Monterey Bay Forum

What can citizens and parents do to reduce ADHD, Autistic Spectrum, intellectual disability and other developmental disorders?

Make sure that all children have safe, healthy water to drink.

no chemicals water

Find out what your community puts in the water children drink.

Communities switched from NaF — which has a track record of safety — to use of SiFs — which have zero record of safety. Two huge studies of children (280,000 in Mass. and 150,000 in New York state) show elevated iron with use of fluoridated water.

Perhaps communities should use of NaF instead of SiF to fluoridate water? Might safer water remove or reduce symptoms associated with lead poisoning?

Go to Keepers of the Well.com. Or contact Jeff Green 800 728-3833 greenjeff@cox.net for more information. Let’s do all we can to see that all children and adults drink healthy water.

DrCameronJackson@gmail.com

Material below is from Keeper of the Well.com

ll items are in Adobe Acrobat (.pdf) file format. You will need Acrobat Reader to view and print these files. If you need to download and install a free copy of this useful software, click here.

NOTICE: In accordance with Title 17 U.S.C., section 107, some material on this web site is provided without permission from the copyright owner, only for purposes of criticism, comment, news reporting, teaching, scholarship and research under the “fair use” provisions of federal copyright laws. These materials may not be distributed further, except for “fair use” non-profit educational purposes, without permission of the copyright owner.

1. Fluoridation On-Point:
Congressional Investigation and Recent Events PDF (33K)
Highlights of the written statements from five government agencies in response to questions posed to each agency in 1999 and 2000 by a subcommittee of the House Committee on Science.

2. Food and Drug Administration (FDA) 2000, response to questions posed by subcommittee of the House Committee on Science PDF (69K)
“Fluoride, when used in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or animal, is a drug that is subject to FDA regulation.” “No New Drug Applications have been approved or rejected for fluoride drugs meant for ingestion.”

3. Title 42 Ð The Public Health and Welfare, section 300g-1. (194K)
“(11) No national primary drinking water regulation may require the addition of any substance for preventive health care purposes unrelated to contamination of drinking water.”

4. Letter, April 2, 1998, from EPA Director, Office of Science and Technology PDF (33K)
“In the U.S., there are no Federal safety standards which are applicable to drinking water additives, including those intended for use in fluoridating water.”

5. Letter, March 14, 1994, from Cosme Water Treatment Plant, City of St. Petersburg PDF (65K)
St. Petersburg, Florida, contracts with Lucier Chemical Industries for its fluosilicic acid. Lucier purchases the chemicals from Cargill Fertilizer, Inc.

6. The 1998 AWWA Standards Committee on Fluorides PDF (65K)
Listed are the 17 members of the “volunteer standards committee” which review and approve the fluoride standard. The Chair, Vice-Chair and Secretary are from the CDC, Lucier Chemical Industries, and Kaiser Aluminum & Chem. Corp., respectively. Cargill Fertilizer Inc. and Chemtech are producer members.

7. Photo of Cargill Fertilizer Inc. with 1979 Fluorine Recovery excerpt PDF (165K)
Required to suppress environmental emissions of fluorine-containing vapours, industry must now find a use or market for the recovered fluorine.

8. Environmental Protection Agency (EPA) 1999, response to questions posed by subcommittee of the House Committee on Science PDF (63K)
In collecting data for a fact sheet, EPA was not able to identify any chronic studies for the two chemicals used in 90% of U.S. fluoridation programs.

9. Letter, Nov. 2000, from US EPA National Risk Mgmt. Research Laboratory PDF (65K )
National Health and Environmental Effects Research Laboratory was unable to find any information on the chronic effects of silicofluorides on health and behavior.

10. Letter, March 2001, from US EPA National Risk Mgmt. Research Laboratory PDF (65K)
In response to Dr. Roger Masters’ request for specific data, the EPA’s National Risk Assessment Laboratory indicates that they are not able to provide reliable data on the complete dissociation of fluosilicates; or, any data on interaction of fluosilicates with other metals, such as aluminum and iron, expected to be found in drinking water.

11. Request for Assistance (RFA) – Measurement of Fluorosilicates in Drinking Water, April 25, 2002 PDF (1000K)
The U.S. EPA National Risk Management Research Laboratory is now soliciting competent researchers to investigate the reactions that take place when fluorosilicates are added to drinking water supplies.

12. National Sanitation Foundation (NSF) 2000, response to questions posed by subcommittee of the House Committee on Science PDF (42K).
For a manufacturer to receive certification for their fluoridation product, NSF requires submission of toxicological information, if available. No studies on the silicofluorides have ever been submitted to NSF.

13. Centers for Disease Control (CDC) 2000, response to questions posed by subcommittee of the House Committee on Science PDF (38K)
90% of tooth decay occurs in pits and fissures of chewing surfaces of teeth; surfaces not as affected by fluoride.

14. Environmental Protection Agency (EPA) 2000, response to questions posed by subcommittee of the House Committee on Science PDF (44K)
Subsets of the population that are unusually sensitive to the toxic effects of fluoride are identified as well as demographic data for each of the identified populations.

15. Letter, June 1993, from John V. Kelly, Assemblyman, State of New Jersey PDF (65K)
The FDA has confirmed that there are no studies demonstrating either the safety or effectiveness of fluoride supplements for children, therefore, he requests the FDA to remove the products from the market immediately.

16. Fluoride warning on toothpaste label, required by FDA since 1997 PDF (129K)
“Warning: As with all fluoride toothpastes, keep out of the reach of children under 6 years of age. If you accidentally swallow more than used for brushing, seek professional assistance or contact a poison control center immediately.”

17. Content specifications of hydrofluosilicic acid as referenced by retailer Lucier Chemical Industry, Ltd., 1990 PDF (35K)
A typical batch of commercial grade fluoridation product is 24% hydrofluosilicic acid and 76% waste water which contains varying amounts of heavy metals.

18. The California Code of Regulations list hazardous waste fluorides PDF (65K)
All three fluoridation substances are included in the list of 39 fluoride compounds classified under California law as hazardous wastes.

19. Toxic waste becomes ‘product’ for two bits PDF (65K)
According to federal regulations, if a fluoridation substance is given away, it is classified as hazardous waste. If it is sold for transportation costs or a token fee, it is a product.

20. The city of Escondido, CA, calculated the amount of product actually used PDF (3K)
The amount intended for the targeted children is only 16 pounds out of 33 tons of product used per year in Escondido.

21. Photograph of a sack of sodium fluorosilicate (picture) PDF (164K)
Kaiser Aluminum & Chemical Corp. is a Producer Member of the voluntary product standards committee for the American Water Works Association.

22. Hydrofluosilicic acid product warning and directions for use PDF (21K)
Product warnings and safety instructions for water department personnel.

23. Opflow Magazine/American Water Works Association, Oct. 2000, Treatment Chemicals Contribute to Arsenic Levels PDF (56K)
About 90 percent of the arsenic that would be contributed by treatment chemicals is attributable to fluoride addition.

24. Two charts comparing toxicity and MCL of lead, fluoride and arsenic
Graph #1 gives the relative toxicity between lead, sodium fluoride and arsenic. Graph #2 shows the maximum contaminant levels for the same three substances.

25. Comparative Toxicity of Inorganic Fluorides PDF (387K)
The products used for fluoridation are many times more toxic than naturally occurring calcium fluoride.

26. Dartmouth news release, Aug. 1999: Silicofluorides are associated with increased lead levels PDF (26K)
Analyzing a survey of over 280,000 Massachusetts children, investigators found a significant association between water fluoridated with silicofluorides and children suffering from blood lead poisoning.

27. NeuroToxicology 21(6):2000:, Abstract: Silicofluorides are associated with increased lead levels PDF (387K)
Analyzing a survey of over 151,000 New York children, investigators found a significant association between water fluoridated with silicofluorides and children suffering from blood lead poisoning. Click here for the full study.

28. Chemical and Engineering News abstract of 1998 Brain Research study PDF (65K)
Test animals treated with the same concentration of fluoride used in fluoridated tap water suffered neural injury and increased deposits of B-amyloid protein in the brain, similar to those seen in humans with Alzheimer’s disease.

29. The California Safe Drinking Water Act of 1996 requires the California Office of Environmental Health Hazard Assessment to adopt Public Health Goals (129K)
Because of the alleged benefit of fluoridated water, several of the most important criteria for Public Health Goals are circumvented.

Send questions/suggestions concerning this site to the webmaster at: toxicfree@qwest.net

The overall goal is to get everyone on the same page: you as parent, MD, therapist, regular ed and special education teacher(s), school nurse, school psychologist, and any government agencies that are involved (e.g., County Mental Health, Child Protective Service for children in foster care).

Unfortunately, what often happens is that the left hand does not know what the right hand is doing. You as parent need to get in the driver’s seat and see that all the “horses” – school, professionals, hospitals, government agencies — move ahead in the right direction.

And that should include that everyone knows what the others have learned. So, make sure that Releases to share information are signed so everybody can communicate, receive records and communicate.


Here’s an example. An elementary school child is in foster care and receives services through Child Protective Service and County Mental Health. To clarify diagnosis the County wants the child to go to nearby Stanford Hospital (LPCH). So what needs to happen? Hopefully, CPS and County Mental Health will see that their mental health records together with the the child’s pediatric MD records and appropriate school records accompany the referral.

Another example: You as parent have concerns and go to your pediatrician. The pediatrician thinks that your child needs additional assessment and your doctor refers to a large, near by hospital complex (UC-SF, Stanford Hospital, Kaisier Permanente). Be sure that you as parent take along with you all relevant school assessments, school grades, and medical records. Get all the players on the same page. And be sure that all the players can talk to each other and exchange information.

Here’s some general ‘how to’ directions for parents of a child with ADHD or Autistic Spectrum Disorder (ASD):

Start with a physical exam by your pediatrician to make sure there are no physical reasons for child’s problems with concentration, attention, focus and organizational problems.

Next, get appropriate assessment of your child for symptoms of ADHD and Executive Functioning abilities. Some pediatricians and psychologists are trained to do appropriate assessment.

Have your MD or psychiatrist write a brief letter to child’s school.
The letter needs to state that the child is under the care of ____ doctor (MD) or psychologist (Ph.D.) and that it is the professional opinion of _____ that the child’s educational performance is significantly impacted by ____ and ____.

Take several copies of the letter from your doctor to your child’s school. Be sure that copies go to: school nurse, teacher, school psychologist & principal.

Make sure that the letter from MD or psychologist including diagnosis of ADHD or Autistic Spectrum is part of your child’s regular education CUM file. That way the school nurse can monitor as needed.

In a separate letter addressed to Special Education at your child’s school (include child’s date of birth, complete name of child, address, telephone number, email address,) ask that your child be identified as Other Health Impaired student. Ask for appropriate assessment by the school. Also ask for a 504 Plan available under the Americans with Disabilities Act. Be sure to date that letter and keep original in your file.

If you do not hear back in two weeks send another copy (with a Second Copy in red) to the school principal and child’s teacher. Typically the second letter gets a quick response.

Of course, be polite and understanding and remember that in these times of substantial change in the economy every school dollar is stretched more than it was.

Your child with ADHD and Autistic Spectrum issues needs your guidance to successfully learn at school.
Questions?

Contact Dr. Cameron Jackson DrCameronJackson@gmail.com

When parents of young children have a concern about their child’s development they often go first to their pediatrician.

Parent concerns might include: “Our child does not turn his head when I call him.” or “ Our child does not make much eye contact or smile.” “He does not play with toys like other children.”

If the pediatrician thinks that more assessment is needed, when MD’s refer out they often refer to to other physicians at large hospitals — such as Stanford Hospital (LPCH), Children’s Health Council and U.C. San Francisco. Physicians know other physicians and often do not know local resources, e.g., licensed psychologists trained in psychological assessment.

When parents are referred to large hospital complexes such as Stanford Hospital, Kaiser Permanente and U.C. San Francisco, parents can help get the best possible assessment by finding out ahead of time:

Will their child’s pediatrician MD automatically send along the child’s medical records as part of the referral process? If not, then the parent needs to request a complete set of medical records and bring the medical records to the appointment.

Who knows the child best besides the parent? Does the child go to a nursery school or day care? Is the child taken care of by a grandparent or neighbor?

Write down the name, address, telephone number and e-mail address for all persons who know your child best. Let those people know that the child will be assessed and that someone from that institution may call to gather information. Bring the list of people who know your child best to the appointment.

Can the parent take a video of the behaviors that concern them? For example, does the child insist on lining up all his toys? Does the child have a melt-down whenever the normal routine changes? If possible, get out your ‘smart phone’ or camera and take a video of those behaviors. Bring the video with you to show whoever does the assessment.

Call ahead of time to the institution where the assessment will be done and find out (and write it down) exactly who will do the assessment? Will it be a team assessment of various areas of functioning or will the assessment be done by only one specialist?

Know that it is Best Practice in the assessment of young children to examine several areas of functioning (e.g., speech, non-verbal communication, gross and fine motor) and that the assessment be done by appropriate specialists.

Depending on the concerns, some times one person doing the assessment is sufficient and sometimes not.

Know that it is Best Practice that records and information be obtained from various sources (MD, school, day care provider, parent, grandparent) over a period of time.

It is often the case that young children do not perform as they typically do when driven several hours to an appointment and then required to do certain activities with persons they do not know.

Summary: Parents can greatly assist in the accurate assessment of young children with possible developmental delays by 1) gathering all medical records and bringing them to the appointment; 2)making a list of all persons who know your child best including email and telephone numbers; 3)inquiring ahead as to exactly who will do the assessment and what areas will be assessed.

And do not be afraid to press the professionals for understandable answers. If they cannot say it so you can understand,they are useless to you and your child.

Any questions or comments? Contact Dr. Cameron Jackson DrCameronJackson@gmail.com 831-216-6002

DrCameronJackson@gmail.com

How to increase the IQ of all children? Especially children with ADHD or Autistic Spectrum difficulties?

This technique to raise IQ applies to all children. It can be especially helpful for children with difficulties with focus, attention, sequencing, executive functioning and ‘working memory’ difficulties. Children with those difficulties are often labeled as having ADHD or Autistic Spectrum difficulties.

Can your child’s IQ be changed? Of course. Can parents and relatives help? Yes! And to raise your child’s I.Q. you don’t need Obama-Care, the U.S. Department of Education nor permission from any federal, state or local governmental entity.

How to raise IQ? Teach to the test. Well, not exactly to the test as IQ tests are proprietary information which test makers and test givers protect. But it’s fine to teach the general tasks measured by many I.Q. tests.

All good teachers teach to the test in some sense. Take the teaching of math.

Everyone knows that 5 + 4 =9 and not 8 or 10. There is one correct answer. If you want a child’s math abilities to increase you have to practice. And if you want them to remember – make it fun.

It’s the same for raising IQ. Teach the general tasks that are tested by IQ tests. And make it fun so they remember and want to learn the tasks.

So, let’s start with one way to strengthen a child’s ability to focus and pay attention.

Digit Span: Measuring digit span abilities is one task which is part of many IQ batteries. So how can this ability become stronger for all children? And is it an important task?

Why teach Digit Span? Every kid needs to learn their phone number including the area code. For safety reasons children should be able to state a telephone number so that an adult can be alerted. So, learning a series of digits is an important, useful task. So, how can we make an important task fun. See how below:

Take my telephone number for example. 831 216-6002 [Please do not call it!] Here’s how to teach a child to learn their telephone number digits:

Get a lined pad of paper and in a column write: 0 at bottom, then 1,2,3,4,5,6,7,8.9 Next, draw dots next to the numbers. And then connect the dots with lines.

Look at the visual image how the dots are connected. That visual pattern is what you want your child to learn. You can see the visual pattern in the image at the top of this post.

Is your child a stronger visual learner? A lot of kids with ADHD and autistic spectrum difficulties are stronger visual learners than they are verbal learners. That means if the child can see what to do they can learn it faster than if they just hear what to do.

Now make learning the telephone number digits fun:

Use sounds to teach telephone number/ Digit Span to child

Try different methods: For example, 1) try using a xylophone and see if music helps cement the digits together for your child. Or 2) try using a different color pens for each digit. One is red, two is blue, three is yellow. Always be consistent so color becomes associated with the number. Or 3) try just drawing the pattern over and over again.
You know your child’s strengths so play to those strengths. Make it a fun activity.

How to start? Small chunks. Teach it in two chunks – the first three digits and then the remaining four digits.

Once a child can learn 3 digits forward, teach those digits backwards. 2-1-6 and 6-1-2. Why also teach backwards? That strengths the visual and auditory memory systems.

Just like push ups strengthen physical muscles learning visual and auditory patterns with numbers strengths your child’s focus, attention and concentration. Your child is having fun doing something with you. And, your child is ‘growing’ his or her I.Q.

Pediatricians frequently recommend medications, e.g., Ritalin, Concerta, to assist with attention, concentration and focus. Research shows that a combination of medication (if they work) and cognitive-behavioral therapy for child and family provides the best results.

In my clinical experience, it only takes one concerned, involved, consistent adult to dramatically affect the overall development of children with various disabilities. So this technique can be used by an older brother or sister, aunt or uncle or grandparent. Sometimes the parents themselves have disabilities such that they are not the ideal person to help ‘grow’ their child’s I.Q.

Try the technique and let me know how it goes for you and your child.

Below is the real story of a young person whose I.Q. could grow if… [personal identifying information has been changed to protect privacy].

Jose is age 17 and a twin. His brother has been diagnosed with mental retardation. Jose’s father is in prison. Jose has an older sister diagnosed with depression. Jose’s mother has various physical disabilities and receives social security, disability. Jose has one older sister who is completing college, has a job and has a boy friend. This sister has been a positive, involved person in his life. This sister is the main person who takes Jose places, listens, helps him set goals and complete tasks. Jose’s teachers over the years report that he shows substantial difficulties with attention, concentration and focus. Jose’s pediatrician tried Jose on five different medications without success. County Mental Health referred Jose to a local counseling service where he received one-to-one therapy from a therapist to address ADHD. Jose’s cognitive I.Q. abilities to think abstractly visually and verbally are in the Low Average range. When Jose’s “working memory” abilities are tested they are low, i.e. in the Deficient range.

Can Jose’s ‘working memory’ be improved? I think so. If there are concerned adults that stay involved with Jose.

DrCameronJackson@gmail.com

To see a book recently published by Dr. Cameron Jackson go to: http://www.smashwords.com/books/view/109312

Some simple techniques can assist children with attention deficit hyperactivity disorder (ADHD) and/ or autistic spectrum disorder (ASD)to be happier and achieve appropriate goals. These techniques are easy for parents and teachers to implement.

Of course a child is not a car but think of the following analogy:

Every car to get to a destination needs a driver. Parents can assist children to get into the driver’s seat and drive their ‘car’ to appropriate ‘destinations’.

Here’s how to assist children who have difficulties with focus, attention, concentration, ‘executive functioning’ or ‘working memory’ difficulties. Executive functioning and working memory are words used by school psychologists. What the parent sees is a child who can’t seem to figure out what comes first and appear disorganized.

What to do: Get a pad of 8 by 12 inch lined paper.

On one per sheet of paper —
1) Write at the top, a Goal that parents/teachers want the child to achieve.
2) Write out all the Steps required to accomplish the Goal.
3) Order the steps from first to last using KISS (Keep It Simple, Simple)
4) Figure out an appropriate Reward for child accomplishing the steps.
Set it up so child can get partial reward for partial completion.
5) Decide the number of Days child needs to complete the Goal.
6) Draw up a Graph with Days across Top of Page and Goals listed on left.

Here’s an example of a Behavior Plan for a child who shows symptoms of both ADHD and ASD:

Gina is 8 years old and was exposed in utero to illegal drugs and alcohol. Her biological mother lost parental rights and Gina has been in foster care since age two. Since age four, Gina has received County Mental Health therapy and medication to assist with focus, attention and concentration. The therapy provided by County Mental Health focuses only on helping Gina to label emotions and better express her emotions appropriately.

Gina’s foster mother and her teacher agree that Gina’s adaptive functioning abilities are considerably below what they expect for her age. Her foster mother wants Gina to 1) wash her face & brush her teeth; 2) make her bed; 3) put toys in basket in her room; 4) set the table with utensils and plates before dinner.

Goals:

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Wash face & clean teeth
Make bed
Put toys in basket
Set table with utensils & plates

Spiritual/ religious beliefs need to be integral to a successful Behavioral Plan.
For example, Gina’s foster mother goes to church and rests on Sunday. Therefore the behavior plan is for six days a week and no work on Sunday, their day of rest. Six days a week time four goals = 24 Goals for Gina to achieve. For each Goal achieved she earns one (1) dime. During the week she puts stickers on the sheet and gets her motivators (dimes) which she puts into a plastic, clear jar. That way she can see exactly what she has earned towards a new toy on the weekend. Her foster mother believes Gina can find age appropriate toys for around $2.50 to $3.00 a toy.

What makes a Behavioral Plan successful?
The answer is simple: practice and more practice so the Steps are as simple as possible and the child gets rewarded for partial and then complete finishing the Goal.

For example, Gina when we started could not make her bed said her foster mom. Well, the cover was too big and too heavy for a thin, small 8 year old to move around. Thus, by simplifying and making a bed simply tossing a light duvet (down comforter) on a twin bed and putting the pillow in place — then making a bed by an 8 year old is simple and possible.

A second example:
Gina has never set the table for dinner. Part of the reason is that the plates are too high for her to reach and they are china easily breakable. Also, the utensils are not easy to get to. This is easily solved by moving plastic plates and smaller folks and spoons to one drawer that the child can reach. The point is to set it up so the child can successfully achieve the Goals.

Overall point: Parents can set simple ‘destinations’ for their child to drive their ‘car’ towards and by keeping the steps simple and practising the steps again and again their child can achieve those destinations to goals that parents set.

Very important: the hugs and ‘You did great!’ and ‘Keep trying!’ are as important and at times more important than any reward system. Parents – whether biological parents or foster parents – are the fire to ignite important, life long change in children.
Send comments to DrCameronJackson@gmail.com

Many CA children are wrongly diagnosed by reputable institutions such as Stanford Hsoital (LPCH) with Intellectual Disability/ Mental Retardation.

Read the story of Maria below. To make a referral to Stanford hospital ( LPCH) as County Mental Health did with Maria is simply wrong. County Mental Health actions — and lack of actions — harm children who deserve better.

Maria’s story is not unusual. The story describes how many children are routinely mis-diagnosed by Stanford hospital (LPCH). Information concerning Maria and the actual parties involved have been changed or not specified to maintain privacy.

Maria, not the child’s real name, was for real exposed in utero to multiple illegal drugs. And as is true for many children exposed in utero to drugs, Maria, now age eight, has substantial difficulties that affect her overall development. Front and center, she has substantial difficulties with with executive functioning, attention and concentration.

Maria was removed at birth from her biological parents. She lives with a foster mother who only speaks Spanish and a handful of other children. In the home, she has no daily chores and prefers to play by herself. For the last several years, Maria has received County mental health services (medications and therapy) to assist with her dificulties related to inutero drug exposure.

In the home, Spanish is the principal language spoken by the foster mother. At school, Maria’s special education classes (SDC) are in English. Maria speaks a mixture of Spaish and English. For example she know shapes (circle, rectangle) and colors in English but not Spanish; on the other hand, she knows animals and and common home items better in Spanish.

Through her public school, Maria’s cognitive abilities have been assessed in Spanish, English and also with non-verbal tests. At school, she performs best on non-verbal, visual tests of intelligence that have less cultural bias. Assessed on multiple occasions, Maria performs variously. On I.Q. tests that do not rely on lanugae she performs in the Average to Low Average range.

County mental health gave Maria a diagnosis of Pervasive Developmental Disorder, Not Otherwise Specified (PPP-NOS). Saying that they sought more ‘diagnostic clarity’, the County recently referred Maria to Lucile Packard Children’s Hospital (LPCH) located in Stanford, CA.

Though County Menal Health initiated the referral to Stanford hospital (LPCH) they did not send along their own mental health records. The Mental Health therapist or psychiatrist could have put relevant mental health summary records in an envelope and given it to the family to take with them. That did not happen.

Nor did County Mental Health assist so that relevant school psychological assessments accompanied their referral to Stanford hospital (LPCH). With a Release signed by the mother the County Mental Health therapist could have ensured that school assessments accompanied the County’s referral to Stanford hospital. That did not happen.

As a result, there was no collaboration between County Mental Health, the local schools and local physicians. As a result Stanford hospital (LPCH) lacked up-to-date relevant records available for review. Very importantly, and one wonders about arrogance by Stanford hospital, LPCH routinely does not seek out additional information other than what it gets from their own assessment.

The family had to travel two to two and a half hours each way to go to Stanford hospital (LPCH). Although there are numerous licensed psychologists trained in assessment and diagnosis the County routinely chooses to refer outside the County to LCPH. If they wanted to, County Mental Health could reaadily refer to the local Psychological Association. Every County in CA has a psychological association.

Maria was recently assessed by Lucile Packard Children’s Hospital (LPCH). Of importance, the LPCH assessment did not request nor review Maria’s multiple prior school assessments. And LPCH did not review Maria’s medical records nor her mental health records.

LPCH limited the assessment of Maria’s current functional abilities to the ratings that they obtained that day from Maria’s foster mother. No ratings were obtained from Maria’s teachers. Based on a one day assessment, done in English using a Wechsler IQ test known to have strong cultural biases, LPCH gave Maria diagnosis of Intellectual Disability/ Mental Retardation.

Yes this 9 year old child suffers from dificulties related to in utero drug exposure. And she has not yet stabilized her language abilities because she hears only Spanish at home and English at school. And yes on certain tests of executive functioning, attention and concentration she scores quite low.

Maria and other children referred by County mental halth deserve an accurate diagnosis based on a thorough review of relevant school, medical and mental health records. County mental health should collaborate with local psychological associations and use locally trained psychologists who can visit schools and observe children in their home enviornment. When referring outside the County, County Mental Healh should see that relevant school, medical and mental health records accompany their referral.

As I wrote above, to make a referral to Stanford hospital ( LPCH) as County Mental Health did with Maria is simply wrong. County Mental Health’s actions and lack of actions harm children who disserve better.

With an erroneous diagnosis in hand, County Mental Health will close Maria’s case saying that her supposed diagnosis of intellectual disability makes it impossible for her to profit from therapy. And with this diagnosis the schools probably will refer the family to social security.

What Maria truly needs is: 1) time to develop and stabilize her language abilities; 2) training in how to use schedules and other techniques that assist persons with problems with attention and concentration. Just because this eight year old tends to skip from step 1 to 4 does not mean she cannot learn to do tasks correctly. With correct interventions, Maria will be happier and society will not have to support her as an adult.

Commnets welcome. Send to: DrCameronJackson@gmail.com

Ritalin helps about 70-80% of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) with a 1 1/2 percent who discontinue due to side effects. Now research shows that Ritalin helps children with Autistic Spectrum Disorders — not to the same extent and with more side effects. A 2005 study shows that Ritalin helps 50% of children on the spectrum with a an 18% discontinue rate due to side effects.

My question: What is helped the most? Executive functioning abilities (attention, planning, sequencing) or impulsively or what?

See the following research article:

“Hyperactivity, distractibility, and impulsivity are common symptoms in children with autism and other pervasive developmental disorders (PDD). Children with PDD who experience these symptoms are not considered to also have Attention Deficit Hyperactivity Disorder (ADHD). This is because their symptoms of hyperactivity and inattention are thought to be secondary to the autistic symptoms and/or intellectual disability, and also the response to treatment may be different. A number of studies have explored the use of stimulants such as methylphenidate in typically developing children with ADHD, but few have examined the use of methylphenidate in children with PDD. This study sought to determine the efficacy and safety of methylphenidate in children with PDD and hyperactivity.

Seventy-two children with PDD and moderate to severe hyperactivity participated in a 1 week test-dose phase to see how well they tolerated methylphenidate. Each child received placebo for 1 day, then increasing doses of methylphenidate (low, medium, high) for 2 days each. The 66 children who tolerated the test-dose were then randomly assigned to the next 4 week phase. The trial was double-blind, meaning that neither child, parent, nor doctor knew whether the children were receiving active drug or placebo. It was also a crossover trial. In a crossover trial subjects are randomly allocated to one of two groups. Subjectsallocated to the methylphenidate group receive methylphenidate first, followedby placebo. Vice versa subjects in the placebo group receive placebo first, followed by methylphenidate treatment. This designallows contrasting the response of a subject to placebowith the same subject’s response to methylphenidate. Each child therefore received placebo and the 3 different dosage levels (provided they were able to tolerate the dosages during this longer phase). Children who responded positively during the crossover phase were then entered into an 8 week open label (i.e. no longer blinded) continuation phase at their best dosage. The primary outcome measure of the study was the hyperactivity scale of the Aberrant Behavior Checklist (ABC).

The investigators found that methylphenidate was more effective in improving symptoms of hyperactivity and inattention than placebo in children with PDD (49% response rate). Adverse effects were more frequent with methylphenidate than placebo and included irritability, decreased appetite, difficulty falling asleep and emotional outbursts. There was an 18% discontinuation rate due to adverse effects. The 49% response rate is less than the 70% – 80% response previously reported in a large study of children with ADHD; the 18% adverse event rate for children with PDD was higher than the 1.4% rate reported in the aforementioned study of children with ADHD.

Conclusions

The investigators conclude that methylphenidate is a reasonable choice for treating hyperactivity in the context of PDD given the response rate of 49%, with the caution that there is a strong possibility of adverse effects.