Unfortunately you are looking at this website because your child, grandchild, or a friend’s child has been diagnosed with autism. To each of you the news has not only been shocking but devastating. The emotions you are experiencing are not only intense but many — fear, sadness, guilt, and anger just to name a few of the most common ones. Some of you are frantically searching for an answer and someone to help as soon as possible. Others of you have heard of physicians like myself but have avoided seeing one of us for a variety of reasons...
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Unfortunately you are looking at this website because your child, grandchild, or a friend’s child has been diagnosed with autism. To each of you the news has not only been shocking but devastating. The emotions you are experiencing are not only intense but many — fear, sadness, guilt, and anger just to name a few of the most common ones. Some of you are frantically searching for an answer and someone to help as soon as possible. Others of you have heard of physicians like myself but have avoided seeing one of us for a variety of reasons searching for an answer and someone to help as soon as possible. Others of you have heard of physicians like myself but have avoided seeing one of us for a variety of reasons. Others of you have seen a physician or physicians like me with little to no benefit so have given up, at least for a while, but are now looking again to see if something may really be able to help your child with a new set of eyes looking into your child’s case.
The good news is that biomedical treatments have worked for the vast majority of those I’ve seen over the last 20 years since I saw my first child with autism. Since that child presented to me in the mid ’90s I have now seen approximately 4000 other children, either on the autism spectrum or children with some other type of developmental delay. With that background and experience I can say with a great level of confidence that if the parents begin biomedical treatment and do them consistently for several years, their child will definitely improve. Though most children do not reach full recovery, the vast majority improve at least moderately, if not significantly, with some reaching full recovery meaning they become indistinguishable from their neurotypical classmates in school or at play. The process to reach their full potential is definitely not fast or easy, and it is definitely not inexpensive though programs can be tailored to meet each family’s individual needs. Also, so that there is no confusion as to what I am saying, it is important for every child on the autism spectrum to partake of every modality that is available to them that they can afford to do, things like ABA, speech and language therapy, occupational therapy, and everything that is taught in the educational school system, whether in schools specifically designed for children on the autism spectrum, or mainstream schools that may or may not have all of the opportunities they would like to see made available for their child.
To say that I have excellent results in my clinic is neither arrogant nor bragging, it is just stating the facts that I can backup from what the parents tell to me on their detailed reporting system whenever we meet. If you are looking for a warm and fuzzy doctor then you are looking in the wrong place. However, if you are looking for results and a doctor that not only has seen just about everything but also has done just about everything, then I may be the right doctor for you to see for your child. One thing I am absolutely sure of is that you are already overwhelmed and tired with too many things to do every day. Therefore you are not looking for more work to do by filling out a bunch of paperwork whenever we meet. However, there is no way that I can take your child to his or her full potential if I do not get the information I need whenever we meet. Therefore I will hold you accountable to present to me everything I require for each consultation and that your work be done comprehensively and accurately and updated line-by-line. You will be required to properly fill out the extensive paperwork that I have designed over the last 20 years so that I can see within just a few minutes at the beginning of every consultation what you have been doing, what you have not yet done, as well as what has worked and what has not worked. This will allow me to compare your child to the thousands of other children I have seen that were like your child so I know how take your child from wherever he or she is today to the place where I know your child has the potential to go over the next few years. The process will be slow and steady but it will be progressive and produce results.
In summary what I can do is assure you that if you do what the average parents that have gone before you have done for their children, then your child will also progress...
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Who is Dr. James Neubrander
Methyl-B12 injections to increase methylation and transsulfuration (e.g. glutathione) biochemistry, two factors critical to improving executive function, speech and language, and appropriate emotion and socialization skills.
Methyl-B12 seems to unlock the areas of the brain that are required to verbalize and communicate effectively. It is not uncommon to see improvements in expressive, receptive, and conversational language as well as the ability to make longer sentences that include pronouns, adjectives, adverbs, etc! Methyl-B12 is known to increase eye contact, focus, attention, awareness, comprehension, and the ability to understand abstract ideas and concepts.
The children become more tolerant of change, transition much more easily, and become more flexible. They are able to communicate their wants and needs more effectively. Methyl-B12 improves their ability to stay on task and the ability to follow more complex commands.
It helps with imaginative play, imitation skills, and engagement with others. Often they become more in touch with their feelings and the feelings of others.
Interests are widened, the children become more inquisitive and they try new things. They become more self confident, opinionated, and their need to be independent is heightened. The children learn more easily, their memory improves, and things that parents did not even know their children knew are now expressed to their parent’s great surprise!
The children become much more affectionate, cuddly, and loving and they have many more good days at home and school than they ever did before.
In addition, methyl-B12 is known to improve the immune system, decrease allergic responses, and it often helps appetite, aids in increasing weight, and frequently helps gross and fine motor skills.
To date, I have prescribed and monitored well over a million doses of methyl-B12. I have used every route of administration (oral, sublingual, transdermal, nasal, intramuscular, intravenous, and subcutaneous) and have documented that the only route of administration that consistently produces significant clinical benefits are from (painless) subcutaneous injections. Though most parents enter my practice very fearful of giving the shots, after administering only one or two injections, 9 out of 10 of them say that this is the easiest thing that they do! When parents know what to look for and how to evaluate whether or not the shots are working, approximately 94% of parents are able to “undeniably document” numerous benefits they have witnessed to occur during the first six weeks of treatment.
Unique to my practice is the fact that during the six week initiation phase I do not let parents make any other ‘biomedical’ changes to their child’s treatment program. By this I mean parents are not allowed to add anything new or take anything away from what they are already doing, nor are they allowed make any modifications to any treatments already in process, e.g. they cannot increase or decrease anything they are already giving. Therefore, when parents evaluate the progress they see in their child, everything that occurred within the six week period of time will have been from the addition of methyl-B12 therapy and not from other things that they may have added simultaneously (the most common way biomedical treatments are started in most other practices).
Also unique to my practice is the evaluation process I use to document clinical progress from methyl-B12 therapy. Parents need to “know for sure without any lingering doubt” that methyl-B12 really is working for their child. In order to do this, I use a form called the Parent Designed Report Form. It works much more effectively than any other evaluation tool because it was you, the parents who created its content and it was you, the parents who determined the language that you wanted it to use so that you could tell your entire story and do it your way. The Parent Designed Report Form is the only evaluation tool available anywhere that allows “anecdote” to become “scientific” by attaching “numbers/value” to what you are able to document “undeniably” that you see occur during the “no other changes made” six week period of time. The Parent Designed Report Form is the only evaluation tool that “validates” what you, the parents see to occur during the evaluation period rather than invalidate your observations by calling them “anecdote”. The Parent Designed Report Form is the only evaluation tool that “recognizes” that only you, the parents, are able to see what occurs in your child “24/7-365” and therefore “your observations” are powerful “scientific tools”, not pieces of worthless information from desperate parents willing to believe any fairy tale out there.
In summary, the Parent Designed Report Form is the only evaluation tool anywhere in the world that makes anecdote scientific and puts the power of anecdote into the hands of the parents who are no longer willing to accept from professionals or the scientific community that their observations are meaningless! Most importantly, it allows the tremendous power of methyl-B12 treatment to be initiated now rather than being delayed until someone designs the perfect study that will take years to finish in order to prove what you, the parents, already know to be ‘undeniably true’!
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Heavy Metal Testing It is important to understand that when using strong chelating agents, things like DMPS, DMSA, or EDTA, but especially when using DMPS, there should be a significant "shift to the right" for almost all the essential elements shown on the Doctors Data test results data page. Remember, the further the tip of the black bar goes to the right, the more of an element there was to lose to the urine, and the further the tip of the black bar goes to the left, the less of an element there was to lose to the urine.
Knowing that minerals are metals, if you think of the strong chelators as magnets, you can understand that when your child takes a chelating pill that acts like a magnet, once it goes through the bloodstream into the tiny capillaries and bathes the tissues, whenever it comes in contact with a mineral [either good minerals or bad minerals -- essential minerals or toxic minerals ], more of this chelating agent/mineral complex should eventually find its way into the urine.
It is also important to understand that the test result data graphs are really based on "normal values" and are not based on values that occur with a chelating agent. Therefore, should one collect a regular urine specimen without swallowing a chelating agent [or doing an IV], the graph you see showing the different percentile rankings should fall within the green columns, the 16th to 84th percentiles, essentially the normal parts of the standard bell shaped curve, those that represent one standard deviation from the mean. Those that fall in the yellow columns are borderline and are within two standard deviations of the mean. And those that are in the salmon-colored columns are seriously high or low and represent values three standard deviations away from the mean.
Without the chelating agent, the heavy metals cling to the tissues and are not "washed off" the tissues into the blood stream. Therefore, just a "normal amount" of minerals/metals come out in the urine. However, now consider what "is normal" when one takes a strong chelating agent. The medicine floats through the body and "magnetically attracts" good AND bad metals [minerals]. Heavy metals are more attracted to the chelating agent than they are to the tissues. In addition, because chelating agents can also bind the essential [good] minerals, these essential minerals will also come out in a higher amounts than they would under normal conditions. Therefore, when the amounts of essential minerals are measured by Doctors Data [or other labs] in the urine, they appear to be present in very high amounts. This is the phenomenon called THE SHIFT TO THE RIGHT. The reason it is called this is because the tips of the black bars are now found to the right side of the 50th percentile column. In fact, usually these minerals are shifted very far to the right and a very healthy urine challenge test with a strong chelating agent has many of the bars off the graph to the right.
Now think of this. When using a strong oral or IV chelating agent, what we want to see and what indicates the child has a healthy amount of minerals is a strong shift to the right. However, when you find elements that are "able to be attracted by the chelating agent the doctor has selected " [this will vary so do not overinterpret this without the help of the doctor] and they are found to be below the midrange 50th percentile column, in reality these minerals were "really very low to start with" and only with the chelating agent's help were able to be seen anywhere near normal. Therefore you will erroneously think that everything is OK when really the child is mineral deficient.
Therefore, when taking a strong chelating agent, what is normal is a strong shift to the right. Things that shift only mildly are mild to moderately deficient and things to the left of the 50th percentile column are moderately to significantly deficient!
CAUTION: Each chelating agent has binding affinities for different toxic and essential metals/minerals and some chelating agents cannot bind to some things at all. For example, DMPS and DMSA do not bind to aluminum. In addition, when a chelating agent can bind to the same essential or toxic metal, they have different degrees of attraction. For example, DMPS, DMSA, and EDTA can all bind to lead and mercury. However, EDTA binds to lead the strongest and DMPS the weakest with DMSA being in the middle. The exact oppositie is true for the binding affinities to mercury whereby DMPS is strongest, EDTA is weakest, and DMSA is in the middle.
One other important point is that the route of administration will have a significant bearing on how much or how little of a metal one finds in the urine. For example, transdermal DMPS will pull very little heavy metals into the urine while oral DMPS will pull more and IV DMPS will pull the most.
And it is important to note that exceptions occur as in an example of the body in a "repletion mode". As an example, I have a patient that illustrates a specific instance where a significant shift to the left did not indicate worsening of the child's condition but rather significant improvement. My comments to the parents read as follows: "In the past, red blood cell elements were found to be low so the parents increased the mineral supplementation amounts their child was taking to correct the problem. In addition to the low red cell minerals, the same test showed many urine essential elements were low normal or low but at that time were not "extremely" low. Eight weeks later, on follow-up, the red cell elements have all improved whereas the urine essential elements now measure "extremely low" causing the parent to be very worried and upset. However, the correct interpretation is that the minerals were now being incorporated into the red cells quite efficiently. In the process, the additional minerals that were "floating around in the blood waiting to enter the red cells" were not electing to be urinated out -- the proper thing for the body to choose to do. Therefore, the urine essential elements on the urine test would show up in far lesser amounts than they were on the previous urine test because they were being utilized by the cells and not being lost through the kidneys!"
As you can see, accurate interpretation requires comparing the current history as compared to the past history including supplementation, the chelating agents being used, new therapies, other medications being used, etc. [especially for the last 8 to 12 weeks], and the previous blood and urine tests as compared to the current blood and urine tests.
THEREFORE DO NOT INTERPRET URINE TEST RESULTS WITHOUT THE HELP OF A DOCTOR WELL VERSED IN THE PROPERTIES OF CHELATING AGENTS AND IN THE CHELATION PROCESS ITSELF!
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Detoxification and chelation therapy have the potential to be a valuable treatment for many children. However, its ‘potential’ need and ‘documented’ benefits have been largely exaggerated, both by professionals and parents alike. The alarm and fear that websites, chat rooms, and parent blogs have created is nowhere close to what I have been able to document in my practice after doing this with hundreds of children over the last 15 years. The furor that exists as to what is the best way to chelate, and often promoted as the ‘only’ way to chelate, has at times reached charismatic levels with the various factions getting no less involved and emotionally charged than what we see when one talks about religion or politics! Still, for any individual child, considered to be a unique being, chelation may play a valuable role in that child’s overall set of treatment modalities to move him or her towards recovery.
I do not believe in blindly chelating a child (or adult). However, if key laboratory screening tests indicate that chelation “may” be a valuable treatment option, and if parents decide they want to chelate, I will then begin to take the next steps with them. Those critical steps include full informed consent by both the mother and father, a detailed discussion as to the pros and cons of chelation, what are the ‘knowns and unknowns’ of chelation itself as well as what will occur with the chelation process we will be using, its potential benefits vs. its relative risks, the costs involved to frequently monitor various tests for safety (liver, kidney, bone marrow), and the steps required to prevent getting into trouble by being too aggressive and not repleting the essential minerals that will also be removed along with the toxic minerals.
Should we come to a mutually acceptable understanding, only then will I begin the chelation process with the family for their child. At that point, I will discuss with the family the method of chelation that I believe will be the best one to use. This decision is based on many factors, e.g. the family’s financial state, where they live relative to my clinic, their belief system and/or fears, their ability to obtain safety tests on a regular basis, and knowledge base they have relative to everything known about the various options I can use to chelate their child. Such options include, but are not limited to: oral DMSA; oral DMPS; intravenous DMPS; intravenous CaEDTA; suppository forms of DMSA, DMPS, or EDTA; transdermal DMPS or DMSA; the “Cutler method” that requires no lab tests; and more natural methods of chelation, e.g. supplements, glutathione, herbal agents, etc.
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Methylation Testing and Treatments
Methylation Testing and Treatments To be written.
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Intravenous treatments that I use in my clinic include glutathione, phosphatidylcholine, vitamins and minerals, regimens that support the immune system, steroid, secretin, and IVIG (intravenous gamma globulin).
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Detoxification and Chelation Therapy
Gastrointestinal issues – diagnosis, treatment, and when necessary, an appropriate referral. Children on the spectrum have some type of GI symptoms more than 50% of the time. The common symptoms include loose stools (“mushy”; “like mashed potatoes”), diarrhea, constipation, infrequent bowel movements, bowel movements that are voluminous for the size of the child (“can fill up much of the toilet bowl”), extremely foul smelling stools (“can clear the room”), stools with atypical or varying colors, much undigested food, very hard or distended protruding abdomens (“looks pregnant”), gas, bloating, abdominal pain, “posturing”, etc. In addition, scientific studies have demonstrated that there are as many neurons in the GI tract as there are in the brain, something now referred to as ‘the gut-brain connection’.
The way this applies to children with autism is that frequently their GI problems are expressed behaviorally or in other ways that do not seem to be related to the GI tract. Examples include, but are not limited to aggression, head-banging, biting, kicking, fits of screaming or outbursts for no apparent reason; unexplained behavioral changes that come on suddenly and then can leave just are quickly, serious sleep disorders, hyperactivity, stimming, etc. Certain anaerobic bacteria from the Clostridial family produce proprionic acid which has been shown to turn normal rats into autistic rats. Many other types of aerobic bacteria also produce organic acids or have direct inflammatory effects that also affect children on the spectrum. This is a process called ‘dysbiosis’. A few of the ‘dysbiotic’ bacterial species commonly seen from families other than the Clostrial family include, but are not limited to Klebsiella, Citrobacter, Pseudomonas, Proteus, etc. It is important to know if there are enough ‘beneficial’ bacterial species present and if not treat using “pro”biotics. It is also important to know if there is enough “nutrition, food, and fiber” present for the beneficial bacteria to thrive upon. If not, treatment with “pre”biotics is indicated. Besides absence, excess, and imbalance of anaerobic and aerobic bacteria, many different genus or species of yeast are often present. Also, it is not uncommon to find parasites in the children’s GI tract when tested.
In addition to determining the types of organisms that are living within the child—good types or bad types or types that are out of balance--it is also important to determine whether the child has digestion/absorption problems; gastrointestinal inflammatory and gastrointestinal immune problems including whether the child produces too much or too little protective ‘secretory IgA’ (the intestine’s first line of defense), or if the child’s body is consuming too much protective ‘secretory IgA’ due to an intestinal inflammatory or infectious process; gastrointestinal metabolic problems; proper fecal pH balance; the ability to process fats; the amount of bile and digestive enzymes present; and whether the child has a “leaky gut pattern” (intestinal permeability which triggers the immune system to react in a manner that often produces negative symptoms).
When symptoms are severe enough and not resolved by the more standard and conservative treatments I use in my office, I will refer patients for a comprehensive workup that may include an endoscopy, colonoscopy, and pill cam procedure that has a ‘camera’ pass through the small intestine. Each of these procedures is done in order to diagnose autistic enterocolitis (AE) and lymphonodular hyperplasia (LNH) vs. other types of bowel disorders.
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LDA: Low Dose Antigen Allergy Desensitization - Most common are food and inhalant (“airborne, environmental”) allergies. In addition, we can diagnose and treat cytotoxic and chemical sensitivities whose symptom complexes are similar to allergies, though not truly “allergic” by the standard definition. Not only do allergies cause significant symptoms, food allergies represent a very important reason children on the autism spectrum develop a “leaky gut”, something that complicates the GI issues commonly seen with this subset of children. According to the Boris/Goldblatt study, children with ADD/ADHD and autism demonstrated significant regressive symptoms that directly paralleled the officially reported pollen counts. In addition, the symptoms that affected the brain did not require that the children have classical allergy symptoms. This confuses many parents and clinicians. To understand why this occurs, it is important to understand that mast cells are sensitized to many different substances and when they come into contact with a triggering substance, they release histamine. Such substances not only include pollens from weeds, trees, and grasses, but also include molds, animal dander, insect droppings, and foods. Once released into the bloodstream, histamine binds to various types of histamine receptors. When a person has histamine receptors in the eyes and nose, they are bothered by classical allergy symptoms. When a person has histamine receptors in esophagus and stomach, they are bothered by acid reflux (“heart burn”). When a person has histamine receptors in the brain, they are bothered by many different types of regressive symptoms. That is why persons without ‘nose and eye receptors’ did not regress from pollens but did regress because they had ‘brain histamine receptors’.
One specific treatment I use for inhalant and food allergies is LDA injections (“low dose antigens”), a treatment that works well with children on the autistic spectrum and one that typically isn’t severely compromised, in my experience, by dietary issues. There are only a few physicians in the country that use this method of desensitizing patients to airborne (inhalant, environmental) allergies because it requires specialized training by the physician. The reason I have switched from the classical method of desensitizing to LDA is because LDA only requires between 10-16 shots over a three year period of time as compared to the numerous shots necessary from classical desensitizing. It addition, LDA can be used to desensitize for food allergies and hypersensitivities as well as chemical sensitivities, none of which conventional allergy treatments can accomplish. One of the benefits I offer family members who also suffer from allergies are LDA shots at a significant family discount rate.
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Dietary Recommendations, Testing, Treatments & Multiple Diets
Anti-Folate Autoantibody Testing and Treatment
Dietary recommendations, testing, and treatments for all types of diets: casein-free gluten-free diet (CFGF); specific carbohydrate diet SCD); food allergy diets and non-allergic food intolerance/sensitivity diets; elimination/rotation diets; yeast-free diet; Feingold and related-type diets (salicylates, phenols, food additives of all types, etc); low oxalate diet (LOD); Gut and Psychology Syndrome diet (GAPS); Body Ecology diet (BED); fermented foods diet, etc. Each of the diets shown above have the potential of helping key issues in specific individuals. Finding the right diet often requires professional help. Knowing what diets have tests that can be ordered, what tests are most likely to be helpful, and whether the information gained from the test will justify the cost almost always requires a professional’s advice. In addition, it is very important to consult with a professional to make sure that foods that ‘test positive’ are not ‘good foods’ that really do not need to be eliminated, or if they must be eliminated that they are not eliminated for periods of time longer than required. It is very common for a parent to obtain a food allergy or food hypersensitivity test and eliminate all the ‘flagged foods’ or eliminate them for a year or more when this is not necessary or far too long to avoid the food. Just as common, if not more common is when parents obtain a test for ‘allergies or hypersensitivities’ that comes back with 25-33% of the foods marked as moderately to significantly abnormal with a report that says to eliminate the foods. Accurate interpretation of such a test requires a professional who knows how to differentiate between a ‘leaky gut pattern’, a GI problem that does not require all the foods be eliminated, or a true food hypersensitivity problem that will require at least some of the foods be eliminated, though not necessarily all of them.
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Folate receptor autoantibodies diagnosis and subsequent treatment options. This is vital information necessary to complete treatment options for three of the most critical biochemical pathways that we find affected to some degree in the majority of children on the autism spectrum: methylation, transsulfuration, and the ‘reduced’ forms of the folic acid family. Antibody formation to folate receptors is an autoimmune phenomenon that blocks methylfolate from crossing the blood brain barrier in order to enter neurons.
In our practice we find approximately 2/3 of children have such antibodies. In addition, folate receptor autoantibodies are believed to be more frequent in children who have seizure disorders. On a related side note, it is important to realize that studies demonstrate approximately 1/3 of children on the spectrum are affected by seizures. Such seizures are mostly nocturnal, usually not witnessed by parents, and typically not severe enough for parents to even notice. However, they are there, affect the children, and should be treated.
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Mitochondrial “disorder/distress” screening & treatments
Mitochondrial “disorder/distress” screening & treatments. Mitochondrial “distress” is not the same thing as severe mitochondrial disease which is referred to specialty clinics that handle such severe cases of mitochondrial problems. Mitochondrial ‘distress’ can be considered a phenomenon in which the mitochondria cannot meet the body’s demand to make enough ATP, whether all the time or just intermittently when the body’s demands are higher than usual.
We find such ‘stress’ on the mitochondria to be much more common than was currently believed to be present in children with autism. Once found, effective treatments can be implemented. Mitochondrial distress/disorder (and disease) is found to be more frequent in children who have seizure disorders. Studies show that approximately 33% of children on the spectrum have some type of seizure activity. The take-home message is that just because parents have never witnessed any type of seizure activity in their child does not negate the fact that if their child was evaluated under controlled scientific conditions, 1/3 of them would test positive.
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Prenatal Consultations I am frequently asked if I would advise parents how to decrease their risks of having an affected child should they decide to get pregnant again. This is something that I will offer to them as long as they understand that such advice is not intended to replace good medical care from their primary care physicians and obstetricians. Principles of healthy living approached from many different ways are options I can help parents understand so they can make better choices before conception, during, and immediately after.
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Comprehensive Laboratory Testing
PANDA’s diagnosis and treatment belongs to the immune/autoimmune category of problems. However, because it is quite specific and problematic for so many children on the autism spectrum, it is listed here as a separate entity. PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections. It was first described by Susan Swedo, M.D. from the National Institute of Mental Health. The disorder is characterized by a child having exacerbation of obsessions or tics. Comorbid symptoms include compulsions, strange body movements (choreiform), emotional lability, personality changes, age inappropriate behaviors, separation anxiety, oppositional defiant disorder, tactile/sensory defensiveness, ADHD, major depression, marked deterioration in handwriting, daytime urinary frequency/enuresis, and occasionally anorexia. The problem with this disorder is that most of the symptoms associated with it also represent many of the classical symptoms of autism and to know what is autism vs. what is PANDAS vs. what is a mixed presentation requires a professional knowledgeable in this field. The diagnosis is established from the history, the chronological sequence as to when the symptoms appeared or became more quiescent, the season of the year, other associated factors, e.g. strep infections at school or at home, etc. There are specific tests that help ‘strengthen’ the likelihood of the diagnosis but to date no test can actually diagnose whether a person has PANDAS or not. That is why professional help is necessary. The treatments include antibiotics, steroids, and IVIG.
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Comprehensive Laboratory Testing: Our clinic offers the full complement of laboratory tests commonly used for children with autism. It also offers a full spectrum of tests for many of the co-morbid conditions associated with children on the autism spectrum or neurodevelopmental disorders. The tests we order are used to diagnose, treat, and subsequently monitor the patient’s care. Not only do I order tests related to the treatment of autism, I also order tests for many other disorders as well as ordering tests for family members when it is in the best interest for the care of their child. With rare exception, the only tests I order are those that affect the treatments I recommend and not be ‘curiosity’ tests that cost the parents money but add no benefit to the child’s treatment plan
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