, But Is Anybody Listening?

Got a few things to talk about this week. The theme? We keep getting warned about potential issues with medications, the political underpinnings of health care, and dangers regarding products we use and consume, but the warnings are side-notes, buried in the back of the paper, confined to the pages on health books generally dismissed by the mainstream medical community, and on the web – if you know where to look. But, if you’re reading this, then you might want to know a couple of things. In no particular order:

When a new client joins our Center, we always ask if they ever (a) suffered from any form of chronic infection, such as ear infections, sinus infections, etc.; and (b) took antibiotics for extended periods of time. You’d be surprised to learn that the majority of our students answer these questions with a resounding “Yes!”

We ask for two main reasons. First, chronic infections often are a sign of a food allergy (or, if you prefer, a food “aversion”). Simply put, the student is eating something that is triggering an immune response and making them sick. But, food allergies are not the point of this blog -- that’s a whole ‘nother story.

It is the second reason that I’d like to address here. For years, we have known that antibiotics can wreak havoc on the digestive system. This can negatively impact the student’s immune system, since the vast majority (70% to 80%, depending on your reference source) resides in the digestive system. Your immune system, of course, has a direct impact on your overall health, but it also has a major impact on your mood and behavior.

Surprise, surprise. While everyone knows that antibiotic use can upset your stomach, a new study reveals that “repeatedly taking [antibiotics] can trigger long-lasting changes in all those good germs that live in your gut, raising questions about lingering ill effects.” Newsday, 9/14/10 at A33. The article noted that three healthy adults who had not used antibiotics in at least the past year where given low, five-day courses of the antibiotic Cipro, six months apart. The researchers found that the “bacterial diversity” of those three individuals “plummeted as a third to half of the volunteers’ original germ species were nearly wiped out, though other species moved in.”

How could this not affect your immune system?

Did you hear? The Food Pyramid may be “so politically influenced that it is ineffective.” (check out Newsday, 10/4/10 at A23). “This year, the meat lobby has opposed strict warnings on sodium that could cast a negative light on lunch meats. The milk lobby has contested warnings to cut back on added sugars, lest chocolate- and strawberry-flavored milk fall from favor.” Really? You don’t say. And, here I thought the Food Pyramid was a totally objective, science-based guide to eating healthy . . .

So who says Frankenfood is bad for you? Well, a lot of people, actually. According to “This Supermarket ‘Health Food’ Killed These Baby Rats in Three Weeks,” written By Jeffrey Smith and Posted By Dr. Mercola on October 4, 2010, Biologist Arpad Pusztai; Irina Ermakova, a senior scientist at the Russian National Academy of Sciences; Embryologist Andrés Carrasco; Epidemiologist Judy Carman; prominent virologist Terje Traavik; and Ohio State University plant ecologist Allison Snow. In one way or another, these researchers and scientists proved that genetically modified foods can be quite harmful. But, each and every one of these individuals was put through a trial by fire. Some were fired from their positions, others had research funding withdrawn, some had their research blocked, and some were even subject to baseless rumors attacking their credibility. See http://articles.mercola.com/sites/articles/archive/2010/10/04/watch-out-there-are-more-problems-with-genetically-modified-foods-than-youre-allowed-to-know.aspx.

Really, if we can’t trust the companies that are genetically mutilating our food, who can we trust?

ADHD: Nutrition versus Meds

Came across an interesting little snippet on an ADHD forum to which I belong. In an attempt to avoid medicating her child, suspected by doctors of having ADHD, a Mom tried to help her son through a nutrition intervention. It is unclear whether she had consulted with anyone about her approach, but what was clear is that the child had an immediate reaction to the intervention – apparently a very bad one which prompted this Mom’s call for help on the forum. Specifically, she indicated that it was as if the child was going through “withdrawal” and after two weeks, she only saw his behavior getting worse.

Tina responded privately to her offering advice and insight into the situation. Among other things, she noted that, as we always tell the parents here at the center, while the “withdrawal” like symptoms may be upsetting, the fact that her child had a definitive response to a new intervention is usually a very positive sign. At a minimum, it shows a clear sensitivity related toward that intervention (in this case, what the child was eating), and that usually means you’re looking in the right direction. The trick now is to figure out the proper approach.

Moreover, as we always tell parents, whenever trying a new intervention, many times things tend to get worse before they get better – especially behaviors. The child literally feels very different, the body is physically affected, and the child’s mind and body must adapt. This can be rough, and lead, at least in the beginning, to worse behaviors.

Finally, like anything else, it takes time to adjust to new interventions. Unlike medication, nutrition intervention takes time. This is especially so if the gut is affected or you are addressing a deficiency. Simply put, it takes time for the body to heal.

Another gentleman on the forum (we’ll call him “Biff”) had a different response. Posted on the forum: give up the diet and give him meds.

Guess who had the right approach?

It turns out that not long after Biff’s post, Mom gave us an update. It took a couple of weeks, but she stuck with the dietary intervention and was now seeing very positive results. In particular, she noted that her son was “calmer,” “focus[ing] longer,” and experiencing “less sensory break downs.”

Tina 1: Biff O

ADHD, Adderall and Lindsay Lohan

So, heard the latest? I am not making this up.

Adderall May Have Unhinged Lindsay Lohan (8/20/2010 12:30 AM PDT by TMZ Staff)
Lindsay Lohan's Adderall dependence -- the result of a medical misdiagnosis -- may have been the reason she went off the rails.

[T]he docs at the UCLA rehab facility believe Lindsay was misdiagnosed with Attention Deficit Hyperactivity Disorder ... and then prescribed Adderall to treat the phantom affliction.

Dr. Joe Haraszti -- a prominent L.A. addiction specialist [states that] people who take Adderall when they don't need it can experience similar effects as people who use cocaine or methamphetamine.

Dr. Haraszti tells us ... people who unnecessarily take Adderall can display manic symptoms ... "and often do things like 'driving around until all hours of the morning ... smoking heavily ... tweeting ... and texting all night long." The doc adds, "They can become very impulsive."

"The doc also notes that people in that situation "might then complain of insomnia and then take Ambien or other sleep aids to help fall asleep ... it's a vicious cycle."

Dr. Marc Kern -- another addiction expert -- tells us alcohol abuse is also very common among patients who take Adderall.

Dr. Kern tells us, 'The Adderall counteracts the sedative side effects of alcohol use … making these people often drink more than someone who does not take the drug."

That is, pretty much, word for word, the article about Ms. Lohan, ADHD and Adderall. Now, let’s play a game. How many things are terribly wrong about the information contained in this article?

Here are my top three:

1. How is someone like Lindsay Lohan “misdiagnosed?” One would assume that she has access to the best medical practitioners around, right? So, are her doctors so inept that they could not diagnose a “disorder” that affects anywhere from 8% to 15% (or more, depending upon your information source) of the population?

Or, is it more likely, that the “disorder” is so vaguely defined, subjectively diagnosed, and misunderstood, both in its manifestation and causes, that it too difficult to diagnose correctly?
In either event, if Ms. Lohan is truly misdiagnosed, either through her doctors’ lack of skill or the inherent vagueness of this “disorder,” how do we know that our kids are not also being misdiagnosed?

2. “[P]eople who take Adderall when they don't need it can experience similar effects as people who use cocaine or methamphetamine.”

Ah, this one’s a bit trickier. Yes, people who take Adderall “can experience similar effects as people who use cocaine or methamphetamine.” No issue there. That’s because Adderall, Ritalin, and the like ARE IN THE SAME CHEMICAL FAMILY AS COCAINE AND METHAMPHETAMINE!! (in fact, Ritalin’s real name is “methyiphenidate”). And, like cocaine, they are all Schedule II controlled substances! (see http://www.justice.gov/dea/pubs/scheduling.html).

Thus, “like cocaine, Ritalin is a powerful stimulant that increases alertness and productivity. Ritalin and cocaine also look and act the same. Both have a similar chemical structure.” http://learn.genetics.utah.edu/content/addiction/issues/ritalin.html

So, what’s terribly wrong with this statement? First, Adderall affects EVERYONE the same way, whether you have ADHD or not! That’s why you can’t use the drug’s so-called effectiveness as a diagnostic tool. So, when you give your “ADHD” kid Adderall, he/she may “experience similar effects as people who use cocaine or methamphetamine,” including as
“Dr. Haraszti tells us … manic symptoms ... and impulsiv[ity]."

And lets not forget what Dr. Kern has to say: “alcohol abuse is also very common among patients who take Adderall.”

3. Just a headcount – how many of you parents out there were told either that (a) ADHD was very difficult to properly diagnose; or (b) that drugs like Ritalin and Adderall are class II controlled substances, just like cocaine, with a similar chemical structure as cocaine, that can cause “manic symptoms, impulsivity, and/or alcohol abuse”?

I’ll bet you were told, like me, these drugs were perfectly safe, with few if any side-effects. And, if your son/daughter had diabetes, you’d give him/her insulin, wouldn’t you?

The Boston Marathon, The Long Island Marathon, and Hearing Loss

Hi All!

Yes, it’s been a while. And, any rumors that you might have heard suggesting that I haven’t blogged because I was embarrassed that I didn’t finish the Boston Marathon are completely untrue. And, I know I said I would blog a bit more consistently (sorry! Just lost track of time), and I am absolutely sure you are all dying to know how I did in the Boston Marathon, so, here’s the scoop.

(Hopefully, you recognize the tongue in cheek tone of the previous sentence. I’m pretty sure you’ve heard no rumors about me, and that you really don’t care about the Marathon. That’s just me.

Funny, I had a long talk with Tina about Facebook. She wanted me to set up an account (and a Twitter account, too!) for Spark, but I just don’t get it. What is the purpose of Facebook? Does Facebook actually serve society?

Tina pointed out that if you’re offering useful information, or networking to find resources, then the answer is “yes.”

But, don’t most people just give their “status,” post pictures of their vacation/party/pets, “poke people,” write on someone’s wall, or whatever else it is you do on Facebook?

Really, isn't Facebook just about publishing yourself?

I don’t personally think I’m all that interesting. But, the last time I blogged, I did mention that I was training for the Marathon, so, to anyone who read the last blog and is the least bit curious . . . )

I finished the Boston Marathon, ran a negative split (which means I ran the second, harder half of the race (the part with “Heartbreak Hill”) faster than the first part, and managed to qualify for the 2011 Boston Marathon. So, I guess I did good.

Two weeks later, I ran the Long Island Marathon. Probably not the smartest thing I ever did. And, it was ridiculously hot and windy, to boot -- two things that make distance running a really bad experience. The race was great until mile 21 when both my legs completely cramped up, but, remembering what I tell the kids at the center – “the race ain’t over till it’s over” -- I struggled on for five more miles. Somehow, despite slowing down dramatically over those last miles, I managed to run my best time ever, again qualifying for Boston, and took third place for my division (I even got a little award to prove it!). So, I guess I did good.

And, if I can help it, I’m never running another marathon again.

Now, on to more interesting things.

“Study: 1 in 5 US teenagers has slight hearing loss”, August 17, 2010 by The Associated Press / CARLA K. JOHNSON (AP Medical Writer). This article, reported in Newsday, cites to a study that found “[a] stunning one in five teens has lost a little bit of hearing, and the problem has increased substantially in recent years.”

What could be causing this? Well, isn’t it obvious?

“Some experts are urging teenagers to turn down the volume on their digital music players, suggesting loud music through earbuds may be to blame — although hard evidence is lacking. They warn that slight hearing loss can cause problems in school and set the stage for hearing aids in later life.”

Specifically, the researchers found the most of the hearing loss was "slight," defined as inability to hear at 16 to 24 decibels. As the article put it, “[a] teenager with slight hearing loss might not be able to hear . . . his mother whispering ‘good night.’"

And, clearly, there would be an impact on attention and learning. As noted, “[t]hose with slight hearing loss ‘will hear all of the vowel sounds clearly, but might miss some of the consonant sounds’ such as t, k and s.” It’s kind of hard to learn and pay attention when you can’t hear the teacher correctly. "Although speech will be detectable, it might not be fully intelligible." See Wednesday's Journal of the American Medical Association.

There’s no question that hearing issues, like any other sensory issue, can cause problems. (That is why we incorporate an auditory training program at Spark (see www.thelisteningprogram.com).

None of this should come as a surprise. What is shocking to me is that the “experts” can only “suggest” that digital devices and earbuds “may” be to blame because “hard evidence is lacking.”

This, in spite of a spike in hearing loss, and a 2010 Australian study that linked use of personal listening devices with a 70 percent increased risk of hearing loss in children!

Are you kidding me?? If the study concluded that playing music too loudly directly into our ear canals caused minor hearing loss, would digital music player manufactures go ballistic because they might lose some sales, or heaven forbid, be sued?

Pesticides and ADHD -- What's next?

Once again, I repeat myself. It seems to be happening a lot lately. I guess the more "new" research comes out, the more support there is for what we always knew (some would say "suspected").

Today, we're talking about the "new" research that has linked pesticide use to the occurrence of ADHD. I quote "new" because pesticide use has long been a suspected link to disorders such as ADHD.

For the record, the list of research-backed, possible contributing factors discussed in our seminars over the past ten years includes: undetected/unrecognized "giftedness," sleep issues, emotional issues (including divorce, bullying, academic pressure/anxiety), food sensitivities, digestive disorders, dietary deficiencies, lack of breast feeding, environmental insults (including thimerosal, mercury, lead, aluminum, pesticides, household chemicals/cleaners/detergents, industrial chemicals), electromagnetic radiation (power lines, microwaves, cell phones), overuse of antibiotics, too much television, computers, and video game use, and physical/mental underdevelopment.

Quite the list, huh?

What's more, I, for one, long ago stopped thinking of ADHD as separate and apart from autism spectrum disorders, and I know some researchers also believe that ADHD is a part of the spectrum. Indeed, given the overlap of symptoms, the massive co-morbidity of ADHD and ASD, and the similar rise in the number of cases over time, how can ADHD not be part of the spectrum? And, if it is part, then it must share the same potential causes . . .

Ah, but these thoughts differ greatly from the medical theories (and I say theories, because despite what any doctor says, no one knows what's really causing the problems) that point to genetics and a clear dividing line between ADHD and ASD.

I suppose that on some level it would be nice if ADHD/ASD was purely genetic. Then, no one could be blamed, no fingers will be pointed, no one has to give up anything. If it's genetic, then it's no one's fault.

We wouldn't have to change our lifestyles; we wouldn't have to change our diets; we wouldn't have to give up our microwaves and cell phones; we wouldn't have to get more exercise; we could keep getting all our meds and vaccines; keep our houses clean and our lawns bug and weed free.

Moreover, if it's genetic, and ADHD is a separate animal unto itself, we have FDA approved medications for it's treatment (see my previous posts re: thoughts about medication). There are no such medically approved treatments for autism, however. So, if ADHD is truly a part of ASD, what would be the impact re: medications?

I'm truly afraid it isn't so. By now, pretty much everyone has stopped trying to argue that these disorders are purely genetic or that the horrific rise in diagnoses is due to "better recognition" or "changing definitions." No, even the government is looking for possible environmental causes.

But, here's the rub. At their heart, these disorders are the result of some sort of neurological underdevelopment or impairment. Something in the brain simply did not develop as it should have. Thus, by definition, anything that could ultimately adversely affect neurological development could be a cause. How is anyone to find the single, "this is it," cause?

Worse, the combination of different insults would surely produce far greater harm than the individual insults could. How can one study all the possible combinations?

No, I've said it before, and I'll say it again. All these "disorders," from speech and language delays to ADHD to ASD, are all part of the spectrum, sharing similar causes (and of course, a genetic predisposition to such harm). The resulting diagnosis is nothing more than our poor attempt to specifically label the ultimate degree and manifestation of the harm that has been caused.

Ultimately, we will realize and admit that this explosion of disorders really is some one's fault -- ours, as a society. We truly need to step back, honestly evaluate the safety and impact of all our modern conveniences, medicines, foods, and social environment, and do something about it instead of just relying on a bunch of pills.

Just a note (yes, another one) on meds

Not to beat a dead horse, but, let’s talk about meds for a minute.

Came across an article that states that commonly used, acid-reducing drugs, have some not so good side-effects, including increased risk of bone fractures and interference with digestive flora. Specifically, “[t]he widely used family of acid-reducing drugs … includ[ing] Prilosec, Nexium and Protonix increases the risk of bone fractures by about 25 percent and can more than double the risk of contracting the troublesome bacterium Clostridium difficile.” Acid-reducing drugs increase risk of bone fractures, Newsday (May 10, 2010). Perhaps even more disturbing is that these drugs “have also been shown to increase the risk of pneumonia.”

(Of course, there is a ridiculous disclaimer in the article. For some reason, the article doesn’t place the blame directly on the drugs, but instead, the blame goes to what the drugs do. “The increased risk is not thought to be caused by the drugs themselves, but by the sharply reduced levels of acid in the stomach and intestinal tract, which make the organs a more hospitable environment for infectious agents like C. difficile and which can impair the uptake of the calcium required for strong bones.”

That’s like saying the bullet doesn’t hurt you: it’s the hole in your body left by the bullet that allows the blood to escape…)

Anyway, here’s the point of my bringing this all up. Whenever you mess around with the body, and try to fix one particular issue with any type of powerful medication, inevitably, you mess up other areas. Everything is connected, and time and again, we miss the side-effects of medications with respect to the amazing systems and overall functioning of our bodies and all the intricate, and complicated, connections between such systems and functions. Hence, the push for more holistic, natural approaches.

Now, think about this in the context of the unbelievably potent, psychotropic drugs used on our children in connection with the treatment of such disorders as ADHD. Remember, these drugs are used even though no one is completely sure what causes such disorders, and no one is completed sure how such drugs actually work!

We’re dealing with a developing, human brain here, and the drugs are supposed to be affecting very specific chemicals in our brains. If we can’t get heartburn and our stomachs right....

And they worry about vitamins . . .

There has been a movement afoot by the medical and pharmaceutical industries calling for the strict regulation of the manufacture and sale of vitamins and supplements. The justification offered by the med/pharm industries is that consumers should be assured that what is on the label of such vitamins and supplements is exactly what is in such vitamins and supplements -- nothing more and nothing less. In addition, the med\pharm industry wants to make sure that any health claims on the vitamin and supplement labels are true. And, finally, there is always med\pharm talk about the safety of such vitamins and supplements.

Now, I agree. Vitamins and supplements, like every other product on the market, should be safe, contain what they purport to contain, and do what they purport to do. That's just decency, honesty, and common sense. Likewise, I am sure that in the vitamin and supplement industry, some manufacturers are good, honest companies selling good, honest products, while some companies may not be quite so good or quite so honest -- just like every other industry on this planet. For the most part, whenever we make a purchase, the best we can do is do our research, check reputations, lay our money down and hope that we get that for which we have paid.

But, I have to ask, what is really prompting the push for such regulations, and exactly how effective would such regulation be anyway?

Regarding the first question, let's, for the moment, assume that the altruistic justifications given by the med/pharm industries are true. Is it possible that something else is motivating such a push? Sure. Money.

If vitamins and supplements became subject to regulation, the testing, studies and manufacture of such vitamins and supplements would become prohibitively expensive. Many companies would be forced out of business -- less competition for the drugs made by the pharmaceutical companies and pushed by the medical industry.

Of the companies that remain, the costs of such vitamins and supplements would skyrocket, thereby becoming less attractive than the alternative med/pharm drugs.

Finally, it may actually become cost effective and/or profitable for the med/pharm industry to get in on the vitamin and supplement market big time. With an infrastructure already steeped in regulation, big advertising dollars, and a worldwide distribution network, it may not cost as much for the pharmaceuticals to produce vitamins and supplements, and with the combination of the government's imprimatur supporting such vitamin and supplement content and effectiveness and the inflated costs of such vitamins and supplements, don't you think that "pharmaceutical grade" vitamins and supplements would be a big hit?

Regarding the second question, exactly how effective would such regulation be? Well, with respect to labeling, I'd like everyone to read "Food Politics" by Marion Nestle. You'll discover how the various lobbies in the food industry work the government, its regulator, and its regulations to the point where you can't really tell what's in the box or its healthiness, despite the label!

And, if you follow this blog, I don't need to point out how many "FDA Approved" medicines hurt and even kill people.

But, even on a more basic level, does regulation keep bad stuff out of medicines? Did anyone catch the Johnson & Johnson major recall of children's and infants' Tylenol, Motrin, Zyrtec and Benadryl? See "Medicines for kids recalled," Newsday at A17 (Sunday, May 2, 2010). Seems that the products were recalled
"in consultation with the FDA after discovering manufacturing deficiencies that could affect the quality, purity or potency of the medicines. The FDA said some of the products many not meet required quality standards.... Some of the products affected by the recall may contain a higher concentration of active ingredient than specified; others contain inactive ingredients that may not meet internal testing requirements; and others may contain tiny particles, the FDA said."

What those "tiny particles" are was not disclosed in the article.

Now, I point this out not only to show that even with regulations, bad stuff can get in, but also note, it apparently was the MANUFACTURER that issued the recall -- NOT the government agency that's supposed to regulate the industry.

Feeling a Bit Philosophical Today

Well, the Boston Marathon is a month away, and I'm deep into the hardest training weeks. I'm following the program pretty closely, but I find myself worrying about my performance.

Truly, not surprising. I can ruin almost anything by worrying about the outcome instead of focusing on the doing. In sports, they call it "choking," and I've done more than my share of that.

So, I'm doing it again. How fast will I run this? Can I break 3 hours (ha, ha, ha)? Did I do enough training? What else can I do before the race? What if it's windy? What should I be eating? Should I get to the gym more? What if I screw this up?

While contemplating this, as well as general life questions -- including taking the Center to the next level, Robert and Katherine's college careers, home renovation plans and the stock market, I found myself wishing that I knew exactly what to do. I wanted to know the future and make the perfect plan.

Then, it hit me.

All of Life is NOT the Outcome -- It's the Process.

I know, I know. You've heard it before. Yes, I've heard it before. Life's a Journey. Enjoy the challenge. It's not whether you win or lose, it's how you play the game (now, I think that does not refer to playing fair -- I think it refers to reveling in the challenge presented and enjoying the experience regardless of the results.)

It's very Zen like.

But, like everything else, you don't actually hear good advice until you're ready to hear that advice.

This simple thought all makes sense, by definition. If you think about "life," it's what we do everyday, from now until ... the outcome (which is the same for everybody . . .). And, what we do is always changing, since our circumstances are continually changing.

We should enjoy it, the change, the movement, the uncertainty, for that is our "life."

I met a gentleman the other day. It was a chance encounter, but we had many interests, beliefs and circumstances in common. I believe we can help each other move forward in this world, although I really don't know if our paths will cross again.

But the encounter gave me hope for, among other things, the plans I have for the future expansion of the Center.

Life's like that, if you keep your eyes open.

I'll be ready for Boston. It'll be what it should be for me -- an extraordinary experience. And, if I surprise myself? All the better.

Fish Oil Affects Your Mental State

Here's a "new" fact that apparently everyone who works in the field of nutrition has known for decades: What you eat not only affects you physically, it also affects you mentally.

"Fish oil pills may be able to save some young people with signs of mental illness from descending into schizophrenia, according to a preliminary but first-of-its-kind study. [Not really -- fish oil's effects on mood and mental state have been addressed before. In particular, fish oil has been found to help with depression and bi-polar]. The Austrian study [of course, not a US study] of 81 patients comes from leaders in the field of youth mental health and adds to evidence suggesting the right intervention might prevent severe mental illness. Though it sounds incredibly simple, fish oil fits one hypothesis for what causes schizophrenia, a possible difference in how the body handles fatty acids." The study's findings appear in February's Archives of General Psychiatry.

For years, we were told that our son's "problems" had absolutely nothing to do with what he was eating. There simply was no connection with the food we ate and our mental health.

Of course, physically, what you ate had a tremendous impact -- your strength, your weight, your physical well-being -- there was never a question about the effect food had on your body from the neck down. But, that all stopped at the top of your neck. Robert's doctors told us, with no reservation whatsoever, that diet and supplements had, and would have, no impact or connection to Robert's mind.

Oh well, guess what? We found out they were all so very wrong so many years ago. Now, the scientific world is catching up to the nutritionists and natural practitioners. (There also was a recent study that addressed the effects of a Mediterranean diet on mood -- I think I discussed that in one of my earlier blogs . . . )

Why is it taking so long? Where's the money in prescribing fish oil? Who is going to spend the money it takes to perform an acceptable study, lobby for its publication, and spread the word?

Never forget, drugs make money. And, just in case you're wondering, here's what the article had to say about drug treatments for schizophrenia:

"About 2.4 million Americans have schizophrenia, a disorder treated with antipsychotic medication. Studies have tried antipsychotics in selected young people, but with troubling side effects. Results have been mixed.

For the new study, researchers identified 81 people, ages 13 to 25, with warning signs of psychosis. The people in the study had sought professional help and most were referred by psychiatrists at the Medical University of Vienna, Austria.

Researchers randomly assigned 41 of the patients to take four fish oil pills a day for three months. The daily dose of 1,200 milligrams was about what many people take to get the protective benefits of fish oil for the heart and costs less than 40 cents a day. The rest of the patients received dummy pills.

After one year of monitoring, 2 of 41 patients in the fish oil group, about 5 percent, had become psychotic, completely out of touch with reality. In the placebo group, 11 of 40, about 28 percent, became psychotic."

Probiotics -- Do Doctors Get It?

Tina, my wife and the Spark Nutrition counselor, is working with a parent whose child has noticeable issues. Let's call this child, "Mary." Part of the regiment she recommended for Mary includes the use of a daily probiotic.

Why would Tina recommend such a thing? Well, first of all, Mary has stomach issues. The probiotic would help with stomach issues.

Also, Mary is prone to colds. Recent research has demonstrated that individuals taking probiotics actually are less prone to colds and flu, and, should they get a cold or flu, their symptoms are less severe and they recover faster.

For these two reasons, alone, the probiotics are important and useful. This is why the addition of probiotics to manufactured food has become such a big selling point.

Finally, there is research connecting possible gut issues, immune system deficiences, and issues ranging anywhere from ADD to ASD. Probiotics are used nearly universally by those treating these disorders through, among other things, diet and nutrition interventions.

But, Mary recently stopped taking probiotics.

Was it because the parent saw no benefit? No.

Was it because Mary had a bad reaction to the probiotic? No.

Was it because there was some issue in the administration of the probiotic? No.

Why? Because Mary's parent was told by the pediatrician that Mary's "red blood count was normal," and therefore Mary "didn't need a probiotic."

What does the red blood count have to do with probitics? Hell if we know. Any consideration of the other reasons a probiotic was suggested? Can't imagine there was. Why tell parents to stop giving their child something that couldn't hurt them and could, and probably was, helping? Can only guess that it was because it wasn't a doctor prescribed "medicine."

We try to help, but how do you overcome the socialization that makes people listen to whatever a doctor says, even if the doctor is discussing a subject about which he has no idea?

Autism and Diet -- Expert Panel Calls for Further Research

Don't be misled. I came across an article of some importance to those with children with ASD. However, the title of this article, as well as the opening paragraph, are extremely misleading and discouraging. It should be just the opposite.

I am referring to "Evidence lacking for special diets in autism," by Carlak Johnson of The Associated Press.

Mr Johnson reports that, "[a]n expert panel says there's no rigorous evidence that digestive problems are more common in children with autism compared to other children, or that special diets work, contrary to claims by celebrities and vaccine naysayers."

While this is technically a true reading of the panel's report published in the January issue of Pediatrics, the title of the article and the manner in which it is written, paint a very distorted view of the diets that many parents and professionals have found to help children with ASD, the connection between digestive issues and autism, and of course, those who employ such diets and believe there is a connection.

In truth, the article should have been entitled, "Experts call for more research concerning diet and autism."

The first paragraph should have read, "An expert panel has found that more research is needed to determine whether digestive problems are more common in children with autism. The panel also called for more research concerning the effectiveness of special diets now employed by the many concerned parents and professionals who work with children with ASD."

I mean, really, what message is Mr. Johnson trying to send when he compares "an expert panel" that "says there's no rigorous evidence" to the "claims by celebrities and vaccine naysayers"?

And, isn't it odd the way the second part of that sentence reads? It sounds like it says that the panel determined that "special diets" don't work. But, what it really says is that "celebrities and vaccine naysayers" belief that there is "rigorous evidence" supporting the use of special diets is incorrect.

Note the difference: the expert panel never, ever said that special diets don't work. It only said that there is a lack of "rigorous evidence" concerning the effectiveness of such diets, and the panel called for more research on this issue!

Words really do matter.

In fact, a careful reading of the actual report paints a very different picture. In a nutshell, the panel recognizes that (i) ASD children do suffer from gastrointestinal issues - some studies noting the prevalence of such issues to be as high as "70% or higher" in that population; (ii) there is evidence that these children have a more prevalent occurrence of food sensitivities and food allergies; and (iii) it is very important that these issues be treated since they may be the cause of many of the behavioral problems these children exhibit. The reason the study was undertaken in the first place was to determine whether there was an "evidence-based" diagnostic and treatment regime for gastrointestinal problems presented by ASD children!

And, while not finding well-structured studies that demonstrate that special diets help these children, the panel acknowledged the anecdotal evidence supporting such diets and called for more research in this area.

Specifically, the report found the following pertinent points:

1. The panel acknowledged that more research is needed on the prevalence of gastrointestinal issues and ASD: "The prevalence of gastrointestinal abnormalities in individuals with ASDs is incompletely understood" with "the reported prevalence of gastrointestinal symptoms in children with ASDs has ranged from 9% to 70% or higher." Furthermore, while "[m]ost of these studies had 1 or more methodologic limitations . . . the preponderance of data were consistent with the likelihood of a high prevalence of gastrointestinal symptoms and disorders associated with ASDs."

2. A specific gastrointestinal issue, i.e., "autistic enterocolitis" has not been indisputably established. The report does not state that "autistic enterocolitis" does not exist. Instead, it merely states that the study that "suggested" its existence is flawed, and therefore, in the panel's opinion, the existence of "autistic enterocolitis" has not been established.

3. At least one study found that 43% of children with ASDs have a problem with "altered intestinal permeability." However, the panel believes the "[e]vidence for abnormal gastrointestinal permeability in individuals with ASDs is limited," and that "[p]rospective studies should be performed to determine the role of abnormal permeability in neuropsychiatric manifestations of ASDs."

4. Nutritional deficiencies are presented by ASD children. "Nutritional deficiencies have been reported in patients with ASDs, which is not surprising because of the narrow food preferences of many affected individuals and/or purported therapeutic diets that might be nutritionally inadequate. In a study of 36 children with ASDs, regardless of unrestricted or restricted diet, essential amino acid deficiencies consistent with poor protein nutrition occurred more frequently than in age- and gender-matched controls."

5. There is evidence that at least some ASD children do respond to dietary interventions. However, the panel believes that more data is needed before dietary modifications can be routinely recommended. "Anecdotal reports have suggested that there may be a subgroup of individuals with ASDs who respond to dietary intervention. Additional data are needed before pediatricians and other professionals can recommend specific dietary modifications. Dietary modifications such as removal of milk for symptoms of lactose intolerance may be approached empirically, as with any other pediatric patient with consistent symptoms. The data on the value of specific diets being effective in the treatment of individuals with ASDs are difficult to assess. Many dietary modifications are believed to have a beneficial outcome, although placebo effects are likely to be high in this setting. The few studies in the literature are difficult to interpret without adequate control groups.

"Many parents and care providers have observed and reported improvements in problem behaviors with nutritional or medical interventions. Some of these therapies are based on purely observational reports; many are based on studies that may have reached erroneous conclusions because of recruitment bias, lack of validated or standardized outcomes, or inadequate controls. . . . Anecdotal reports that restricted diets may ameliorate symptoms of ASDs in some children have not been supported or refuted in the scientific literature, but these data do not address the possibility that there exists a subgroup of individuals who may respond to such diets."

6. While not endorsing a "gluten-free" or "casein-free" ("GFCF") diet, the panel does recognize that in at least one study, parents of ASD children who undertook these special diets "reported positive subjective clinical changes while their child was on the GFCF diet." Moreover, the panel does not explicitly discourage the use of such diets.

"Few studies have examined the effects of a casein-free diet, a gluten-free diet, or combined GFCF diet on the behavior of individuals with ASDs. To our knowledge, only 1 double-blind placebo controlled study has been published to date. In this double-blind crossover trial of GFCF or typical diet in 15 children with ASDs, there were no differences in measures of severity of ASD symptoms, communication, social responsiveness, and urinary peptide levels after 12 weeks. Nevertheless, after being informed of the results, 9 parents wanted to continue the diet and reported positive subjective clinical changes while their child was on the GFCF diet. . . . Parents need information to help plan a balanced diet within the restrictions imposed by the chosen diet. Given the real hardships associated with implementation of a strict GFCF diet, additional studies are needed to assess risk factors and possible markers that identify individuals who might benefit from these diets."

7. The panel recognized that immune problems have been reported in ASD children, and that research exists that suggest such problems may impact neurodevelopment. However, the panel notes that a direct relationship between immune dysfunction and ASD needs to be proven.

"There has been research to suggest that immune responses can influence neurodevelopment and that significant immunologic alterations may play a key pathogenic role in some individuals with ASDs. We are now able to accurately define immune status in individuals with ASDs. Well-defined studies are needed using larger sample sets and age- and geographically matched controls, with extensive immune analysis, to determine the precise relationship of immune dysfunction to clinical symptoms."

8. Moreover, there are preliminary findings that suggest a relationship between gastrointestinal inflammation and gastrointestinal symptoms associated with ASDs. Additional investigation into such a relationship is needed. "A few studies have suggested a relationship between gastrointestinal inflammation and gastrointestinal symptoms associated with ASDs. The gastrointestinal tract is the largest immune organ in the body, containing up to 80% of Ig-producing cells in the body. . . . These studies suggest an underlying chronic inflammatory process in some individuals with ASDs and co-occurring gastrointestinal disturbances. . . . These findings should be considered preliminary and will require confirmation."

9. Gut flora, health and disease are significantly related. Additional research concerning the relationship between gut flora and ASDs must be performed. "The microbiological ecosystem of the gut is complex and poorly understood but likely plays a significant role in both health and disease. Few researchers, however, have attempted to critically examine the relationship of gut microflora to ASDs. Future studies will require molecular approaches aimed at identification and quantification of microbial species. If an association is identified, it may lead to novel treatment trials."

In summary, the panel noted, [a]ccrual of new knowledge will advance our approach to the management of ASDs and co-occurring medical conditions. Recognition that problem behaviors might indicate an underlying medical condition will facilitate diagnosis and treatment and ultimately improve the quality of life for many persons with ASDs. This expert panel has addressed considerations in the diagnostic evaluation of gastrointestinal symptoms in individuals with ASDs that may lead to effective treatment options, with the hope that patients will have better access to enlightened care."

"Enlightened care." I like the sound of that.