Saturday, March 28, 2009

Clinic Notes: A New Autism Drug

According to several reports online Curemark has received FDA clearance for a Phase III clinical drug called CM-AT for the treatment of autism. CM-AT would be given with meals to help a small subset of children with autism who do not digest protein. Problems in protein digestion can lead to other problems in digestion and a decrease in neurotransmitters.
I recall several years ago a physician who's two year old had just been diagnosed with autism. She took the child to the gastroenterology department of the hospital where she worked and they told her that autism was a gastric disorder, which they could treat. Not satisfied she went to the immunology department and they told her that autism was caused by an immune disorder, which they could treat. Still not satisfied she went to the neurology department where she was told that autism was a neurological disorder, which they could treat. Confused she emailed me and asked what autism was. I told her in the end autism was a neurological disorder, however a subset of children with autism have gastric and immune problems. Hopefully, this new drug will help those children with autism who have gastric problems and perhaps even help us understand autism in general.

Wednesday, March 18, 2009

Clinic Notes: ABA for ASD, ADD, ADHD, SD, ODD, OCD, TS, and Whatever Else is That is Left in the Alphabet

A syndrome is a collection of symptoms. So if we say a child has Attention Deficit Hyperactivity Disorder (ADHD) we know that this child has problems paying attention, is easily distracted, will not stay on task, will not sit still, will get out of his seat, not listen to the teacher, etc. Naming a syndrome such as Autism (ASD), Obsessive Compulsive Disorder (OCD), or Oppositional Defiant Disorder (ODD), is the short hand of clinicians as they communicate with each other, patients and their families, and the public. Clinicians also have shorthand for therapies. For example, Applied Behavior Analysis includes a long list of behavior therapies.
In a recent Schafer Report, an article titled, "The Rise of the Alphabet Kids," the author asks if the rise in the use of acronyms, such as ADHD, ASD, or ODD is helping or hindering treatment. In his view many British children have a list of diagnostic letters following their names because they have overlapping disorders. In my clinic I see this all the time. A child comes in with a diagnosis of Autism (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). Does the child have both? Or does the child have autism? Or does the child have ADHD? Usually, the child has autism. Many kids with autism have problems paying attention and many kids with autism are hyperactive. In my view, the added ADHD diagnosis is only describing a common feature of autism. The same is true of some of the other alphabet disorders. The added diagnosis is describing a feature of another diagnosis and is redundant. Of course, when you define behavior problems behaviorally (what is observable and measurable) then the problem disappears.

Saturday, March 07, 2009

Clinic Notes: Boy Locked Away by Parents for Seven Years

In a recent Schafer report (March 6, 2009) there was a report of a young boy who had been locked in a dark barren room for seven years. He never played with other children, been to the doctor, gone to school, and was beaten by his father. Inquiring neighbors were told by the parents, that the boy was autistic and receiving treatment at home. The parents are going to jail and the young boy will receive therapy and probably be placed in an orphanage or possibly a foster home. Unfortunately, incidents like this happen periodically and I documented several in a case history titled "Wild Child" (Available at Not only are cases like this barbaric, they tend to occur when the child is young and critical periods for the formation of language and other skills are programmed to occur. If this is prevented by the limited environment, then the child does not develop these skills because by the time they are rescued the critical periods are past. In this particular case I see hope. The police said that when they found the boy and took the father into custody, the boy said, "He won't hit me this evening." So it seems that he has some language development.

Thursday, March 05, 2009

Clinic Notes: Survey on Physicians Feeling Ill-Equipped to Treat Autism

In a recent survey, (see Schafer Autism Report, March 4, 2009) over 2000 physicians were surveyed about their views on treating autism in their practice. Of note, only 19% responded and those that did respond felt unprepared to treat autism. Primary care physicians, especially pediatricians, are being encouraged to screen young children for autism. And I think they are responding. I am getting more physician initiated requests to do autism evals. Of course, some physicians, such as pediatric neurologists, are involved in treating autism, prescribing medications that are helpful and doing evals. But I'm not sure what the role of primary care physicians should be in treating autism. I'm always looking for a pediatric neurologists to refer children to for medication. But often there is a long waiting period. I guess, with additional training, perhaps primary care physicians could help out there. Also some children with autism have digestive problems and that could possibly be another useful role for primary care physicians. Now pediatric gastroenterologists handle most of these cases and again there is a long wait for appointments usually. Many parents of children with autism are wary of traditional medicine, often blaming vaccines for causing their child's autism. Furthermore, many parents have turned to alternative medicine in treating autism. Other concerns reported by physicians in the survey were reimbursement problems and a lack of training. I think the real question that should be asked is do primary care physicians want to be involved in the treatment of autism.