I love my CPAP. I got it from Nationwide Medical, Inc., 28632 Road Side Drive, Agoura Hills, CA 91301
I was not going to write this blog article, until I thought about the implications for others. I also thought that this might be a problem with other CPAP equipment providers, and for those who be using a CPAP in the future. It also has implications for national health care.
We all know that most aspects of health care in the United States are currently profit making, profit taking concerns. There are times when profit making tends to over ride ethical practice when it comes to consumer money and healthcare insurance. I found one concern that needs to be addressed in a broader forum than a single complaint to a company. I hope that more people read this than one or two others. I strongly advise readers to share this post with as many people as possible.
Using a CPAP requires the periodic replacement of certain parts. Some parts clearly need replacement more frequently than others. The problem arises when the CPAP provider insists on replacing more durable parts on a more frequent schedule than necessary. This is the case with the CPAP mask AND straps. No one who cares for their mask by judiciously washing it with soap and water needs to receive a new one every month, six weeks, six months or even every year. My own physician confirmed this for me. He even went so far as to say that this was clearly a money making (taking!!!!) proposition for the company. Take good care of your plastic mask and it will last for a long time. Save money, and tell your CPAP accessory provider to stop sending a new mask unless you specifically request one.
It is important to emphasize hygienic care of the accessories that accompany the CPAP. Keep the parts as clean and free from bacteria and other environmental pathogens as possible. Coincidentally, I recently received an e-mail about a website that discusses healthcare associated infections that is sponsored by Kimberly-Clark. All of the concerns were related to hospitals. It might be worthwhile to add something about the care of CPAP equipment. For those who are interested in healthcare associated infections, I recommend that you consider visiting http://haiwatchnews.com
Once again, share this blog with as many people as you can. Forward it to your health care insurance provider.
Friday, May 28, 2010
Sunday, April 4, 2010
The Right-Handed Desk
There is a sinister problem that pervades American schools for up to ten percent of the student population that few people consider worthy of solving. The 10% minority faces bias because they are ignored and often forced to join the right culture.
The word for "left" in Latin is "sinister." Student desks (and most other academic equipment) are almost always made for right-handed students. The unfortunate part about this problem is that people who are right-handed tend to minimize the problem for the roughly 10% of students that are left-handed.
There are two issues to consider before we discuss the results of forcing left-handed students (or ignoring the needs of left-handed students) to write at right-handed desks. One issue is the availability of desks designed for left-handed students. Many school systems have left-handed desks available to students. Placing a left-handed student at a separate desk designed for them makes them "separate but equal." They stand out among their peers just as African American students stood out in their separate but equal schools. The second issue is the availability of unbiased seating that can be comfortably used by both right and left-handed students, thus integrating the 10% minority into the general school population.
It is an easy matter these days to do a computer search (if you are left handed, use a left-handed mouse) on the effects of left-handed students sitting at right-handed desks. My young friend, Dr. Mayer Green, a chiropractor in Maryland, would undoubtedly support the fact that a left-handed student who contorts his or her body around a right-handed desk will suffer chronic back, neck, and shoulder pain. Thus, the issue is certainly worthy of a national campaign by chiropractors to stop school systems from abusing 10% of their students.
There are surveys of things that happen to left-handed students during their school career. Do any parents of left-handed students hear complaints about their sons and daughters being fidgety, having problems paying attention, cheating on tests, taking too long to complete timed exams, etc? Would anyone in the mental health field be the least bit interested in finding out how many students who have been diagnosed with Attention Deficit Hyperactivity Disorder or Attention Deficit Disorder are left-handed. I doubt it, because fixing the problem by simply changing desks would probably result in a huge reduction in the number of prescriptions written for medicine to keep them focused (medication that is unnecessarily prescribed).
Please do a search on the problem of handedness in the schools. You may save your child's school career. Start with http://handedness.org/action/fairdesks.html
The word for "left" in Latin is "sinister." Student desks (and most other academic equipment) are almost always made for right-handed students. The unfortunate part about this problem is that people who are right-handed tend to minimize the problem for the roughly 10% of students that are left-handed.
There are two issues to consider before we discuss the results of forcing left-handed students (or ignoring the needs of left-handed students) to write at right-handed desks. One issue is the availability of desks designed for left-handed students. Many school systems have left-handed desks available to students. Placing a left-handed student at a separate desk designed for them makes them "separate but equal." They stand out among their peers just as African American students stood out in their separate but equal schools. The second issue is the availability of unbiased seating that can be comfortably used by both right and left-handed students, thus integrating the 10% minority into the general school population.
It is an easy matter these days to do a computer search (if you are left handed, use a left-handed mouse) on the effects of left-handed students sitting at right-handed desks. My young friend, Dr. Mayer Green, a chiropractor in Maryland, would undoubtedly support the fact that a left-handed student who contorts his or her body around a right-handed desk will suffer chronic back, neck, and shoulder pain. Thus, the issue is certainly worthy of a national campaign by chiropractors to stop school systems from abusing 10% of their students.
There are surveys of things that happen to left-handed students during their school career. Do any parents of left-handed students hear complaints about their sons and daughters being fidgety, having problems paying attention, cheating on tests, taking too long to complete timed exams, etc? Would anyone in the mental health field be the least bit interested in finding out how many students who have been diagnosed with Attention Deficit Hyperactivity Disorder or Attention Deficit Disorder are left-handed. I doubt it, because fixing the problem by simply changing desks would probably result in a huge reduction in the number of prescriptions written for medicine to keep them focused (medication that is unnecessarily prescribed).
Please do a search on the problem of handedness in the schools. You may save your child's school career. Start with http://handedness.org/action/fairdesks.html
Sunday, March 14, 2010
Chicken or Egg, Sleep Problems Cause ADHD
Working with children under 3 years old, 40 hours per week for the last 5 years creates a unique opportunity to study the possible origins of ADHD. Most of the powers that be aver that it is strictly a neurological problem. There must be considerable doubt about this, because the common treatment with medication can cause more problems than it actually treats. Looking at older children, one notes that a high percentage of children (and adults) diagnosed with ADHD have sleep problems.
There is something of a statement regarding sleep and ADHD at http://www.sleepfoundation.org/ Another good website, with links to tons of educational articles is http://www.sleepeducation.com/ You can see it on that site if you look hard enough, or you can examine the results of a large survey of parents of children under ten years old at www.sleepfoundation.org/sites/default/files/2004SleepPollFinalReport.pdf . Perhaps not amazingly, the treatment of the sleep problems literally cures a high percentage of the children who have been diagnosed with ADHD. Where, in heavens name, do sleep problems in tiny children originate? There are four main sources of child sleep problems, and host of minor connections. Before I generate a host of critical comments, yes, I realize that the sleep problems MIGHT be neurological. However, the sleep problems start somewhere else in most cases. Make yourselves comfortable because this has the potential of becoming a long blog. I am going to spend some time with it before I publish it.
Pretty close to 100% of new parents have no idea what sleep hygiene means. The lack of knowledge about this interacts with how parents freely provide small children with access to television, DVDs, and video games. Sprinkle in poor dietary management, and there is a huge opportunity to create an epic movie, with multiple sequels entitled "Sleepless in America." Such a film would not be romantic.
Sleep hygiene, at its most basic level, refers to specific organized sleep routines. The sequence and events can be engineered according to family needs. The approximate amounts of sleep that children need at each age level is readily available on the internet. Suffice it to say that up to age of 2 years, children need to spend more than 50% of a 24 hour period sleeping. Significantly less than that creates behavior problems that include hyperactivity, mood swings that are NOT bipolar disorder, and acting out. Start by establishing a set bedtime that has very little variability. This needs to be early enough to allow a child to get almost all of their night time sleep in an uninterrupted sequence (with the exception of changes and feedings). Children should be sleeping straight through the night when they are no older than 9 months. I once saw a 7 year old in private practice whose parents claimed that he had never slept through the night. The referral was for - - - ADHD and aggressive acting out behavior at school. The use of Melatonin on the night before he started school for the term resulted in his first "A" for behavior on the next day. His parents were overjoyed! Small children need more in the routines for sleep. Cut off all visual electronic stimulation at least one hour before the established bedtime. The last meal for the day should be finished. Then, it should be time for a bath with warm, soothing water, and quiet music. Drying off after a bath needs to be a pleasant time, possibly followed with a smooth lotion rub if it is okay with your child's physician (and if the child tolerates it). Put the child in bed, without toys, and read a child oriented story in a soft voice. Turn down the lights, say a prayer. If you don't believe in prayers, say things like, "Today was the day before tomorrow. Tomorrow is a day full of things to do and learn. I/we love you. Have a good night." Give your child a gentle kiss, and leave. You can also refer to www.cantfalltosleep.com/sleepintoddlers.html
Television is one of the most overlooked sources of behavioral difficulty in children. The moving images and sound are very attractive to children because they don't have to do anything. Images on the television screen move by themselves. Many researchers believe that television interferes with falling to sleep because the nerve cells involved in watching keep firing for at least an hour if it is cut off. The continuous firing delivers the message, "I am still awake." The American Academy of Pediatrics recommends limiting the viewing of television to an hour or less per day for children under 2 years old. I concur strongly with that recommendation with the added advisory that background television (viewed by adults) contributes to disruption of sleep onset. There should be no television in a child's room, ever. Why should a child socialize with parents when they have their own television (and video games)? The purpose of a bedroom is for sleeping (homework should be done elsewhere, as well).
Caffeine is a drug. The stimulant effects help to keep people alert. However, caffeine in young children creates a host of dangers. The primary danger of caffeine consumption in young children is sleep disruption. Would it surprise anyone to learn that this author has known of parents who put tea (has caffeine) in baby bottles? A recent case involving a two year old who had tremendous tantrums revealed that the child was consuming Mountain Dewtm throughout the day just like his parents. Mountain Dewtm contains 55 mg of caffeine per 12 ounce can according to most sources. The United States does not publish guidlines concerning recommended limits for caffeine amounts per age group. Canada has such guidelines, with the recommended limited being 45 mg for children under 5 years old. The Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-R-TR) of the American Psychiatric Association lists three separate caffeine related disorders. The criteria for Caffeine Intoxication (for adults) includes consumption of more than 250 mg (defined as more than 2-3 cups of brewed coffee). Soft drinks other than Mountain Dewtm also contain caffeine. There are resources for the amounts of caffeine in various beverages www.energyfiend.com/the-caffeine-database Lest we forget, chocolate contains various amounts of caffeine as well. Many decongestants and cough medicines contain caffeine. Check the label for ingredients. One could also imagine that mood swings could be associated with caffeine consumption in small children. Can we envision small children stepping up to the bar and requesting a Bipolar Cola?
We must not forget the physical problems that disrupt sleep. Swollen tonsils and adenoids can contribute to sleep interruption in small children. These problems can cause behavioral difficulty. Parents need to watch their children for snoring and hitches (hesitations) in breathing. Ear, nose and throat specialists (otolaryngologists) are a good place to start considering ways of improving a child's sleep. There are also sleep specialists that can perform sleep studies on children.
Another connection to sleep problems in children relates to parents who smoke. If the parents smoke in the home, then the children do the same. I refer you to http://sleepeducation.blogspot.com/2010/01/secondhand-smoke-sleep-in-children-with.html
Recommendations:
1. Don't entertain (I love that word) a diagnosis of ADHD without first considering the world of sleep.
2. Discuss the amount of sleep each child needs with your pediatrician.
3. Eliminate caffeine from your child's diet.
4. Reduce all exposure to television, especially during the hour before bedtime.
5. The last daytime nap needs to END at least five hours before the night time sleep period.
6. Establish sleep routines with a fixed, set bedtime.
7. Monitor your child for physical causes of sleep problems (for example, snoring).
Part II written March 21, 2010
People with profound vision impairment tend to have more sleep problems than those who can see. This is especially true for children. The other interesting fact is that there are differences between those who have ocular based visual impairments, and those with vision impairments caused by cortical problems (cvi). Those children with cvi are more likely to have sleep problems.
There is probably a need to be more attention to premature infants who have had grade 3 or grade 4 intraventicular hemorrhages (IVH) and associated visual impairment. One important factor to consider would be treatment parameters. While Clonidine has been used to treat many sleep problems, it is probably a lot wiser to use Melatonin whenever possible. Do not rely on the word of pharmaceutical representatives on this one. They have only one purpose in mind, and that is to sell their product. Those allopathic preparations should be a last resort. Evidence based research also reveals that behavioral interventions combined with Melatonin make for easier cessation of the supplement.
There is one publication that I found online at www.icevi.org/publications/ICEVI-WC2002/papers/10-topic/10-verv/oed.html
Other online and medical library searches will undoubtedly yield more information.
There is something of a statement regarding sleep and ADHD at http://www.sleepfoundation.org/ Another good website, with links to tons of educational articles is http://www.sleepeducation.com/ You can see it on that site if you look hard enough, or you can examine the results of a large survey of parents of children under ten years old at www.sleepfoundation.org/sites/default/files/2004SleepPollFinalReport.pdf . Perhaps not amazingly, the treatment of the sleep problems literally cures a high percentage of the children who have been diagnosed with ADHD. Where, in heavens name, do sleep problems in tiny children originate? There are four main sources of child sleep problems, and host of minor connections. Before I generate a host of critical comments, yes, I realize that the sleep problems MIGHT be neurological. However, the sleep problems start somewhere else in most cases. Make yourselves comfortable because this has the potential of becoming a long blog. I am going to spend some time with it before I publish it.
Pretty close to 100% of new parents have no idea what sleep hygiene means. The lack of knowledge about this interacts with how parents freely provide small children with access to television, DVDs, and video games. Sprinkle in poor dietary management, and there is a huge opportunity to create an epic movie, with multiple sequels entitled "Sleepless in America." Such a film would not be romantic.
Sleep hygiene, at its most basic level, refers to specific organized sleep routines. The sequence and events can be engineered according to family needs. The approximate amounts of sleep that children need at each age level is readily available on the internet. Suffice it to say that up to age of 2 years, children need to spend more than 50% of a 24 hour period sleeping. Significantly less than that creates behavior problems that include hyperactivity, mood swings that are NOT bipolar disorder, and acting out. Start by establishing a set bedtime that has very little variability. This needs to be early enough to allow a child to get almost all of their night time sleep in an uninterrupted sequence (with the exception of changes and feedings). Children should be sleeping straight through the night when they are no older than 9 months. I once saw a 7 year old in private practice whose parents claimed that he had never slept through the night. The referral was for - - - ADHD and aggressive acting out behavior at school. The use of Melatonin on the night before he started school for the term resulted in his first "A" for behavior on the next day. His parents were overjoyed! Small children need more in the routines for sleep. Cut off all visual electronic stimulation at least one hour before the established bedtime. The last meal for the day should be finished. Then, it should be time for a bath with warm, soothing water, and quiet music. Drying off after a bath needs to be a pleasant time, possibly followed with a smooth lotion rub if it is okay with your child's physician (and if the child tolerates it). Put the child in bed, without toys, and read a child oriented story in a soft voice. Turn down the lights, say a prayer. If you don't believe in prayers, say things like, "Today was the day before tomorrow. Tomorrow is a day full of things to do and learn. I/we love you. Have a good night." Give your child a gentle kiss, and leave. You can also refer to www.cantfalltosleep.com/sleepintoddlers.html
Television is one of the most overlooked sources of behavioral difficulty in children. The moving images and sound are very attractive to children because they don't have to do anything. Images on the television screen move by themselves. Many researchers believe that television interferes with falling to sleep because the nerve cells involved in watching keep firing for at least an hour if it is cut off. The continuous firing delivers the message, "I am still awake." The American Academy of Pediatrics recommends limiting the viewing of television to an hour or less per day for children under 2 years old. I concur strongly with that recommendation with the added advisory that background television (viewed by adults) contributes to disruption of sleep onset. There should be no television in a child's room, ever. Why should a child socialize with parents when they have their own television (and video games)? The purpose of a bedroom is for sleeping (homework should be done elsewhere, as well).
Caffeine is a drug. The stimulant effects help to keep people alert. However, caffeine in young children creates a host of dangers. The primary danger of caffeine consumption in young children is sleep disruption. Would it surprise anyone to learn that this author has known of parents who put tea (has caffeine) in baby bottles? A recent case involving a two year old who had tremendous tantrums revealed that the child was consuming Mountain Dewtm throughout the day just like his parents. Mountain Dewtm contains 55 mg of caffeine per 12 ounce can according to most sources. The United States does not publish guidlines concerning recommended limits for caffeine amounts per age group. Canada has such guidelines, with the recommended limited being 45 mg for children under 5 years old. The Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-R-TR) of the American Psychiatric Association lists three separate caffeine related disorders. The criteria for Caffeine Intoxication (for adults) includes consumption of more than 250 mg (defined as more than 2-3 cups of brewed coffee). Soft drinks other than Mountain Dewtm also contain caffeine. There are resources for the amounts of caffeine in various beverages www.energyfiend.com/the-caffeine-database Lest we forget, chocolate contains various amounts of caffeine as well. Many decongestants and cough medicines contain caffeine. Check the label for ingredients. One could also imagine that mood swings could be associated with caffeine consumption in small children. Can we envision small children stepping up to the bar and requesting a Bipolar Cola?
We must not forget the physical problems that disrupt sleep. Swollen tonsils and adenoids can contribute to sleep interruption in small children. These problems can cause behavioral difficulty. Parents need to watch their children for snoring and hitches (hesitations) in breathing. Ear, nose and throat specialists (otolaryngologists) are a good place to start considering ways of improving a child's sleep. There are also sleep specialists that can perform sleep studies on children.
Another connection to sleep problems in children relates to parents who smoke. If the parents smoke in the home, then the children do the same. I refer you to http://sleepeducation.blogspot.com/2010/01/secondhand-smoke-sleep-in-children-with.html
Recommendations:
1. Don't entertain (I love that word) a diagnosis of ADHD without first considering the world of sleep.
2. Discuss the amount of sleep each child needs with your pediatrician.
3. Eliminate caffeine from your child's diet.
4. Reduce all exposure to television, especially during the hour before bedtime.
5. The last daytime nap needs to END at least five hours before the night time sleep period.
6. Establish sleep routines with a fixed, set bedtime.
7. Monitor your child for physical causes of sleep problems (for example, snoring).
Part II written March 21, 2010
People with profound vision impairment tend to have more sleep problems than those who can see. This is especially true for children. The other interesting fact is that there are differences between those who have ocular based visual impairments, and those with vision impairments caused by cortical problems (cvi). Those children with cvi are more likely to have sleep problems.
There is probably a need to be more attention to premature infants who have had grade 3 or grade 4 intraventicular hemorrhages (IVH) and associated visual impairment. One important factor to consider would be treatment parameters. While Clonidine has been used to treat many sleep problems, it is probably a lot wiser to use Melatonin whenever possible. Do not rely on the word of pharmaceutical representatives on this one. They have only one purpose in mind, and that is to sell their product. Those allopathic preparations should be a last resort. Evidence based research also reveals that behavioral interventions combined with Melatonin make for easier cessation of the supplement.
There is one publication that I found online at www.icevi.org/publications/ICEVI-WC2002/papers/10-topic/10-verv/oed.html
Other online and medical library searches will undoubtedly yield more information.
Sunday, March 7, 2010
Can Alzheimer's Be Prevented?
Please consider that the following article is hypothetical. It is based on research, however.
Based on things that I have read, there are natural ways to prevent Alzheimer's. It takes some information synthesis to get there, so please hang-on. The most amazing link that has been found is a relationship between the herpes simplex virus type I (HSV-I) and Alzheimer's amyloid plaques. The article can be found summarized at www.sciencedaily.com/releases/2008/12/081207134109.htm The team conducting the research discovered that HSV-I DNA is "located very specifically in 90% of plaques in Alzheimer's disease sufferer's brains" (Wozniak, Mee, and Itzhaki, 2008).
The researchers hypothesized that antivirals can be used to inhibit the harmful consequences of HSV-I action. However, there is another, more inexpensive and effective possibility. The amino acid L-lysine has been demonstrated to inhibit HSV-I (Griffith, 1987, 1978; Kagan, 1974). The naked virions of HSV-I contain protein VII, which is arginine rich, at the core. The virions contain significantly less lysine (Olshevsky and Becher, 1970). Adding lysine inhibits viral replication.
Now, the logical conclusion needs to be investigated. It is a reasonable proposition that prophylatic loading of L-lysine in people who have the genetic prospect of developing Alzheimer's. Further, people with a history of HSV-I outbreaks as cold sores need to be investigated as potential subjects for such a study.
References
Griffith, R. S. (1987). Success of L-lysine therapy in frequently recurrent herpes simplex infection. Dermatologica 175 183-190.
Griffith, R. S. (1978). A multi-centered study of lysine therapy in herpes simplex infection. Dermatological 156 257-267.
Kagan, C. (1974). Lysine therapy for herpes simplex. The Lancet 1 137.
Olshevsky, V. & Becher, V. (1970). Virology 40 948.
Wozniak, M. A., Mee, A. P. & Itzhaki, R. F. (2008). Herpes simplex virus type I DNA is located within Alzheimer's disease amyloid plaques. The Journal of Pathology 217(1), 131-138.
Based on things that I have read, there are natural ways to prevent Alzheimer's. It takes some information synthesis to get there, so please hang-on. The most amazing link that has been found is a relationship between the herpes simplex virus type I (HSV-I) and Alzheimer's amyloid plaques. The article can be found summarized at www.sciencedaily.com/releases/2008/12/081207134109.htm The team conducting the research discovered that HSV-I DNA is "located very specifically in 90% of plaques in Alzheimer's disease sufferer's brains" (Wozniak, Mee, and Itzhaki, 2008).
The researchers hypothesized that antivirals can be used to inhibit the harmful consequences of HSV-I action. However, there is another, more inexpensive and effective possibility. The amino acid L-lysine has been demonstrated to inhibit HSV-I (Griffith, 1987, 1978; Kagan, 1974). The naked virions of HSV-I contain protein VII, which is arginine rich, at the core. The virions contain significantly less lysine (Olshevsky and Becher, 1970). Adding lysine inhibits viral replication.
Now, the logical conclusion needs to be investigated. It is a reasonable proposition that prophylatic loading of L-lysine in people who have the genetic prospect of developing Alzheimer's. Further, people with a history of HSV-I outbreaks as cold sores need to be investigated as potential subjects for such a study.
References
Griffith, R. S. (1987). Success of L-lysine therapy in frequently recurrent herpes simplex infection. Dermatologica 175 183-190.
Griffith, R. S. (1978). A multi-centered study of lysine therapy in herpes simplex infection. Dermatological 156 257-267.
Kagan, C. (1974). Lysine therapy for herpes simplex. The Lancet 1 137.
Olshevsky, V. & Becher, V. (1970). Virology 40 948.
Wozniak, M. A., Mee, A. P. & Itzhaki, R. F. (2008). Herpes simplex virus type I DNA is located within Alzheimer's disease amyloid plaques. The Journal of Pathology 217(1), 131-138.
Thursday, February 11, 2010
The Abdominal No Man
The therapist was doing an intake of an 11 year old male who was in a school program for emotionally disturbed students. He allegedly had a problem with explosive outbursts of aggression and anger. He was being treated with psychoactive medication that apparently had no impact on his behavior. The fellow was born to a drug using mom, tested positive for drugs at birth, was taken at the hospital by a community social worker. He was fortunate because he was adopted.
His adoptive father came in for the first visit. A psychologist needs to ask medical questions because these are infrequently considered significant by medical mental health professionals when treating and diagnosing. Billy had a very significant problem with constipation. His father reported that it was not unusual for him to go longer than a week or two to have a bowel movement. These were difficult events for him. His parents tried to help by providing over-the-counter laxatives. They talked to his pediatrician, who informed them that there were no pediatric gastroenterologists in the area.
The therapist easily convinced the father to take him to one of the closest medical teaching hospitals. A pediatric gastroenterologist diagnosed his problem and has been treating him. He does not have constipation any longer. Here is the surprise (perhaps) - his behavior problems have disappeared.
His adoptive father came in for the first visit. A psychologist needs to ask medical questions because these are infrequently considered significant by medical mental health professionals when treating and diagnosing. Billy had a very significant problem with constipation. His father reported that it was not unusual for him to go longer than a week or two to have a bowel movement. These were difficult events for him. His parents tried to help by providing over-the-counter laxatives. They talked to his pediatrician, who informed them that there were no pediatric gastroenterologists in the area.
The therapist easily convinced the father to take him to one of the closest medical teaching hospitals. A pediatric gastroenterologist diagnosed his problem and has been treating him. He does not have constipation any longer. Here is the surprise (perhaps) - his behavior problems have disappeared.
Wednesday, February 10, 2010
Red Lipstick
Way back in 1968, the student in Abnormal Psychology class was working on an on-going project to get a 19 year old institutionalized autistic female to say a specified sound. The technique used was to hold an M & M close to his mouth to get her attention, say the sound, and when she said it, give her the candy. Repeat throughout the session. The young woman had others doing the same thing. The class never got to learn whether she could ever speak on her own.
One thing that we have known about autistic children for a long time is that they frequently have disordered/disrupted sensation/perception. Some clinicians have used this to help people with autism.
It is now 2010. Methods for getting autistic children to look at a mouth have not changed much. It is especially difficult for young children. There has actually been research with two to four year old children that found (using sophisticated equipment) that focusing on the mouth is diagnostic. Regardless of age, children with Autistic Spectrum Disorder spent significantly less time looking at the mouth than typically developing children (Chawarska and Shic, 2009). When a person considers that the research is basically an expansion on the theme of figure ground perception, a perceptive person can consider ways to enhance the facial features so that they may stand out from ground. Doing this can, and should help autistic children learn.
I recently began mentioning the use of red lipstick by parents and therapists to acquire and maintain the attention of autistic children on the mouth for the purpose of conducting speech therapy. A parent of a set of autistic children (not from twin or other multiple births) reacted to my suggestion with astonishment because she does not ordinarily wear lipstick. She bought some bright red lipstick on a whim, applied it, and was amazed at how much attention her children were paying to her mouth. Her children ranged in age from 8 years old to 13 years old. One child was a girl, and the others were boys.
There is a shortcoming with red lipstick. Male therapists are unlikely to use it. Fathers working with their children are unlikely to use it. There are two possible solutions. Men can apply the lipstick and wear it only during therapy. That is an easy solution, but one that is unlikely to sit well with many of them.
The second solution would involve the purchase of a small theatrical moustache that can be worn multiple times on the upper lip. The hair should be dyed the same shade of red as lipstick. Men can use this to draw their child's/client's attention to the mouth. As much as many men are loath to wear red lipstick under any circumstances, women are likely to reject the option of wearing a bright red colored theatrical moustache on their upper lip. However, when a woman does not want to wear red lipstick, the bright red theatrical moustache can be an option for them.
A secondary aspect of speech therapy can involve having the child look in the mirror. An autistic child is unlikely to look at themselves AND their mouth to practice speaking. When the child does not have a sensory sensitivity to wearing lipstick, it may be possible to apply bright red lipstick to them to wear during speech practice in front of a mirror. Of course, under the same awareness of possible sensory sensitivity, they could also wear a bright red colored moustache during practice sessions. Perhaps having the parent use either option during speech practice would make the use of the same option on them in front of mirror more acceptable.
It would be excellent to get some feedback on the use of red lipstick. Please respond with comments.
Reference
Chawarska, K. & Shic, F. (2009). Looking but not seeing: Atypical visual scanning and recognition of faces in 2 and 4-year-old children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 39, 1663-1672.
One thing that we have known about autistic children for a long time is that they frequently have disordered/disrupted sensation/perception. Some clinicians have used this to help people with autism.
It is now 2010. Methods for getting autistic children to look at a mouth have not changed much. It is especially difficult for young children. There has actually been research with two to four year old children that found (using sophisticated equipment) that focusing on the mouth is diagnostic. Regardless of age, children with Autistic Spectrum Disorder spent significantly less time looking at the mouth than typically developing children (Chawarska and Shic, 2009). When a person considers that the research is basically an expansion on the theme of figure ground perception, a perceptive person can consider ways to enhance the facial features so that they may stand out from ground. Doing this can, and should help autistic children learn.
I recently began mentioning the use of red lipstick by parents and therapists to acquire and maintain the attention of autistic children on the mouth for the purpose of conducting speech therapy. A parent of a set of autistic children (not from twin or other multiple births) reacted to my suggestion with astonishment because she does not ordinarily wear lipstick. She bought some bright red lipstick on a whim, applied it, and was amazed at how much attention her children were paying to her mouth. Her children ranged in age from 8 years old to 13 years old. One child was a girl, and the others were boys.
There is a shortcoming with red lipstick. Male therapists are unlikely to use it. Fathers working with their children are unlikely to use it. There are two possible solutions. Men can apply the lipstick and wear it only during therapy. That is an easy solution, but one that is unlikely to sit well with many of them.
The second solution would involve the purchase of a small theatrical moustache that can be worn multiple times on the upper lip. The hair should be dyed the same shade of red as lipstick. Men can use this to draw their child's/client's attention to the mouth. As much as many men are loath to wear red lipstick under any circumstances, women are likely to reject the option of wearing a bright red colored theatrical moustache on their upper lip. However, when a woman does not want to wear red lipstick, the bright red theatrical moustache can be an option for them.
A secondary aspect of speech therapy can involve having the child look in the mirror. An autistic child is unlikely to look at themselves AND their mouth to practice speaking. When the child does not have a sensory sensitivity to wearing lipstick, it may be possible to apply bright red lipstick to them to wear during speech practice in front of a mirror. Of course, under the same awareness of possible sensory sensitivity, they could also wear a bright red colored moustache during practice sessions. Perhaps having the parent use either option during speech practice would make the use of the same option on them in front of mirror more acceptable.
It would be excellent to get some feedback on the use of red lipstick. Please respond with comments.
Reference
Chawarska, K. & Shic, F. (2009). Looking but not seeing: Atypical visual scanning and recognition of faces in 2 and 4-year-old children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 39, 1663-1672.
Monday, February 1, 2010
Do asthma medications cause behavior problems?
A nurse at work recently asked for a consultation. She was concerned about a 2 year, 4 month old boy who was displaying extreme mood swings, and very aggressive behavior. The nurse casually mentioned that the child was taking Singulair for breathing treatments. I casually asked if she thought that the behavior might be related to the Singulair.
The thought really concerned me so I researched the web. Behavior problems are listed as a rare but serious side-effect of montelukast sodium (aka Singulair). There were blogs written by parents who noticed this problem and reported that the behavior problems disappeared when they discontinued the medication. One such blog could be found at www.drugs.com/sfx/montelukast-side-effects.html
Another horrible thought crossed my mind. What if other asthma/allergy meds did the same thing? Take a look at www.medications.com/effect/tag/pulmicort I also found similar, disturbing notes about Advair.
I talked to the pediatrician at work. Her first response was classical (for her). She asked if I thought that she did not know about it. I said, that this was not the point. The question was, "What should we tell parents who bring their child to us because of severe behavior problems, and we learn that they take medication?" She suggested that we tell them to talk to their pediatrician. There is a problem here - many pediatricians do not believe that a child could be having this side-effect. She then said it came down to a choice between wheezing kids who had trouble breathing, or violent kids with severe mood swings. There is another way.
A number of years ago, I read that children in Israel are rarely prescribed asthma medications. Instead, they are given behavioral treatment. They are taught to "belly breath" their way through an asthma attack. Would you be surprised if I told you that I did this with a kid? I did. The child's mother was in my waiting room with a rescue inhaler. I put him through the process of learning belly breathing while he was having an asthma attack. His attack subsided.
Now, about twenty years after the therapist stopped an asthma attack in his own patient, there was an article that was summarized at www.sciencedaily.com/releases/2010/02/100212141108.htm
This presents a summary of Anbar et al. (2010) Adding hypnosis to the therapeutic toolbox of pediatric respiratory care. Pediatric Asthma Allergy Immunology
Questions: Why is it that we do not treat asthma by teaching belly breathing instead of prescribing medications that can change their behavior in such a way that they seek psychiatric or psychological assessments often resulting in the prescription of psychoactive medications that cause other side-effects (ad nauseam, ad infinitum)? Why not try hypnosis?
The thought really concerned me so I researched the web. Behavior problems are listed as a rare but serious side-effect of montelukast sodium (aka Singulair). There were blogs written by parents who noticed this problem and reported that the behavior problems disappeared when they discontinued the medication. One such blog could be found at www.drugs.com/sfx/montelukast-side-effects.html
Another horrible thought crossed my mind. What if other asthma/allergy meds did the same thing? Take a look at www.medications.com/effect/tag/pulmicort I also found similar, disturbing notes about Advair.
I talked to the pediatrician at work. Her first response was classical (for her). She asked if I thought that she did not know about it. I said, that this was not the point. The question was, "What should we tell parents who bring their child to us because of severe behavior problems, and we learn that they take medication?" She suggested that we tell them to talk to their pediatrician. There is a problem here - many pediatricians do not believe that a child could be having this side-effect. She then said it came down to a choice between wheezing kids who had trouble breathing, or violent kids with severe mood swings. There is another way.
A number of years ago, I read that children in Israel are rarely prescribed asthma medications. Instead, they are given behavioral treatment. They are taught to "belly breath" their way through an asthma attack. Would you be surprised if I told you that I did this with a kid? I did. The child's mother was in my waiting room with a rescue inhaler. I put him through the process of learning belly breathing while he was having an asthma attack. His attack subsided.
Now, about twenty years after the therapist stopped an asthma attack in his own patient, there was an article that was summarized at www.sciencedaily.com/releases/2010/02/100212141108.htm
This presents a summary of Anbar et al. (2010) Adding hypnosis to the therapeutic toolbox of pediatric respiratory care. Pediatric Asthma Allergy Immunology
Questions: Why is it that we do not treat asthma by teaching belly breathing instead of prescribing medications that can change their behavior in such a way that they seek psychiatric or psychological assessments often resulting in the prescription of psychoactive medications that cause other side-effects (ad nauseam, ad infinitum)? Why not try hypnosis?
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