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OVERVIEWWhen should I refer a child to a
pediatric neurologist?
1 Unusual movements or “spells”
2 When thinking about meds for problem behaviors
3 Complex cases
When to refer…
1 Unusual movements or “spells”
o Seizureso TicsoOther movement disorder
…how are these different from stereotypies?
Medications for problem behaviors
1 Combinations of meds at low doses sometimes work better than single meds at high doses
2 Challenges with long-term use (side effects, lose efficacy over time, higher and higher doses needed, tapering off)
3 Potential alternatives to meds (supplements, acupuncture, neurofeedback, etc.)
*supplements may be needed during psychopharm therapy to counteract med toxicities (e.g. carnitine)
4 Trying relationship-based behavior programs in addition to ABA-based
Complex Cases• Multiple neurological symptoms
o Intellectual disabilityo Epilepsyo Low tone, incoordination, weaknesso Headacheso Vision and hearing problemso Movement disorder, tics, etc.
• Multi-system dysfunction• Minimal improvement with behavioral and
educational intervention
The more severe and complex the phenotype, the more likely a
causative mutation can be found.
Complex Cases
Researchers identified a form of autism (with epilepsy and intellectual disability) that is likely treatable with dietary amino acid supplementation.
80% of children with autism had blood tests showing mitochondrial dysfunction
mitochondria
