Parents Can Detect, Contribute to, or be Affected by Critical Events During a Child's Hospitalization

Parents Can Detect, Contribute to, or be Affected by Critical Events During a Child's Hospitalization

Problem

Today, parents are often permitted around-the-clock visiting hours to stay with their hospitalized children, even in neonatal and pediatric intensive care units (ICUs). Many parents take advantage of this option and remain with their children as much as possible. For an ill child, this can be comforting and provides an important emotional benefit. At the same time, parents may be carefully watching and interacting with healthcare professionals, and observing the specialized equipment at their child's bedside, including infusion pumps, IV lines, and drainage systems. A study published by Frey et al. in 2009 suggests that parents who stay with their hospitalized children are inevitably involved in safety issues.^[1] In particular, the study showed that parents can help detect critical (harmful or potentially harmful) events precipitated by healthcare professionals. However, the study also showed that parents can contribute to a critical event and are often adversely affected by a critical event.

The study was conducted over a 5½ year period in a neonatal-pediatric intensive care unit and a neonatal intermediate care unit in a university children's hospital. During the first 2 years of the study, visiting hours for parents were limited to afternoons and evenings; morning visitations were not allowed and overnight stays were strongly discouraged. Around-the-clock visiting hours were permitted during the last 3½ years of the study.

During the span of the study, a total of 2,494 critical events were recorded; 101 of these events directly involved parents. In 18 cases, a parent contributed to the critical event. In 11 cases, a parent detected a critical event. In the remaining 72 cases, a parent was one of the affected individuals. For each event, the actual and potential severity was determined to be minor (requiring no interventions), moderate (requiring routine therapy available outside a critical care unit), or major (requiring therapeutic interventions specific to critical care units, or resulted in death).

In the group of critical events that involved parents (n=101), medication events (38%) and line disconnections/reconnections (28%) were most prevalent. In the group of critical events that did not involve parents (n=2,393), events involving medications were again most prevalent (33%), but issues with line disconnections/reconnections (2.7%) were significantly lower. Most events precipitated by parents and subsequently detected by healthcare professionals caused actual harm determined to be of moderate severity, and some events had the potential to cause a high severity of harm. On the other hand, critical events detected by parents did not cause actual harm, although the events had the potential to cause harm of moderate severity. Further details about the study follow.

Parents Detecting Safety Problems

The most common safety problems detected by parents involved medication errors, tubes or drains that became disconnected, and respiratory distress. Examples include:

• A mother who realized that a physician had prescribed a five-fold overdose of carvedilol for her child (5 mg BID instead of 1 mg BID)
• A mother who noticed the wrong weight listed on her child's medical record used for prescribing medications
• Parents who called attention to their child's respiratory distress or failure.

It took parents between 0–70 hours (median 10 hours) to detect a critical event precipitated by a healthcare professional. This suggests that without the parents' interventions, some critical events might have continued without correction. The authors determined the potential harm from continuation of the detected critical events to be severe in 4 cases, moderate in 6 cases, and minor in 1 case. All of the events detected by parents occurred only after around-the-clock visiting hours were made available. This observation suggests that it is easier for parents to detect safety problems if they spend more hours at their child's bedside, observing and participating in their care.

Parents Contributing to Safety Problems

The most common safety problems precipitated by parents involved the disconnection of tubes and drains, medication errors, and physical trauma. Examples include:

• A mother accidentally disconnected a central venous line while breast feeding her baby
• A mother accidentally disconnected a pleural drain while holding her infant
• A father fell off a chair with his child on his lap.

All of the disconnected tubes and drains happened in young infants, from 4 days to 1½ years old. It took healthcare professionals between 0–29 hours (median 0.25 hours) to detect a critical event precipitated by a parent. The authors note that this finding suggests that healthcare professionals are providing appropriate supervision of parents and hospitalized children. Most of these events caused moderate harm (10 cases) before being detected. In all but one event, quick discovery of the problems averted severe harm.

Parents Affected by Safety Events

The most common types of problems affecting parents involved miscommunication and feeding mix-ups. One can expect parents to be emotionally affected by most critical events that involve their children, especially those leading to harm. However, with some critical events, parents were directly affected in ways that were not anticipated. One of the most common examples included mothers who were subjected to viral testing because their breast milk was accidentally fed to another child. Failures such as this increase parental stress during a child's hospitalization.

Safe Practice Recommendations

Consider the following recommendations to strengthen the partnership between the treatment team and a hospitalized child's parents, prevent parental contribution to critical events, promote parental detection of errors, and protect the hospitalized child from harm.

Educate Parents. Teach parents about the disease/condition, medical tests, and treatment plan for their hospitalized child. Specifically tell parents about all the medications their child is receiving, the prescribed doses (including the fact that it differs from the dose taken at home, if applicable), potential side effects, and when and how they are given. Write down important information for parents to reference as needed. Parents who know what to expect can help recognize when something is not right.

Update Parents. Provide parents with timely and comprehensive updates regarding their children in language they understand. Some children's hospitals encourage parents to be part of "family-centered" rounds, allowing them to gain a better understanding of their child's total treatment plan and current status since the entire medical team is available to answer questions and address concerns.

Anticipate Involvement. Be aware of increasingly independent parental involvement in the medical care of their children. A 2001 study by Hurst showed that parents continuously analyze hospital procedures and develop an action plan to protect their babies.^[2] A fundamental challenge for mothers in this study was to increase their position of authority relative to the medical team, thereby safeguarding their babies. Parents may intervene during the care of their children, which can lead to prevention and detection of a critical event, or contribution to a critical event despite good intentions. Close parental involvement in the child's treatment plan should be encouraged, supervised, and monitored.

Encourage Parents to Speak up. Encourage parents to report any concerns or worries they have regarding their child's care. Frey et al. suggests periodically asking parents these two questions: "Are there aspects of your child's care that you find concerning?" and "What do you worry about when you leave your child?" Encourage parents to keep asking questions or voicing concerns until they receive an answer with which they are comfortable and fully understand. Remind parents that they know their child better than anyone on the medical team; thus, communication of their observations is extremely important.

Respond to Parents' Queries Appropriately. Parents do not want to be labeled as being "difficult" or "demanding;" they fear no one will want to take care of their child if they are perceived this way.^[2] Some may even view basic questions or requests for information about their child's condition as a slight to the medical team's competence. So, when parents do speak up, healthcare professionals should perceive and reflect their actions in a manner that fosters true collaboration and empowerment, and should encourage and reinforce the parents' role in making queries by providing thoughtful and complete answers.

Provide Access to a Rapid Response Team. Allow parents to activate a rapid response team if they feel no one is addressing their expressed concerns regarding their child's condition and/or medical treatment. Instruct parents, upon their child's admission, regarding the purpose of the rapid response team and how to activate it.

Establish Safe Handling Guidelines. To reduce the risk of tubing disconnections, establish guidelines for safe handling of infants and children with lines and drains, teach these guidelines to parents, and monitor adherence to the guidelines.

Teach Parents Not to Reconnect Tubes. Orient parents to the tubes or drains attached to their child. Teach them about the dangers of reconnecting tubes and drains themselves and how to call for immediate help from a healthcare professional if their child's tubes or drains become dislodged or disconnected.

[ CLOSE WINDOW ]

References

1. Frey B, Ersch J, Bernet V, Baenziger O, et al. Involvement of parents in critical incidents in a neonatal-paediatric intensive care unit. QualSaf Health Care. 2009;18(6):446–449.

2. Hurst I. Vigilant watching over: mothers' actions to safeguard their premature babies in the newborn intensive care unit. J Perinat Neonatal Nurs. 2001;15(3):39–57.

ISMP Medication Safety Alert © 2011 Institute for Safe Medication Practices

Brain injury study under way at Camp Pendleton

MILITARY: Brain injury study under way at Camp Pendleton
MILITARY: Brain injury study under way at Camp Pendleton
http://www.nctimes.com/search/?l=50&sd=desc&s=start_time&f=html&byline=By%20MARK%20WALKERmlwalker%40nctimes.comNorth County Times Posted: Friday, September 30, 2011 8:00 pm



A hyperbaric chamber at Camp Pendleton is being used to treat troops with mild traumatic brain injuries in a trial program to see if it speeds their recovery. Courtesy photo
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Related: MILITARY: Brain-injured Marines to test new treatment
A half-dozen Marines with brain injuries from combat in Afghanistan or Iraq will crawl inside a hyperbaric chamber at Camp Pendleton next week to begin eight weeks of treatment breathing pure oxygen to see if it speeds their recovery.
Up to 100 base troops eventually are expected to take part in the study trying to find the best treatments for what is known as traumatic brain injury.
Many other troops suffering from post-traumatic stress disorder from their battlefield experiences also are expected to take part in the study to see if it helps them heal.
"I'm really hopeful that this potential treatment will help," said Navy Cmdr. James Caviness, head of occupational health services and the study's principal investigator at Naval Hospital Camp Pendleton.
"The anecdotal reports of hyperbaric chamber use in civilian settings are positive, and we need to rigorously look at this to see if we can use it," he added.
The troops taking part in the study are volunteers. Hundreds of others at the Marine Corps' Camp Lejeune in North Carolina and at Army bases at Fort Carson, Colo., and Fort Gordon, Ga., are taking part in similar studies.
Researchers will measure whether the use of the chamber can ease the headaches, memory loss and other ailments from mild traumatic brain injury, which are common after-effects for troops who are injured in roadside bomb attacks.
When the program was designed last year, U.S. Army Col. Richard Ricciardi at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury described it as one of many commissioned by the Pentagon to improve brain injury care.
"It's one part of the arsenal of treatments being tested across the system to tackle this challenging problem and do the right thing for our warriors," he said.
Traumatic brain injury has emerged as a common injury among troops in Iraq and Afghanistan, where anti-government forces rely on homemade bombs as a primary weapon.
More than 134,000 U.S. troops have been treated for such injuries since the Afghanistan and Iraq wars began, according to Pentagon statistics.
Close to 1,400 service members have suffered concussions or traumatic brain injury so far this year, according to the Defense Department.
The malady is divided into three classifications. Mild cases involve loss of consciousness for up to 30 minutes and mild amnesia.
The hyperbaric chamber at Camp Pendleton is inside a trailer adjacent to the hospital. Pressure inside it will be equivalent to what divers experience at about 20 feet under water.
The pressurization forces pure oxygen into the cells. The experiment tests whether the repeated trips to the chamber speed healing.
Some troops breathe pure oxygen administered under a tentlike hood so no gas escapes. Others will get a lesser amount of pure oxygen, and a third group will breathe normal air under near-similar pressure conditions to test the results.
Camp Pendleton's role is to help establish the precise treatment regimen and baseline testing troops will undergo to see if the treatment helps.
"There are a lot of unknowns about traumatic brain injury, which has emerged as the 'signature injury' of the wars in Iraq and Afghanistan," Caviness said. "We need to learn a lot more, and this study will hopefully demonstrate it is something we can use."
Troops suffering from moderate or severe brain injuries are not part of the study because there is no evidence hyperbaric chambers speed their recovery.
Among the measurements technicians will use are batteries of memory, mood and motor function tests administered to troops before the study, as it takes place and at the end of the eight weeks.
Read more: http://www.nctimes.com/news/local/military/article_b93bb889-8830-5f98-801b-0d5278c1871b.html#ixzz1ZebPDmYw

Low Vitamin B12 Tied to Memory, Cognition Problems

» Low Vitamin B12 Tied to Memory, Cognition Problems

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on September 27, 2011

A new study suggests low blood levels of vitamin B12 markers in older adults may be associated with lower brain volumes and problems with cognition.

Researchers at Rush University Medical Center say that foods from animals, including fish, meat, especially liver, milk, eggs and poultry are usual sources of vitamin B12.

Investigators took blood samples from 121 older residents of the South Side of Chicago who are a part of the Chicago Health and Aging Project (CHAP) — a large study of 10,000 biracial subjects over the age of 65.

The results of the study are published in Neurology, the medical journal of the American Academy of Neurology.

The participants had blood drawn to measure levels of vitamin B12 and B12-related markers that can indicate a B12 deficiency. The same subjects took tests measuring their memory and other cognitive skills.

After about 4 1/2 years, MRI scans of the participants’ brains were taken to measure total brain volume and look for other signs of brain damage.

Researchers determined vitamin B12 deficiency was associated with having lower scores on the cognitive tests and smaller total brain volume.

“Our findings definitely deserve further examination,” said Christine C. Tangney, Ph.D., associate professor in the department of clinical nutrition at Rush University Medical Center, and lead author of the study.

“It’s too early to say whether increasing vitamin B12 levels in older people through diet or supplements could prevent these problems, but it is an interesting question to explore. Findings from a British trial with B vitamin supplementation are also supportive of these outcomes.”

Tangney noted that the level of vitamin B12 itself in the blood was not associated with cognitive problems or loss in brain volume. She said that low vitamin B12 can be difficult to detect in older people when looking only at blood levels of the vitamin.

“Our findings lend support for the contention that poor vitamin B12 status is a potential risk factor for brain atrophy and may contribute to cognitive impairment,” said Tangney.

Source: Rush University Medical Center

APA Reference
Nauert PhD, R. (2011). Low Vitamin B12 Tied to Memory, Cognition Problems. Psych Central. Retrieved on September 29, 2011, from http://psychcentral.com/news/2011/09/27/low-vitamin-b12-tied-to-memory-cognition-problems/29812.html

Hyperbaric Oxygen May Help in Treating Aggressive Brain Cancer

Hyperbaric Oxygen May Help in Treating Aggressive Brain Cancer

Unique Clinical Trial at Neurological Surgery, P.C. Looks at Augmenting Standard Treatment for Malignant Glioblastoma

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Rockville Centre, NY (PRWEB) September 23, 2011

In a unique study, researchers at The Long Island Brain Tumor Center at Neurological Surgery, P.C. are examining whether hyperbaric oxygen therapy – breathing pure oxygen while in a pressurized chamber – may prove a useful addition to the current standard of care for patients newly diagnosed with glioblastoma, an aggressive brain cancer. The Phase II study is currently enrolling participants, and is being conducted at Neurological Surgery, P.C. offices in Nassau and Suffolk Counties, New York, as well as at Winthrop University Hospital, Mineola, NY.

“Malignant glioblastoma is the most aggressive type of brain cancer, and it generally has a poor prognosis,” says neuro-oncologist J. Paul Duic, MD, principal investigator on the study and co-director of The Long Island Brain Tumor Center. “Novel treatment strategies are clearly needed.”

According to the National Cancer Institute, malignant brain tumors are the second leading cause of cancer deaths in people under 35, and the fourth leading cause of cancer death in people under 54. Glioblastoma is the most common and most aggressive primary (non-metastatic) type of brain cancer. Median survival for glioblastomas is 12-14 months, and only 26 percent of patients survive two years.

Patients enrolled in the study must be newly diagnosed with malignant glioblastoma, and have previously received brain tumor surgery, but not radiation or chemotherapy. All patients in the study will receive the current standard of care for those newly diagnosed with glioblastoma – temozolomide (Temodar®) plus radiation therapy – as well as hyperbaric oxygen therapy.

“We know that these brain tumors prefer a low-oxygen metabolic state, and there is evidence that this metabolic state may contribute to the tumors’ ability to resist the effects of radiation therapy and chemotherapy,” says Jai Grewal, MD, sub-investigator on the study and co-director of The Long Island Brain Tumor Center. “We want to see whether increasing the oxygen concentration of the tumor increases the effectiveness of standard therapy.”

Drs. Duic and Grewal are also interested in evaluating the effect of this treatment on patients’ quality of life and stress levels. Participants will be asked to complete several brief questionnaires.

Hyperbaric oxygen has shown some benefit in pre-clinical studies, and in two recent Japanese clinical trials. In the first clinical trial, published in 2006, Ogawa and colleagues found that patients who received radiation therapy immediately after hyperbaric oxygenation, combined with chemotherapy, had longer survival rates, relatively few adverse events and no late toxicities. In 2007, Kohshi and colleagues reported additional survival benefits with minimal additional toxicity for previously treated high-grade glioma patients who were given hyperbaric oxygen combined with stereotactic radiosurgery.

In the current study, which is the only one of its type underway in the U.S., patients will first receive blood and medical imaging tests. They will then be given six weeks of hyperbaric treatments combined with radiation (Monday-Friday) and chemotherapy with temozolomide, which they will take at home daily. They will then have four weeks off treatment, then resume taking temozolomide on a monthly basis.

Study participants will receive the experimental hyperbaric therapy prior to each radiation treatment during the initial six weeks of treatment. During the hyperbaric treatment, the patient will lie on a stretcher in a hyperbaric chamber and breathe oxygen at greater than normal atmospheric pressure. Blood sugar measurements will be taken, and medical imaging tests will also be done.

Patient participation in the study lasts one year, unless the patient cannot tolerate further treatment or side effects, or shows evidence of tumor progression. Patients may also voluntarily withdraw from the study.

Study results will be compared with those from the recently published multi-center trial by Stupp and colleagues, which demonstrated that temozolomide, when added to radiation therapy, can prolong the lives of those newly diagnosed with glioblastoma. This study defined the current standard of care.

The Long Island Brain Tumor Center at Neurological Surgery, P.C. provides the most comprehensive care available on Long Island, with state-of-the-art facilities located across Nassau and Suffolk Counties. The Center offers a multi-disciplinary approach to treating brain tumors, provided by a team of more than 20 physicians and surgeons with various sub-specialties. The team works in concert with patients’ medical oncologists and other health care professionals, and treats primary brain and spinal tumors, as well as metastases and CNS lymphoma. The Center is currently conducting two clinical trials.

For more information on this or other brain tumor studies, please call Kerry McConie, RN, (516) 478-0010, or Julia Trojanowski, RN, (631) 864-3900.

About Neurological Surgery, P.C.
Neurological Surgery, P.C. is one of the New York City area’s premier neurosurgical groups, offering patients the most advanced treatments of brain and spine disorders. These include minimally invasive procedures such as stereotactic radiosurgery (Gamma Knife® and CyberKnife®), aneurysm coiling, neuro-endoscopy, spinal stimulators, carotid stents, interventional pain management, microdiscectomy, kyphoplasty, and X-STOP®. The practice’s physicians represent a range of surgical and nonsurgical specialties, combining compassionate care with highly specialized training. They are leaders in the region’s medical community, with appointments as chiefs of neurosurgery in some of Long Island’s best hospitals. NSPC offers eight convenient locations in Queens, Nassau and Suffolk Counties. For more information, call 1-800-775-7784 or visit http://www.NSPC.com.

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For the last 13years+ Rapid Recovery Hyperbarics has been treating many conditions with amazing results! Lyme Disease, Autism, Stroke, RSD, CP, Near drowning, Closed head injuries and much more!
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Exercise may help prevent brain damage caused by Alzheimer's disease

What does exercise do? Increase circulation, combined with HBOT imagine the results! www.hbot4u.com

New York, NY, August 15, 2011 – Regular exercise could help prevent brain damage associated with neurodegenerative diseases like Alzheimer's, according to research published this month in Elsevier's journal Brain, Behavior, and Immunity.

"Exercise allows the brain to rapidly produce chemicals that prevent damaging inflammation", said Professor Jean Harry, who led the study at the National Institute of Environmental Health Sciences in the United States. "This could help us develop a therapeutic approach for early intervention in preventing damage to the brain."

Previous research has already demonstrated that exercise after brain injury can help the repair mechanisms. This new study shows that exercise before the onset of damage modifies the brain environment in such a way that the neurons are protected from severe insults. The study used an experimental model of brain damage, in which mice are exposed to a chemical that destroys the hippocampus, an area of the brain which controls learning and memory. Mice that were exercised regularly prior to exposure produced an immune messenger called interleukin-6 in the brain, which dampens the harmful inflammatory response to this damage, and prevents the loss of function that is usually observed.

Pharmacological therapies to downregulate inflammation and address cognitive decline in older adults, and those with Alzheimer's disease, have been less successful. This research helps understand how exercise could be used to affect the path of many human conditions, such as neurodevelopmental disorders and neurodegenerative diseases. In addition, as a chemical model of neuronal damage was used, it also raises the possibility that exercise could offer protection against the potentially harmful effects of environmental toxins.

"This elegant series of experiments reveals an alternative pathway by which voluntary physical exercise may protect hippocampal neurons", said Dr. Ruth Barrientos from the Department of Psychology and Neuroscience at the University of Colorado. "The study on the role of exercise as a therapeutic intervention will undoubtedly get a workout in the years to come. Perhaps the greatest challenge with this line of research will not be more discoveries of compelling evidence of the anti-neuroinflammatory effects of exercise, but instead, getting humans to exercise voluntarily and regularly."

###

The research was funded by the Division of Intramural Research, National Institute of Environmental Health Sciences, and the National Institutes of Health.

Notes to editors

The article is "Voluntary exercise protects hippocampal neurons from trimethyltin injury: Possible role of interleukin-6 to modulate tumor necrosis factor receptor-mediated neurotoxicity" by Jason A. Funk, Julia Gohlke, Andrew D. Kraft, Christopher A. McPherson and Jennifer B. Collins. The article appears in Brain, Behavior, and Immunity, Volume 25, Number 6 (August 2011), published by Elsevier.

About Brain, Behavior, and Immunity

Brain, Behavior, and Immunity, founded in 1987, is the official journal of the Psychoneuroimmunology Research Society (PNIRS). This innovative journal publishes peer-reviewed basic, experimental, and clinical studies dealing with behavioral, neural, endocrine, and immune system interactions in humans and animals. It is an international, interdisciplinary journal devoted to investigation of the physiological systems that integrate behavioral and immunological responses. The journal welcomes original research in neuroscience, immunology, integrative physiology, behavioral biology, psychiatry, psychology, and clinical medicine and is inclusive of research at the molecular, cellular, social, and organismic levels. The journal features online submission and review, leading to timely publication of experimental results. There are no submission fees or page charges for Brain, Behavior, and Immunity, which is published eight times a year.

About Elsevier

Elsevier is a world-leading provider of scientific, technical and medical information products and services. The company works in partnership with the global science and health communities to publish more than 2,000 journals, including The Lancet and Cell, and close to 20,000 book titles, including major reference works from Mosby and Saunders. Elsevier's online solutions include SciVerse ScienceDirect, SciVerse Scopus, Reaxys, MD Consult and Nursing Consult, which enhance the productivity of science and health professionals, and the SciVal suite and MEDai's Pinpoint Review, which help research and health care institutions deliver better outcomes more cost-effectively.

A global business headquartered in Amsterdam, Elsevier employs 7,000 people worldwide. The company is part of Reed Elsevier Group PLC, a world-leading publisher and information provider, which is jointly owned by Reed Elsevier PLC and Reed Elsevier NV. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).

History of Asperger's Disorder

History of Asperger’s Disorder

By Ami Klin, Ph.D and Fred R. Volkmar, M.D.

Rapid Recovery Hyperbarics
www.hbot4u.com

Asperger Syndrome (AS, also known as Asperger’s Disorder) is a severe developmental disorder characterized by major difficulties in social interaction, and restricted and unusual patterns of interest and behavior.

Autism is the most widely recognized pervasive developmental disorder (PDD). Other diagnostic concepts with features somewhat similar to autism have been less intensively studied, and their validity, apart from autism, is more controversial.

One of these conditions, termed Asperger syndrome (AS) was originally described by Hans Asperger, who provided an account of a number of cases whose clinical features resembled Kanner’s (1943) description of autism (e.g., problems with social interaction and communication, and circumscribed and idiosyncratic patterns of interest). However, Asperger’s description differed from Kanner’s in that speech was less commonly delayed, motor deficits were more common, the onset appeared to be somewhat later, and all the initial cases occurred only in boys. Asperger also suggested that similar problems could be observed in family members, particularly fathers.

This syndrome was essentially unknown in the English literature for many years. An influential review and series of case reports by Lorna Wing (1981) increased interest in the condition, and since then both the usage of the term in clinical practice and number of case reports and research studies have been steadily increasing. The commonly described clinical features of the syndrome include:

1. paucity of empathy;
2. naive, inappropriate, one-sided social interaction, little ability to form friendships and consequent social isolation;
3. pedantic and monotonic speech;
4. poor nonverbal communication;
5. intense absorption in circumscribed topics such as the weather, facts about TV stations, railway tables or maps, which are learned in rote fashion and reflect poor understanding, conveying the impression of eccentricity; and
6. clumsy and ill-coordinated movements and odd posture.

Although Asperger originally reported the condition only in boys, reports of girls with the syndrome have now appeared. Nevertheless, boys are significantly more likely to be affected. Although most children with the condition function in the normal range of intelligence, some have been reported to be mildly retarded. The apparent onset of the condition, or at least its recognition, is probably somewhat later than autism; this may reflect the more preserved language and cognitive abilities. It tends to be highly stable, and the higher intellectual skills observed suggest a better long-term outcome than is typically observed in autism.

Higher Functioning Autism or Asperger’s?

There are many similarities with autism without mental retardation (or “Higher Functioning Autism”), and the issue of whether Asperger syndrome and Higher Functioning Autism are different conditions is not resolved.

To some extent, the answer to this question depends on the way clinicians and researcher make use of this diagnostic concept, since until recently there was no “official” definition of Asperger syndrome. The lack of a consensual definition led to a great deal of confusion as researchers could not interpret other researchers’ findings, clinicians felt free to use the label based on their own interpretations or misinterpretations of what Asperger syndrome “really” meant, and parents were often faced with a diagnosis that nobody appeared to understand very well, and worse still, nobody appeared to know what to do about it.

School districts are often not aware of the condition, insurance carriers could not reimburse services provided on the basis of this “unofficial” diagnosis, and there was no published information providing parents and clinicians alike with guidelines on the meaning and implications of Asperger syndrome, including what should the diagnostic evaluation consist of and what forms of treatment and interventions were warranted.

Asperger’s Ascent to an Official Diagnosis

This situation has changed somewhat since Asperger syndrome was made “official” in DSM-IV (APA, 1994), following a large international field trial involving over a thousand children and adolescents with autism and related disorders (Volkmar et al., 1994). The field trials revealed some evidence justifying the inclusion of Asperger syndrome as a diagnostic category different from autism, under the overarching class of Pervasive Developmental Disorders. More importantly, it established a consensual definition for the disorder which should serve as the frame of reference for all those using the diagnosis. However, the problems are far from over. Despite some new research leads, knowledge on Asperger syndrome is still very limited. For example, we don’t really know how common it is, or the male/female ratio, or to what extent there may be genetic links increasing the likelihood of finding similar conditions in family members.

Clearly, the work on Asperger syndrome, in regard to scientific research as well as in regard to service provision, is only beginning. Parents are urged to use a great deal of caution and to adopt a critical approach toward information given to them. Ultimately, the diagnostic label – any label, does not summarize a person, and there is a need to consider the individual’s strengths and weaknesses, and to provide individualized intervention that will meet those (adequately assessed and monitored) needs. That notwithstanding, we are left with the question of what is the nature of this puzzling social learning disability, how many people does it affect, and what can we do to help those affected by it. The following guidelines summarize some of the information currently available on those questions.

This article by Ami Klin, Ph.D., and Fred R. Volkmar, M.D., Yale Child Study Center, New Haven, Connecticut and was originally published by the Learning Disabilities Association of America, June 1995. To learn more about Asperger’s Syndrome and Autism, please visit the Yale Developmental Disabilities Clinic website.

The benefits of Hyperbaric Oxygen Therapy for ASD, PDD, ADD, and other Autistic type disorders

The benefits of Hyperbaric Oxygen Therapy for

ASD, PDD, ADD, and other Autistic type disorders

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1. Angioneogenesis from the addition of oxygen: (regrowth of new blood vessels)

2. Angioneogenesis from the removal of oxygen: (regrowth of new blood vessels after the treatments are completed, 40 hours of HBOT standard of care)

3. Increases in blood flow independent of new blood vessel formation.

4. Decreasing levels of inflammatory biochemicals:

5. Up-regulation of key antioxidant enzymes and decreasing oxidative stress:

6. Increased oxygenation to functioning mitochondria:

7. Increased production of new mitochondria from HBOT.

8. Bypassing functionally impaired hemoglobin molecules, the result of abnormal

porphyrin production, thereby allowing increased delivery of oxygen directly to cells:

9. Improvement in immune and autoimmune system disorders:

10. Decreases in the bacterial/yeast load found systemically and in the gut:

11. Decreases in the viral load found systemically and possibly decreases in a viral presence that may exist in the intestinal mucosa:

12. Increases in the production of stem cells in the bone marrow with transfer to

the CNS: Studies have shown that HBOT increases the production of stem cells in the bone marrow and that transfer of stem cells to the central nervous system is possible.

13. Direct production of stem cells by certain areas in the brain.

14. Increased production and utilization of serotonin:

15. The possibility that oxidation may help rid the body of petrochemicals.

16. The possibility that oxidation may help rid the body of mercury and heavy metals.

17. Increases patients own Stem Cells to heal the brain.

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