New Brain Wave Test for ADD;
Cutting Edge Technology or Snake Oil?
The FDA recently approved a new medical device to aid in the detection of ADD in children ages 6 to 17 years old. It is called the Neuropsychiatric EEG Based Assessment Aid, NEBA for short. The approval was based in part on a single study of 275 children.
The test analyzes different brain wave frequencies that are known to be more common in ADD kids than in otherwise normal kids. It is painless, non invasive and safe to use. It basically is an EEG for ADD! The question is, will it add to our methods for accurately diagnosing ADD, or will it simply add to the cost of the evaluation?
Here is my opinion. I think it actually has a place in the diagnosis of children with possible ADD. If a kid is having mild or unusual symptoms, or has other issues, such as depression, anxiety, etc, then the test can help to sort things out. I don’t feel that it should be used solely and alone as the only “test” for ADD, nor do I think it should be used to assess whether or not medication is working.
It should be used with other testing and clinical information about the child to complete the diagnosis. And it needs to be interpreted by those who know how to interpret EEGs, most notable neurologists and psychiatrists (not psychologists).
If someone tells you that they have a single test for ADD, or that they can interpret EEG brain wave patterns, and they are not well versed in EEG reading, politely and quickly move on! As with any new therapy or test, there are those out there who are willing to play to the anxieties and worries of parents, who naturally want the best for their child.
Always feel free to discuss this with me at any office visit
Sensory Integration Therapy
Revolutionary Therapy or a Waste of Time and Money?
Many of my patients, some of whom may be your sons and/or daughters, are undergoing a form of therapy called “Sensory Integration Therapy”. I have signed many prescriptions for this, talked to parents about it, and maybe have even recommended it, though with reservation.
The prestigious journal Pediatrics (2012;129: 1186-9) recently reviewed the best available data regarding this therapy, and its conclusions do not give a very good endorsement of this modality.
Briefly, the authors state that the amount of research that shows effectiveness is limited and inconclusive. I’m quite sure that the people who provide this therapy would beg to differ, but the cold hard facts are that this therapy is probably not helpful. It appears not to be harmful, but takes both time and money.
I can tell you that from my experience most of the children that I see who have this label simply don’t have a “disease”. They are normal kids who have sensitivities to sound, touch, tastes or smells, but who eventually outgrow these tendencies. A few of these children do have other behavioral issues, and when these issues are addressed, the “sensory” part gets better. But when you as a parent are faced with a therapist who says your child has a “disorder”, what are you to do? Someone has given you a diagnosis, with hopes for improvement. Unfortunately, this improvement will come in due time, with or without therapy. Again, I know I’m stepping on toes, but the facts bear out what I have witnessed over the past 25 plus years of my practice.
So what are you to do? My recommendation is that if you want to go ahead with SI Therapy, investigate the treatment prescribed, ask questions (including asking me if you wish), consider giving the therapy a trial period, and have definite goals in mind as to when the therapy ends or is given up. Most insurance companies will not cover this expense.
And lastly, I ask all my patients to ask me a simple question: Would you do this for your child. In the case of SI Therapy, the answer is a firm NO. I believe it is a waste of time.
Cholesterol Screening in Children
Routine screening blood testing for high cholesterol in children has been the topic of debate among pediatricians, cardiologists and epidemiologists for many years. Different recommendations have been made over this time, including screening everyone, screening only those with a positive family history, or screening no one!
Recently, the American Academy of Pediatrics released its newest recommendation, and that is to perform screening on ALL children at the ages of 11-12 and again at 17-21, regardless of family history. The reason for this universal recommendation is to hopefully prevent adult cardiovascular disease by identifying patients at a younger age and implementing a prevention process earlier in life. Several studies over the past few years have shown that atherosclerosis (hardening of the arteries) begins in childhood in certain populations. It is anticipated that earlier identification may result in earlier intervention, and therefore less adult death and disease.
Please feel free to discuss this at your child’s next visit. We can discuss whether or not to screen, and if the screen is positive, what to do about it.
HPV Vaccine in Males
This month (March 2012) the American Academy of Pediatrics (AAP) published its recommendations for the use of HPV vaccine in males. As you are probably aware, HPV is the most common STD in the US. The highest prevalence of HPV infection is found in sexually active adolescents and young adults. The vaccine has been licensed for use in girls and women ages 9 through 26 years since 2006.
So why immunize boys? There are two reasons. First is the prevention of spread to women who then may get cervical cancer from the virus. There are 15,000 cases of cancer each year in women from this virus (mostly cervical). Second is prevention of cancer in males. There are about 7,000 cases of cancer in males (genital and anal) from this virus. If you contract the virus before immunization, there is no protection from cancer, so immunization before sexual contact is paramount.
Additionally and not as well known, about 60% of all mouth/throat cancers are caused by HPV. It is assumed that vaccination will go a long way to preventing these as well, although studies on this specific topic are lacking.
In terms of safety, surveillance of side effects continues through several data sources, including the Vaccine Safety Datalink (composed of large HMO practices throughout the US). After more than 40 million doses over the first 5 years of vaccination, no serious events have been detected with the exception of a very rare allergic reaction (anaphylaxis). As always, feel free to discuss this and all other vaccines with me at your next visit.
Vaccines and Adverse Effects
On August 25th 2011, the prestigious Institute of Medicine (IOM) released a report entitled “Vaccines and Adverse Effects: Evidence and Causality.” You may see the report in its entirety at http://www.iom.edu/Reports/2011/Adverse-Effects-of-Vaccines-Evidence-and-Causality.aspx. This review looked at 8 specific vaccines and whether or not adverse effects occurred after the administration of the vaccine, and if so, did the vaccine actually cause the event. Indeed, and not unexpectedly, there were 14 different adverse, rare, events that were convincingly caused by vaccines, including acute anaphylaxis (an allergic reaction). All of these reactions have been well described in the past. For instance, the MMR vaccine was linked to fever related seizures (without long term consequences), and vaccine administration can cause fainting. Most importantly, the committee found that there was NO evidence for vaccines (specifically the MMR) causing Autism or Diabetes.
This committee is composed of experts in the fields of Pediatrics, Infectious Diseases, Biostatistics, Neurology, Autoimmune Disease, Microbiology, and others. It reviewed over 1,000 documents and articles surrounding this topic.
Therefore, once again, vaccines have been exonerated as a cause of Autism. This topic continues to smolder, in spite of overwhelming evidence to the contrary. Vaccines don’t cause Autism. The cause is likely genetic, and research continues.
Copyright 2012, Albert G. Karam