For Parents and Caregivers of a Child With Special Needs: A Guide to Taking Care of Yourself by Luciana C Leo LAc

 

“The care you give to yourself is the care you give to your loved one”.  Yes I know what you are thinking while you read this phrase… it is so easy to say, but very hard to implement!  I always give this advise to all the parents that bring their children to my office.  I found out that parents have a hard time accepting this advise.  But the reality is that most of the children that come for treatment to my office are healthier than their parents!  Many studies showed that about 60% of caregivers show signs of clinical depression, anxiety, stress overload and burnout.
Sometimes is hard to see beyond all the chores and tasks you have to do each day, and  finding time to nurture yourself might seem impossible. But you owe it to yourself to find the time. Without it, you may not have the mental or physical strength to deal with all of the stress you experience as a caregiver. Give yourself permission to rest and to do things that you enjoy on a daily basis. You will have much more energy and you will be a better caregiver for it.

Tips for taking care of yourself:

• Do things and activities for yourself, even if you do not feel like it.  Join the gym, a class of your interest, get a manicure and pedicure, take a bubble bath… whatever makes you happy.   
• Eat balanced meals.  
• Try to exercise daily, at least take a walk around the block.  Exercise is a good stress releaser!
• Try to sleep at least 7 hours at night.  If you can’t sleep at night, take a nap while your child is in school, daycare or a therapy.
• Learn how to manage your time wisely. Be realistic about how much of your time and yourselves you and your child can give.  I see parents trying to do the impossible to schedule three or four therapies in a day for a child.  They run all over the place, eating inside the car and fighting with the kids cause at one point there are exhausted too.  
• Disconnect from technology:  It is very important that you educate yourself about your child’s condition, but do not allow yourself to be “googling” or searching the web 24/7.  Set up a “research time” and do not exceed it.
• Laughter really is the best medicine.  Try to be around positive people, go to a comedy show, or just watch a comedy movie.
• Keep a journal. Write down your thoughts and feelings. This helps provide perspective on your situation and serves as an important release for your emotions. 
• Try to set a time for afternoons or evenings out. Seek out friends and family to help you so that you can have some time away from the home. It is important that you interact with others. 
• Accept your feelings.  Taking care of your loved one with special needs can trigger a host of difficult emotions, including anger, fear, resentment, guilt, helplessness, and grief. As long as you don’t compromise the well-being of your child, allow yourself to feel what you feel.  Don’t delay in getting professional help when you need it.
• Allow people to help you by giving them a specific task to do.  You do not have to do everything yourself.

Remember that even though your main goal is to help your child get better and to progress in life, you also have a life to take care of.  Because once you burn out, care giving is no longer a healthy option for either you or the person you’re caring for. So it’s important to watch for the warning signs of caregiver burnout and take action right away when you recognize the problem.

Common warning signs of caregiver burnout:

• You have much less energy than you used to.
• It seems like you catch every cold or flu that’s going around. 
• You’re constantly exhausted, even after sleeping or taking a break. 
• You neglect your own needs, either because you’re too busy or you don’t care anymore. 
• Your life revolves around taking care of your child, but it gives you little satisfaction. 
• You have trouble relaxing, even when help is available. 
• You’re increasingly impatient and irritable with the person you’re caring for. 
• You feel overwhelmed, helpless, and hopeless.

Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed and unable to meet constant demands. As the stress continues, you begin to lose the interest or motivation that led you to take on a certain role in the first place.
Burnout reduces your productivity and saps your energy, leaving you feeling increasingly helpless, hopeless, cynical, and resentful. Eventually, you may feel like you have nothing more to give.
Most of us have days when we feel bored, overloaded, or unappreciated; when all the things that we are juggling in our lives are just to much; when dragging ourselves out of bed and staying up requires six cups of espresso. If you feel like this most of the time, you may be flirting with burnout.
Having your own life outside of taking care of your child will help you maintain perspective, so that care giving doesn’t become your only reality.  Once parents actually start to accept this advise, they bloom and so do their children.
Happy parents, happy kids!

Understanding Yeast Overgrowth By Luciana C Leo LAc DOM

Yeast are present in all of us.  They are fungus that normally live in our bodies (skin, mouth, throat, intestines and vagina) in harmony with other organisms, like bacteria.  However, this harmony between organisms can be disrupted in the bodies of many individuals with autism.  It is very important to understand that yeast are “opportunistic” organisms; this means that they will take advantage of any breakdown in the normal defense mechanism of an individual in order to multiply and grow out of control.  This creates a condition of “yeast overgrowth”.   

Yeast overgrowth can be due to three main causes: 

1) Over-feeding of yeast

The eating habits of today’s younger generations are not the more appropriates for them.  Many children’s diets are based on sugar such as candy, juices, or soda; and starchy foods such as pizza, bread, pasta or cereal.  Starch can quickly brake down into simple sugars in the body.  Sugar is not only your child’s favorite treat, it is also the yeast’s favorite food.  It can easily grow on sugar.

2) Unbalance of organisms in the body:   

The number one reason for yeast overgrowth is frequent antibiotics use.  Antibiotics are meant to kill the abnormal bacteria causing the infection being treated.  Unfortunately, antibiotics kill not only the bad bacteria; they also kill the good bacteria in the body.  When this happens, yeast no longer have competition and begins to overgrowth. 

     3) Immune dysfunction:

If an individual has an underlying immune condition, then yeast will take advantage of the situation and will start spreading.

A person with yeast overgrowth can present physical and behavioral symptoms:

Physical Symptoms: headaches, abdominal pain, diarrhea or constipation, skin rashes, eczema, heartburn, muscle aches, a very white or yellow coating on top of the tongue (the coating of the tongue reflexes your Gastrointestinal System’s health), malar flush, fungal infections in the fingernails or toenails or red ring around the anus in between others.

Behavioral Symptoms: My favorite most recognizable symptom of yeast is the inappropriate laughter or the “Joker” (from Batman) laughter! Other symptoms that can present may be sleep disturbances, unexplained intermittent crying episodes, depression, fogginess, lack of concentration, hyperactivity, inattention, anger, aggression, increased self-stimulatory behaviors, climbing or jumping off things, sugar cravings, confusion, or lethargy in between others. 

To top it all, yeast produces toxins that depress the immune system, making an individual more reactive to allergies and more susceptible to infections.  Also, as yeast toxins are absorbed in the colon, and enter the bloodstream, they cause the individual to have yeast sensitivity which leads to many other symptoms that the individual may present such as dark circles around his/her eyes, frequent colds and constant runny nose, sinuses in between others.

There are many tests available to check for yeast overgrowth.  The tests can be done in blood, urine and stool.  The blood test is to measure candida antibodies; the problem with this test is that if an individual’s immune system is weak to detect yeast, then it will not create antibodies against them so the test will come out negative even though the person may have yeast overgrowth.  The urine test is called a Urinary Organic Test (OAT) and it measures the yeast waste products in the urine.  My favorite test is the stool analysis which will check for the type of yeast an individual has, how much of it and what treatment will be the most effective to treat the problem.  All these tests need to be ordered by a physician.

The treatment of yeast overgrowth can be very streaky.  There are two ways of treating yeast, with medications or with alternative medicines.  The problem is that yeast are live organisms with a very strong memory, so they can get use to be exposed to a particular products and become resistant to it.  Because of this reason, it is important to rotate medications or supplements at least every three months when treating yeast.  Also, if you want yeast dead, the best way to speed up the process is to starve them.  It makes no sense to be taken medicines or any other products if you are going to continue feeding the yeast with candy, pizza or pasta.  The best base for a successful treatment is to clean up the diet.

Recommended Dietary Modifications:

Eliminate:

1.  Yeast and sugar for one month
2. Milk and milk products for one month
3. Alcoholic beverages and fermented products for one month
4. Fruit for two weeks

Eliminating sugar can be the most difficult part of the yeast-free eating program, in part because so many foods contain added sugar. In addition to cane sugar and beet sugar, you will have to avoid honey, corn syrup, maple syrup, molasses, fruit sugar (fructose), milk sugar (lactose), and malt sugar (maltose), because yeast grows on sugar. Refined grains and starchy foods such as bread, pizza, pasta, cereal, potatoes, and rice are also off limits because they can be quickly broken down into simple sugars.

Some of the best choices to treat Yeast overgrowth:

Prescribing medications: Nystatin,  ketoconazole, Diflucan or fluconazole, and Amphotericin B in between others.

Alternative medicines: Grapefruit seed extract, candida freedom, olive leaf extract, candidase from Enzymedica, Saccharomyces Boulardii, and berberine in between others.

Understand that dosing and frequencies are recommended based on the individual’s age and weight.  A physician will prescribe the treatment according to the individual’s unique needs. Yeast treatments can require several treatments or reoccurring treatments to remedy the imbalance. Rarely is one yeast treatment the only requirement for keeping bacteria in balance.

An unusual, but very beneficial sport for children with ASD: Ice Skating

When parents start looking for a sport or activity for their children with special needs, most of the time, they try more conventional sports like soccer, baseball or karate.  Any type of physical or group activities are beneficial in one way or another.  Sometimes the options can be expanded if we think outside the box! What about ice skating?  I was surprised when I found out that there is a coach in Broward County that teaches ice skating to children with autism.    
Kris Davidson has been ice skating for over thirty years and she teaches this fabulous sport to individuals diagnosed with ASD at the Pines Ice Arena in Pembroke Pines, Florida .  Somehow, Kris always showed interest in the special needs population.  Ever since she used to go to work with her father, who worked with children with hearing impairment.  Kris’s interest to learn more about ASD increased when her own cousin was diagnosed with autism.  Since then, she got a bachelors degree in exceptional education, and she is currently a fifth grade ESE teacher at the Autism Charter School in Hialeah.
Due to her extensive background in both areas, exceptional education and figure skating, Coach Kris is able to incorporate both of her passions into one and share it with families who are looking for a special activity for their children.  
Ice skating is a well-chosen physical program for a child with autism, or any other exceptionality, that will assist with a child using appropriate behavior, self-control, and learning.  There is not a doubt that Ice skating is a very difficult sport, but because of that, it helps children to increase their ability to concentrate, improves their motor function, strengthens postural control, encourages communication, promotes social skills, and helps children gain a greater sense of self esteem.
I had the opportunity to meet one Saturday at the Ice arena with Kris and one of her students, Wesley who is 11 years old.  When I went inside the ring, I saw how many people were skating all over the place, I heard the loud music, and how cold it was.  Right away I though to myself, this is not the appropriate environment for a child with autism considering how many sensory issues they can have.  Kris approached me at the ring and asked me if I saw Wesley already, I answered no.  She pointed at him, he was already skating on the ice all by himself.  I was amazed and surprised at the same time watching him skating with a big smile from ear to ear.  Wesley blended so well in between the other skaters.  He was enjoying the people, the music, and the ice.  Wesley has been able to cope with these stressor by concentrating on the skating.  He has been showing great improvement on behavior, social skills, coordination and speech. 
Coach Kris not only teaches children how to skate, she also teaches them social skills, communication, confidence, and how to make a friend.  She also uses the ice to draw for educational purposes, to play and to work in sensory input.  Ice skating in South Florida is an amazing experience to have without living in a northern climate, it is also a great sport that can be done indoors and without sweating!  Two of the most important factors that sports and treating a child with special needs have in common are CONSTANCY and CONTINUITY.  It is recommended to start classes at least for 30 minutes, once a week.  Ice skating is a sport that can help children gain great skills while having fun… When you think that there is nothing else you can do, just think outside the box!

Fighting Flu Season! By Luciana C Leo LAc

Many of us look forward to the Holiday Season! But unfortunately, it comes hand on hand with the “Flu Season”.  Flu is unpredictable, and it's impossible to say with any certainty what kind of season we're going to be in for.  This flu season started officially in October and flu activity usually peaks in January, February, and March.  The flu is a virus usually acquired through contact with an infected individual.  The young and old population are the ones at most risk, specially if they have an impaired immune system which is the case for many children and adults with autism.
The flu makes most people feel sick all over. Common flu symptoms are fever, cough, sore throat, runny or stuffy nose, body aches, headache, dizzinesvent flu, ws, chills, and fatigue. Some also might have vomiting and diarrhea. Mostly it last for five to seven days.  Because the flu is a virus, there is not a particular medicine that will help you get rid of it.  Treatment is usually geared toward improving the present symptoms.

What to do if your child gets the flu…

For Fever:
1) Dip: Let your child sit in a tub of coolish water (definitely not ice cold water, which can induce shock) for half an hour.
2) Strip: With the body exposed as much as possible, the sweat glands will be better able to release moisture, which will make the person feel more comfortable. Strip down to your skivvies, that means a diaper for an infant and underpants and thin undershirt for an older child or adult.
3) Sip: Fever can be accompanied by vomiting or diarrhea, leading the body to fluid loss and an electrolyte imbalance, so it's important to keep drinking.  Some cool natural kitchen remedies to help dehydration during fever are:

• Pour a pint of boiling water over an entire head of lettuce and let it steep, covered, for 15 minutes. Strain, sweeten the liquid to taste (with stevia, honey or xylitol), and drink.  This lettuce infusion may help improve sleep pattern also..

• Pineapple. Fresh is best. It's one of nature's anti-inflammatory agents that can fight fever. Pineapple is also packed with juice that can prevent dehydration.

      These two decoctions can be made into popsicles for children.
4) Resort to over-the-counter relief: If a fever is making you or your child very uncomfortable, a nonprescription antipyretic (fever-reducing) drug can be used.  For children, stick to Ibuprofen.

For other flu symptoms:
The best way to fight the flu is by strengthen your child’s immune system and by giving him/her natural antiviral to help relieve some symptoms of the flu, reduce the length of time it will take to recover from it, and reduce the risk of serious complications from the flu such as pneumonia.  Here are some options for natural antiviral:
1)Echinacea - It has long been used as an antiviral remedy for colds and flu.  It appears to work by boosting production of interferon, the body’s own antiviral fighter, as well as stimulating infection-fighting white blood cells.  The compounds of Echinacea have specific antiviral properties that can resist viruses.  The best way of testing if you bought a good strength of Echinacea is the tongue test.  After tasting it with your tongue, the tongue should feel numb or tingly. Dose: Adults should follow the dose in the label.  For children do 1/3 of the adult dose on the label.
2) Virastop from Enzymedica - It contains a blend of proteases which can help to break down protein pathogens in blood, including viruses.  Dose: Adults and children take one capsule three times a day in an empty stomach (meaning 1 hour before or 2 hours after a meal).
3) Vitamin C - It is a powerful antioxidant that protects against infection and enhances immunity.  Dose: Adults take up to 5000mg per day.  Children take up to 2000mg per day, for children younger than 2 years old consult with your primary physician.  You can also give 15mg of Zinc daily to improve the body’s absorption of vitamin C.
   
How to prevent the flu…

1) Wash your child’s hands frequently.  Use warm water and soap.  The flu virus can enter the body through the mouth, nose and eyes. 
2) During flu season all the family members in the household can take 500 to 1000mg of vitamin C to boost the immune system combined with 15mg of Zinc to increase vitamin C’s absorption.
3) Encourage physical activities for at least 30 minutes a day for your child by going to the park, riding the bike, playing the Wii, dancing, jumping, or by signing them up in sports or activities.
4) Children need a good night sleep in order for the body to recharge itself.  A good sleep is essential for the immune system.

Some thing to know about the flu vaccine…

To vaccinate or not to vaccinate??? That is the question! When it comes to a child’s health, parents need to educate themselves in order to decide what is best for their children!!!

1) It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against influenza virus infection.  Therefore, if your child presents initial symptoms of the flu, do not vaccinate.  By the time the vaccine starts to work, the virus will be out of your child’s body and the body would have developed antibodies to the flu on its own.  DO NOT GET YOUR CHILD VACCINATED IF HE/SHE IS SICK!!!
2) According to Dr J. Anthony Morris, the former Chief Vaccine Control Officer at the FDA, “There is no evidence that any influenza vaccine, thus far developed, is effective in preventing or mitigating any attack of influenza”.
3) The 2010-2011 multi-dose vials seasonal flu vaccine DO contain thimerosal (mercury-based preservative) as explain in the Q&A page of the Centers for Disease Control and Prevention (CDC) website (http://www.cdc.gov/flu/protect/vaccine/thimerosal.htm).  If you decide to vaccinate, the single dose units and the nasal spray vaccine do not contain thimerosal. 
4) Keep in mind that the nasal spray flu vaccine is live virus and should not be given to children younger than 2 years of age, children with a  weak immune system, children younger than 5 years old with severe allergy/asthma/wheezing problems, anyone with muscle or nerve disorders (such as seizures or cerebral palsy) or anyone in long-term aspirin treatment.
5) Influenza vaccine virus is grown in eggs. Children with an egg allergy should not get flu vaccine.

This year the flu season does not have to get you and your family down!  Remember that the best attack is a good defense.  Take care of yourself and the ones you love by implementing the necessary measures of prevention against the influenza.  Don’t let the flu virus be the center of attention during these holidays season!

Siblings: The Unconditional Friends! by Luciana C Leo A.P.

Reading articles, research papers and watching tons of videos in YouTube about siblings of children with special needs to prepare this article, I came to a simple conclusion: All relationship between siblings are complicated, no matter what. Friendships are different, because most of the time the people we picked to have as friends have things in common with us that we can share. Instead, we don’t pick our brothers or sisters, we are actually forced to live with them most of our childhood and teenage years. We learn what they like, what they don’t like, their dreams, their fears, their weaknesses and strengths. We come to know how to push their buttons and make them very mad, but we also learn about what makes them happy!. The relationships between brothers and sisters do not grow overnight. It can be very difficult at times due to different personalities or preferences in the individuals. However, there is a strong bond in between siblings that nothing can brake, not even autism.

Sometimes it can be difficult for parents of children with special needs to juggle the demands of all the family members, the house chores and work, when they are trying to do all they can for their child with special needs. Many parents also worried about how the siblings may cope with their brother or sister with autism. What if they feel embarrassed by their brother or sister? What if they feel jealous? What if they compete for attention? Well…The reality is that these feelings and questions just mentioned are very common in a sibling relationship. I went through those stages of jealousy, anger, competency, frustration, embarrassment with my brother and my sister and they don’t have special needs. I bet every single person when through those phases with their siblings! In order for these feelings not to go out of control, children need to learn how to mange them. They need to learn coping skills and the most important teachers of these coping skills are a child’s mother, father, and even their sibling with special needs.

Here are some suggestions that parents can do within the family to improve the interactions among the children in the family:

1) Don’t try to push them to play together if they are doing different things, they may not have the same interests. What you can do is engage them in playful interactions. For example, blowing bubbles, playing with a hose outside, doing a pillow fight , doing races, or playing with the wii.

2) Find some separate time for the children: Different activities, different group of friends, etc.

3) Do not over-protect your child with special needs, let him/her self defense (unless is a dangerous situation) and figure out how to resolve the problems with siblings. The other way around, if your child with special needs hits a sibling or takes something away from him/her, let the sibling respond to the action (unless he/she is not old enough or the aggressive behavior is very intense)

For most Brothers and sisters of children with special needs, the experience with their siblings is positive. It teaches them to accept other people as they are. Some become deeply involved in helping parents care for their brother or sister, often assuming responsibilities beyond their years in terms of that individual's care and the maintenance of the household. It is not uncommon for siblings to become ardent protectors and supporters of their brother or sister with special needs or to experience feelings of great joy in watching him or her achieve even the smallest gain in learning or development. Increased maturity, responsibility, altruism, tolerance, humanitarian concerns and careers (85% of siblings of children with special needs start a humanitarian career), a sense of closeness in the family, self-confidence, and independence are among the other positive effects noted in siblings (Lobato, 1990).

As I said at the beginning of the article: All siblings relationships are complicated, no matter what. I believe that the relationship in between siblings is like a Sour Patch, bitter and sweet at the same time. Siblings can be so different, but at the same time have so much in common! I believe that the bond between brother and sister is one of the strongest that you can ever have with anyone else. That is why they can be very far, but feel very close. They can be super mad at you, but they will be there when you need them. They can be saying nothing and at the same time saying so much. The love of a brother or a sister is forever, no matter what!

Research Review: Acupuncture Improves Language and Social Interaction in Children with ASD by Luciana C Leo A.P.

The Centre for Neurocognitive Function Enhancement at The Chinese University of Hong Kong did a randomized controlled trial to evaluate the effect of an acupuncture technique, called "Seven-Star Needle Stimulation", for the treatment of children with Autism Spectrum Disorder (ASD). Thirty-two children were assigned randomly into the treatment group and the control group. Children in the treatment group underwent 30 sessions of stimulation over 6 weeks (Sessions were 5 to 10 minutes long, 5 times per week), while children in the control group were on a waiting list and did not received any treatment during this period. Children in the treatment group were stimulated at the front and back sides of their body and the head by using a Seven-Star Needle.

The tool for the Seven-Star Needle Stimulation looks like a thin long hammer with a handle on one side and a head that consist of 7 blunt needles forming the shape of a seven-point star on the other side. Due to the way this tool is designed, it can provide maximum stimulation without penetrating the skin making the treatment very suitable for children. Seven-Star Needle Stimulation has been used for over 1000 years in China. Two underlying mechanisms might explain the therapeutic effect of this technique. The first is based on the Traditional Chinese Medicine concept that there are 20 channels distributed over the human body, and the channel on the front and the one on the back govern the harmony of the body, including the brain. The other hypothesis suggested that the treatment effect of Seven-Star Needle Stimulation is related to the stimulation of the sympathetic nervous system distributed along the spine (Bai, 1989).

Children in both groups were assessed before and after the treatment group underwent treatment, first at baseline and then 6 weeks later. They were assessed by parent’s rating on 3 major areas that characterized children with ASD: language, social interaction and behavioral problems; as well as motor functioning. In addition, their change in quantitative electroencephalography (qEEG) profile was assessd to serve as a relatively objective outcome measure. Results showed that the treatment group demonstrated significant improvement in language and social interaction, but not in stereotyped behavior or motor function, compared to the control group. qEEG spectral amplitudes in the treatment, but not the control group, were also reduced significantly. The results suggested that Seven-Star Needle Stimulation might be an effective intervention to improve language and social functioning of children with ASD.

"Seven-Star Needle Stimulation Improves Language and Social Interaction of Children with Autistic Spectrum Disorders"

Agnes Chan, Mei-Chun Cheung, Sophia Sze aadn Winnie Leung

What is The Role Of The Pediatrician in Early Intervention and Management of ASD by Luciana C Leo A. P.

The numbers of children affected with autism has been increasing for the past couple of years at a very high speed.  An early diagnosis and early intervention are crucial to help the children reach their highest potential academically, physically and mentally.  Pediatricians are usually the first physicians to examine and evaluate children.  They are also the first point of contact for parents.  Because of the ongoing visitations to the Pediatricians during the children first years of life, they are the ones that can follow up on how the children are developing, playing an important role in early recognition and evaluation of autism spectrum disorders (ASD), but also in the chronic management of ASD.
A survey completed in 2004 revealed that 44% of Primary Care Pediatricians (PCP) had at least 10 children with ASDs in their practices; however, only 8% of PCPs stated that they routinely screened for ASDs.  It is critical that Pediatricians are able to recognize early signs of autism and be aware of the new data regarding treatments and interventions programs that may benefit the children outcomes.
In November of 2007, the American Academy of Pediatrics (AAP) in combination with the Council on Children With Disabilities created an autism tool kit for clinicians rendering pediatric care.  The tool kit contains two guides with screening and surveillance tools, practical forms, tables, and parent handouts (You can download the autism kit at www.aap.org/pressroom/aappr-autism-issuekit.htm):

1) Identification and Evaluation of Children with Autism Spectrum Disorders.
Chris Plauche Johnson, MD, Med, Scott M. Myers, MD, and the Council on Children With Disabilities.
Pediatrics, Nov 2007; 120:1183-1215

2) Management of Children With Autism Spectrum Disorders
Scott M. Myers, Chris Plauche Johnson and the Council on Children With Disabilities
Pediatrics, Nov 2007; 120:1162-1182

The purpose of the Identification and Evaluation of Children with Autism Spectrum Disorders Guide is to support the Pediatricians in the identification and care of children with ASD.  This guide explains the diagnostic criteria for the 3 pervasive developmental disorders that fall inside the autism spectrum: autistic disorders, Asperger’s syndrome and pervasive developmental disorder-not otherwise specified (PDD-NOS).  The guide explains in detail the clinical signs for each disorder in order for the PCPs to be able to identify them and it provides Pediatricians with a written policy to follow in order to do developmental surveillance and screening in children.  It also provides with all the necessary diagnostic tools and forms, and the download site for the forms.  All the forms are available to the PCPs free of charge. 
According to the AAP policy statement, “Surveillance” is the ongoing process of identifying children who may be at risk of developmental delays.  This group of children will include younger siblings of children diagnosed with ASD or with a family history of cognitive conditions.  “Screening” is the use of standardized tools at specific intervals to support and refine risk of autism spectrum disorder or any other cognitive delays.  The protocols for surveillance include preventive care visit.  During the visits the Pediatricians should monitor for early abnormal signs, ask parents open ended questions about their concerns regarding child’s development and behavior, ask age-specific questions about whether certain developmental milestones have been attained (you can find a list of these milestones at www.firstsigns.org).  In addition, a Pediatrician should be pay attention to concerns mentioned by the parents stimulated by comments made by other care providers such as child care staff or school teacher.  According to the AAP, A standardized screening tool should be administered at any point when concerns about ASDs are raised spontaneously by a parent or as a result of clinician observations or surveillance questions about social, communicative, and play behaviors.  If the screen on a child is positive for possible ASD, the Pediatrician should provide the parents material and education tools on autism, referred the child for a comprehensive ASD evaluation, to early intervention/early childhood education services (An official diagnosis is not needed for a child to receive early intervention), and an audiologic evaluation.  The AAP policy recommends that all children be screened with a standardized developmental tool at the following specific intervals: 9, 18, 24 and 30 month visits regardless of whether a concern has been raised or at risk has been identified during the surveillance process.  The Identification and Evaluation of Children with Autism Spectrum Disorders Guide states that “the PCPs have to do an ASD-specific screening when parents raise a concern about a possible ASD, and PCPs SHOULD NOT TAKE A WAIT-TO-SEE APPROACH”.
On the other hand, The Management of Children With Autism Spectrum Disorders Guide reviews the educational strategies and associated therapies that are the primary treatments for children with autism spectrum disorders.  The Guide addressed management of associated medical problems, pharmacologic and no pharmacologic intervention for challenging behaviors or coexisting mental health conditions, and use of complementary and alternative medical treatment.  It is very important for a Pediatrician not only to be able to recognize early symptoms of ASD, but also to be able manage the care for this chronic condition being that they are the main physicians for the children for the first 18 years of life.
The AAP protocols for Pediatricians for the management of children with ASDs implies that “to deliver appropriate and effective medical care, the history, approach to the patient, physical evaluation, and treatment options must be considered in the context of the patient’s ASD.  Familiarizing the patient with the office setting and staff, allowing ample time while talking before touching the patient, allowing the child to manipulate instruments and materials, keeping instructions simple, using visual cues and supports, slowing down the pace and exaggerating social cues.  In a nationally representative sample, it was found that children with ASDs spent twice as much time with the physician per outpatient visit compared with children in control groups”.
The AAP also has a session in the second guide that talks about complementary and alternative medicine and it suggests Pediatricians to recognize that many parents are going to choose nonstandard therapies for their children.  It is very important for Pediatricians to become knowledgeable about the alternative therapies and treatment available for ASD.  PCPs should ask parents about the current and past complementary treatments or therapies use.  Pediatricians should educate the parents about how to evaluate information in order to decide the right treatment for their children AVOIDING BECOMING DEFENSIVE OR DISMISSING ALTERNATIVE TREATMENTS OR THERAPIES IN WAYS THAT CONVEY A LACK OF SENSITIVITY OR CONCERN, MAINTAINING OPEN COMMUNICATION, AND CONTINUING TO WORK WITH FAMILIES EVEN IF THERE IS DISAGREEMENT ABOUT TREAMENT CHOICES.
The involvement of the primary pediatrician of the children with ASD is extremely important in their plan of care.  Families and practitioners are still learning about this syndrome, and it is very important that everyone works together in order to help our children reach their fully potentials.  Share this information with your practitioners or other parents, a copy of the complete guides can be downloaded at www.aap.org/pressroom/aappr-autism-issuekit.htm