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Targetted Probiotics

This is a great video by Kurt Woeller about the several kinds of probiotics.  While we all know that probiotics are good for you, I didn’t quite absorb which ones target what kinds of conditions.

Kurt references the following:

  • Culturelle used for Clostridia
  • VSl3 breaks down Oxalates
  • Threelac attacks yeast
  • Saccharomyces boulardii (yeast)  attacks candida (yeast) and clostridia.
Categories: Autism

General Insurance Authorization info for ABA

January 30, 2013 Leave a comment

ABATrumpet Behavioral Health (TBA) and TACA (Talking about Curing Autism)  recently held a webinar about gaining insurance coverage for ABA (Applied Behavioral Analysis). ABA has typically been a 40 hr/week program at home aimed and infants and toddlers to train children in correct behavior.   It is not based on deep cognition.  Nonetheless it is one of the few things studied that have been shown to help autism, and what’s new is that insurance companies are beginning to cover it!    You can imagine  that any intervention  of 40 hrs/week with trained individuals can get quite expensive.

Important General Insurance Info

Regulating Health Plans in CA

TBA is based in California so there will be a California-centric view. In CA these are the organizations which regulate health plans: DMHC (Department of Managed Health Care) and CDI (California Division of Insurance).  If you have been denied healthcare these agencies can review the determination and may overturn insurance decisions.  They cannot change any benefits in the plan, but if the benefits are already in the plan they may be able to help you get them.

In your state, you might be able to go to the analogous agency in your state.  To find out who regulated insurance in your state you can simply ask the insurance company, and of course look it up on the web.

Type of Insurance Plan

  • Fully Insured – large group plans, regulated by the government, owned by insurance companies, regulated by state agencies.
  • Self Funded – employers money funds the plan so government mandates do not apply.  They may still hhave 3rd party administrators that look like insurance companies like the Fully Insured but employers decide final benefits. Several self insured plans cover ABA, such as Microsfot Home Depot etc

A Summary Plan Description- has the details of your plan, research this for benefit  actual benefit determination

Authorization

ABA falls under Mental Health benefit, therefore use mental health phone number when contacting the insurance company/administrator.  Your plan may have Autism Unit/Care Manager.  The best way to get authorization is to get a precise list of what documents are needed for authorization.

Assessment

ABA or any therapy requires an assessment.  You will want to find out what details are required to gain coverage.  Question can be:

  1. Who can do assesment?  Masters Level clincian? Licensed? How many hours after their masters are required i any?
  2. How long is the assessment? # of hours?  Are there different coverages for the assessment and the writeup for the assessments?  Is there a maximum timeperiod during which the report can be submitted?
  3. When is reassessment required?
  4. What code will you bill under?
  5. What assessemnt tools used by provider are approved?

Supervision

  1. Who can provide supervision? Masters? BCBA Licensed?
  2. Can Supervision be billed on same day as direct ABA Service?
  3. How many hours of supervision is approved?
  4. Does supervision have to be in presence of client?

Direct Services

  1. How many hours of direct therapy are covered?
  2. Who can provide direct therapy?
  3. Where can services be provided (historically it was at home), if clinic setting is there a different copay?
  4. What are approved dates of service?

Treatment Plan Requirements

  1. What forms should be used for authorization? Are they found online?
  2. Resend treatment plan before authorization expires?
  3. What to include in the treatment plan to be covered?
    • goals
    • objecives
    • target dates
    • baseline
    • transition plan
    • discharge criteria
    • Parent Involvement

How TBA can Help

Members of this organization fight for coverage under your exsiting coverage, they have several years of experience with  insurance companies, and state organizations.  They can help with the following to get coverage:

  • coding,
  • copay/ # of sessions
  • authorizations and
  • billing
Categories: Autism, Tools Tags:

ADHD and Executive Function

January 27, 2013 Leave a comment
Human Eye with different lines. The line of si...

Human Eye with different lines of sights.

We know that ADHD exists, so I’m not going to go into proofs that the child is not “raised irresponsibily”.  On the other hand, having a child with any disability does require you to be a more sophisticated parent and more sympathetic.

Executive Function (EF)

Executive Functions or EF are the skills used to filter, organize, and prioritize stimulus and cognition to perform a function.  Kids with ADHD  “exhibited significant impairment on neuropsychological
measures of response inhibition, vigilance, working memory, and planning”.   

Tests

From the neuropsych perspective, the Wisconsin Card Sort,  the Rey–Osterreith, and the Tower of Hanoi have been used to test EF.  You may have seen these tests on the Neuropsych Report when you had your child tested at the psychologists office.

EF part of ADHD or IS ADHD?

The International Journal of Disability, Development and Education, published a paper about how ADHD can be looked at with respect to EF with two perspectives: 1) Executive Function is part of the ADHD diagnosis or 2) Executive Function is the reason you have ADHD in the first place. 

Many meta studies have shown that while there is weakness of executive functioning in a part of the ADHD population it is not a singular representation of ADHD behaviors and outcomes.  Some studies show that only 30% of those diagnosed with ADHD have executive functioning problems.  And  people with autism, oppositional defiant, traumatic brain injury and other disorders also show EF problems.

Others like Denckla, Barkley, T.E. Brown and others show that there is significant cognitive impact, especially the ability to inhibit.  Brown has modeled the areas where this cognitive deficit can be seen:

  1. Activation: Organising, prioritising and activating to work.
  2. Focus: Focusing, sustaining, and shifting attention to tasks.
  3. Effort: Regulating alertness, sustaining effort, and processing speed.
  4. Emotion: Managing frustration and regulating emotions.
  5. Memory: Utilising working memory and accessing recall.
  6. Action: Monitoring and self-regulating action.

Brown argues that tests traditionally used in a neuropsych report are insufficient indicators of EF strengths.  The reason for this is that dissecting a problem into constituent parts is reductionist and does not reflect the whole.  While you can put body parts together and add electricity, you will not get a whole functioning human from it.  Rather a test of normal daily functions is a better indicator of EF ability.

Stealth Dyslexia

Sometimes EF problems can result from Stealth Dyslexia.  Have you or child made “stupid mistakes”?  You know that 3+12=15, but on a test you may multiply the left hand side and come up with an answer of 36, and not know you made the mistake.  Even if you go back and check.  Dyslexia originally thought to be a reading disorder may manifest in several ways not currently recognized as dyslexia.  What if the dyslexia manifested cognitively outside of just reading?  Eides and Eides have determined that Stealth Dyslexia have these in common:

  • Characteristic dyslexic difficulties with word processing and written output.  This is sometimes found as high IQ and verbal comprehension but trouble with output: terseness, spelling mistakes etc.
  • Findings on neurological and neuropsychological testing consistent with the visual language, auditory, and motor processing deficits characteristic of dyslexia.  Visual Percepetion issues and not attention could be the cause of coding/tracking problems.  Visual Problems can often be addressed by seeing a Developmental Optometrist.  Central Auditory Processing Disorder (CAPD) is found in many kids (and adults) where one cannot manage and filter background sounds from primary communication.
  • Reading skills that appear to fall within the normal or even superior range for children their age, at least on silent reading comprehension.  But writing and listening may be problematic.  Sometimes one can tape the lecture knowing that ideas will be recorded for later recall, several times if needed.   That way one can listen to the lecture and absorb the concepts.

Processing Speed

Yes slow processing speed is a recognized condition and can contribute to the impulsivity of ADHD.  People with SPS (I just made that up), cannot participate in dynamic conversations because just as they’ve figured out the pace, direction and tone, it has moved on.  They also have trouble “getting” things that are taught.  You might find very intelligent people teaching themselves, and rather than get behind they teach themselves ahead of everyone else. If you cannot keep up, you might just  forget it and decide to go for things.  And this may become a habit, that manifest as EF.  Some studies show that processing speed normalizes around 27 years of age, but if you can’t wait that long…or have regressed because of TBI, you can consider neurofeedback or SimplySmarter which works on sequential processing  and therefore could help processing speed in general. 

Medications have not been known to help with any of these things that interfere with clear EF, but knowledge of these aspects may allow you to have the sympathy to support your child (spouse?) better.

Categories: Affect/Emotion, Anxiety, Autism

DAN to MAPS for Autism Treatment

December 27, 2012 Leave a comment

You may have heard of Defeat Autism Now!  or DAN. This group of doctors were giving it their all to find causes and solutions to the Autism epidemic that was and still is affecting our kids.  That group of doctors provided biomedical breakthroughs but apparently did not organize and develop past their burst of research to further develop medical professionals.  Thus MAPS was created; it stands for Medical Academy of Pediatric Special Needs.

In this video from Autism One, Intro to MAPS, you get the background and purpose of MAPS.  Allow me to list my notes for this lecture.

MAPS

Lecture Notes

  • Most treatments are off label except for Risperadol or Abilify (for irritability)
  • Autism does not have biomarkers so diagnosis is based on behavior
  • Autism likely can have several causes rather than just one or similar combinations
  • Causes might be
    • Mitchondrial dsyfunction
    • Inflammation
    • Oxidative Stress
    • Metabolic problems
      • Inhibition of function
        • e.g. clostridia releases toxin (propionic acid) that inhibits mitochondria, increases inflammation
        • Folate antibodies in the brain
        • Deficiencies (glutathione, iron etc)
  • Shades of grey, not disease but maybe dysfunction.
    • Gluten Intolerance vs Celiac Disease
    • Cerebral Folate Deficiency – treat with high dose folinic acid
    • Hypothyroidism
    • 2/3 of autistic kids have iron deficiency (low ferritin)
    • 1/3 of autistic kids have Low Cholesterol
  • Will use Biomarkers (testable) for
    • Endocrine
    • Methaylation and Transulfuration
    • Oxidative Stress
    • Immune Dysfunction
    • GI Stress
    • Toxicity
    • Mitochondrial Dysfunction
  • Varied treatments up to practitioner but treatments are changing fast
    • How can we get people to keep up
    • Can we create a protocol?
    • But we should be able to identify what is individual and what is more generally successful
    • Should know risk to benefit ratio of any treatment
    • Sometimes genetic tests create passivity when gene is identified even if things may still be helpful
  • MAPS is trying to categorize strengths of evidence into 4 categories
    • A – 2 or more randomized clinical trials (RCT) or 1 systematic review (like the melatonin study!)
    • B – 1 or more RCTs or 2 non RCT
    • C – 1 non RCT or 2 series cases
    • D – inconsistent or no improvement studies
  • Here is a table listing what works in Autism based on studies, only melatonin gets an A.
    • Vitamin C gets a B
    • HBOT gets a B
    • BH4 gets a B too.
  • Other way to evaluate treatement
    • S – Safety
    • T – Tolerable
    • E – Efficacy
    • P – Price
    • S – Simplicity
  • MAPS wants to see behavior as a changeable
  • Wants to understand underlying contribution not just medicate for behavior
  • Type of Medicine
    • Disease Oriented Medicine – lowering of cholesterol, doesn’t mean that life is better
    • Patient Oriented Evidence that Matters — maybe patients lived longer
    • e.g.Methyl B12
      • DOM: Boost Gluathione
      • POEM: Increases Speech
  • About Professonal Development
Categories: Autism, Condition

Say “No” to TyleNOl

February 27, 2012 3 comments

Several years ago, I had heard that Tylenol was about the worse drug you can take because it actually reduces L-glutathione which is the master antioxidant in your body.   NPR has raised this issue again by asking if it makes asthma worse.  In the past some in the autism community had foresworn the use  of it and to use Ibuprofen instead.

Have you noticed that if you go to a pediatrician’s office they always prescribe ibuprofen and not acetomenophen?  Why is that?  Do they know something we don’t know?   Even if this is the case, sometimes your kid may have a high fever that ibuprofen does not address sufficiently.  The fever doesn’t come down enough or it doesn’t come down enough for a long enough time before the next dose of IB can be taken.  You are then told to alternate with acetomenophin….I wouldn’t do it!  See this pubmed article about the link between autism and asthma.

I’ve found that vitamin C is a sufficient anti-inflammatory for me.  In fact I did not need to take codeine after a root canal because the Vit C held back the inflammation.

Categories: Autism, Condition, Nutrition

Glutathione…for what?

February 18, 2012 Leave a comment

image

Glutathione is the master antioxidant in your body.  It is made from 3 amino acids L-Cystein, L-glutamic acid, and Glycine.  So presumably if you have these in your body you should be making enough glutathione.  But that assumes you have the enzymes you need, and that you have no biochemical processes that are “using up” the glutathione. 

Low glutathione is implicated in Autism, Bipolar, Schizophrenia, Cancer, AIDS, etc.  However it is very difficult to take supplements orally to help.  There are several options.

1) Whey Protein.  Usually found in the liquid part of the yogurt.  Drink this!  You can also get supplements such as Immunocal which is a dry powdery mix that you can mix with liquids and ingest.  This is not glutathione but provides the building blocks to make it.

2) Alpha Lipoic Acid is an antioxidant that helps increase gluathione (this is also a liver support)

3) N Acetyl Cysteine or (NAC) is a precusor for direction transformation however some people do not methylate well and taking Cysteine could be problematic

4) Reduced Glutathione location from Kirkman’s is glutathione in a lipid base that is available to the body transdermally. Just apply it directly to the skin. 

Glutathione has sulfur in it, so you may notice a sulfury smell, but the good it will do you is worth it. In this day of oxidative stress, and inflammatory conditions, supporting your body’s production or supplementing transdermally is a great way of boosting your health naturally.

Categories: Autism, Condition, Nutrition
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