Rare disease leads to Minnesota man’s drastic personality change

Sharon and David DeLeo pose for a picture

Sharon and David DeLeo pose for a picture in September 2011 after Lewy Body disease, a form of dementia often associated with Parkinson’s disease, had taken its toll on him. (Photo courtesy of Sharon DeLeo)

DULUTH, Minn. - Wet and cold, huddled under a blanket in a small Coast Guard rescue boat, the hull of their foundering 53-foot powerboat Hermit Crab barely showing in the Gulf of Mexico, Sharon DeLeo turned to her husband, David.

“I looked up at him and said: ‘Dave, I’ve gone through a lot of things with you, but this takes the cake,’ ” Sharon recalled. “And he laughed.”

It was March 8, 2005, and the Duluth Township couple were in the midst of the most harrowing adventure of an idyllic, fun-loving marriage. They couldn’t have known that just a few months later, they’d begin a much more terrifying struggle.

Lewy Body disease, a form of dementia frequently associated with Parkinson’s disease, would inalterably damage David DeLeo’s mind and drastically change his personality.

“David was the best, the nicest guy,” Sharon DeLeo said during an interview this month in the rustic house they bought in 1987, across North Shore Drive from Lake Superior. He was easygoing, never worried, never bothered by anything.

Lewy Body “turned him into a hallucinogenic, paranoid person,” she said, so violent that one of the caregivers she hired quit in fear.

David’s son Jim DeLeo, a St. Paul-based management consultant, also saw a stark change.

“People wanted to follow him,” Jim said. “He always knew what he wanted to do. Very confident. Very decisive. … After the Lewy Body, when he started having hallucinations, you could see his confidence level wane. There wasn’t that same decisiveness.”

Sharon’s daughter, Jackie Moen of Isanti, Minn., said the change in David was “almost beyond words. To go from the gentle soul who was fun-loving, confident and decisive, to being combative and violent. It was almost like walking in a nightmare.”

It was a bewildering adjustment for his family to make.

“You’re stunned. You’re so stunned by this change in behavior,” said Sharon DeLeo, 72. “David was a totally different person. It was like living with a stranger.”

On Dec. 3, the disease ended his life. He was 75.

‘We had a good life’

David and Sharon DeLeo would have celebrated their 29th wedding anniversary on Saturday. The experiences of the past few years haven’t dimmed Sharon’s memories of most of their time together.

“We had a good life, really,” she said. “We had the kind of marriage where we did whatever we felt like doing. … Our marriage was magical. We were magical together. We didn’t fight. There was nothing to fight about.”

Jim DeLeo, who was a young adult when Dave and Sharon married, remembers their companionship.

“They were absolutely devoted to one another, and everything they did they did together,” he said.

Both David and Sharon grew up on the Iron Range. Their marriage was the second for both, and each had two children, a boy and a girl apiece. He spent 40 years as an executive in the mining industry, including top positions with Reserve Mining and as president of EVTAC. They started a business, Carousel Antiques, in Two Harbors in 1986, and four years later added Shari’s Kitchen, a restaurant. They had a home in Florida as well as in the Northland.

They traveled widely, often on a sailboat. David was an avid, competitive sailor; Sharon, though prone to seasickness, often went with him. “Everybody kept asking me for years, ‘Why do you keep sailing?’ ” she recalled. “Well, I wanted to be with David.”

Jim DeLeo still marvels at that.

“Can you imagine?” he asked. “Getting seasick virtually every time you go out, having to put the patch on or take pills, or whatever. But just muscling your way through it because you wanted to be with him. That’s amazing to me.”

Although David was diagnosed with Parkinson’s in 1990, it didn’t keep the couple from enjoying life. They adjusted their diet and made sure he got plenty of exercise to minimize the effects, Sharon said.

When Parkinson’s forced him to give up sailing in 1995, they switched to a powerboat. The accident occurred about 9 p.m. March 7, 2005, in heavy seas about 35 miles from the Florida Gulf Coast, with only the DeLeos and a cousin of Sharon’s aboard. A waterspout hit, damaging the boat and knocking out its power steering. David steered the boat manually while radioing the Coast Guard. Sharon was lying on a couch, suffering from seasickness. Sharon’s cousin was suffering from a diabetic episode.

After the Coast Guard arrived about 2:30 a.m. the boat took on water, and the three-person crew and two Coast Guardsmen were in the water, swimming against waves toward the Coast Guard boat.

All five people made it to safety, but the DeLeos’ Maltese dog was lost at sea. Sharon DeLeo has two Maltese dogs today, named Sugar and Spice.

‘He wanted a better life’

David still was coping well with the effects of Parkinson’s in 2005, Sharon said, but he wasn’t satisfied.

“His gait was getting more noticeable,” she said. “It did bother him. He was a big, strapping football player, a swimmer in high school and college. … He couldn’t walk like he wanted to walk.”

David sought deep brain stimulation, a surgical procedure in which a device is implanted in the patient’s brain to cut off the abnormal nerve signals that cause Parkinson’s symptoms. The patient must be awake throughout the procedure.

He was turned down by the Mayo Clinic in Rochester, told that a blood-thinning medication he used would make the surgery unsafe. He turned to the Mayo Clinic hospital in Jacksonville, Fla., about a five-hour drive from the couple’s Florida home, and was told that the medication could be suspended for a few days.

“He wanted a better life,” Sharon said. “Poor darling. His life was over with that surgery.”

The procedure was scheduled for Aug. 31, 2005. Two days earlier, David was given a neuropsychological evaluation, but they weren’t told about the results, Sharon said. Instead, the surgeon told them David was a good candidate for the surgery. She didn’t learn until five years later, when she requested medical records from the clinic, that the evaluation found David had symptoms of Lewy Body disease. “I wouldn’t have known what Lewy Body was,” she said. “Someone would have had to explain it to me.”

But David already had shown signs of the illness. Sharon’s son, David Jensen, who is in the construction industry in Florida, said he became aware of his stepfather having hallucinations as early as 2003 or 2004.

Because of the clinical signs of Lewy Body, Sharon believes the procedure never should have been allowed. “One of the criteria is you cannot have deep brain stimulation surgery if you’re showing any signs at all of dementia,” she said.

Dr. Wolcott Holt, a neurologist at Essentia Health in Duluth, said signs of dementia normally preclude the procedure.

“Most places do not do deep brain stimulation when there’s cognitive impairment, because it makes it worse,” Holt said.

The Mayo Clinic hospital in Jacksonville didn’t respond directly to News Tribune questions about Sharon DeLeo’s complaint but said its care was appropriate.

“We extend sincere and deep sympathy to the family for their loss,” spokesman Kevin Punsky said. “Mayo Clinic aspires to provide the best care to every patient every day. We believe the care provided in this case by Mayo Clinic physicians and allied health staff was appropriate. Our respect for patient privacy prevents us from offering any additional information.”

David experienced temporary improvement in his gait, Sharon said. But his loss of short-term memory was immediate and devastating. “He could no longer use the remote control on the television set. He couldn’t use a cell phone, and he certainly couldn’t use a computer,” she said. “And because he was so smart, he could not acquiesce to all this. He just didn’t want to believe it wasn’t somebody else’s fault.”

One night around midnight, she heard him calling DirecTV, claiming there was something wrong with satellite service. Another time, when a light bulb needed to be replaced, he tore out the entire light fixture. “And then, of course, David got so defensive. He knew something was wrong, but he would not admit to it. Oh, life was a nightmare.”

‘She was afraid of David’

David and Sharon moved back to the Northland from Florida for the last time in May 2010, accompanied by Jackie Moen and David Jensen. Moen said her stepfather deteriorated dramatically during the three-day journey, apparently because of highway traffic.

“Movement is very hard on a person with Lewy Body,” she said. “To see that much movement coming at you is terrifying. David was literally shrinking in his seat.”

But the family still didn’t know the cause until later that month, when David was officially diagnosed with Lewy Body at the Struthers Parkinson’s Center in Golden Valley, Minn. By then, hallucinations were occurring frequently.

Jim DeLeo said he witnessed some of those episodes.

“He would say something to me like, ‘What are all those people doing in your car?’ ” Jim recalled. “And I would say, ‘Dad, that’s the Parkinson’s. There’s nobody there.’ And he would kind of grin and accept it. If it came from me, he would accept it.”

But he wouldn’t accept, or trust, the nursing aides Sharon hired to help with his care.

“He was so violent with them,” she said. “He was paranoid. He thought they were stealing from us. He’d grab them and shake them and tell me to reach into their pockets. … He said, ‘You’re stupid! They’re robbing us blind!’ ”

David was still an athletic, powerful man, and he intimidated some of the aides.

After one incident, a caregiver quit, Sharon said. “She was afraid of David when he’d grab her arm and not let go. He was very strong. You couldn’t break his grip.”

And when Sharon tried to correct David in the midst of his hallucinations, she became the enemy.

“There were two Sharons in his life,” she said. “The bad Sharon that my family was afraid he was going to harm. And the other Sharon that he still loved.”

David was never violent toward her, Sharon said. But one night in July 2010 she called 911 after he started talking about double suicide. “That creeps you out at 3 in the morning,” she said. “I thought: Well, what if he covers my face with a pillow?”

It came to a head the next month, when David threw a heavy object at a male caregiver. The other man caught the object, preventing it from flying through a bedroom window, but badly cut his hand in the process. Sharon decided she couldn’t care for her husband at home any longer.

‘It’s beautiful’

But the eight months David spent in assisted-living facilities and hospitals were equally nightmarish, Sharon said. She believes most of the facilities relied far too heavily on medications to regulate his behavior, a process she describes as “snowing” the patient. There still were episodes of violence. He fell while fighting with a caregiver, breaking his hip. David would never walk again.

In January 2011, he nearly died because of a twisted colon.

Sharon wanted to bring David home, but their house wouldn’t readily accommodate a wheelchair. Jensen converted a three-car garage into an assisted-living annex. It wasn’t quite ready when she brought him home on April 1, 2011, but soon the couple moved in and shared the last months of his life together there. A small dining table in the apartment is next to a window that looks out over Lake Superior, where David had spent so much time sailing.

“It’s beautiful,” he said, when he first saw it.

David’s intelligence never diminished, Sharon said, but it became difficult for him to verbalize what he wanted to say. An answer would come 10 minutes after the question, or it would be addressed the next day.

But David remembered family and friends to the end.

“The one thing that never escaped him, even to the day he died, was that ability to remember people and their names and faces,” Jim DeLeo said.

It was the right ending, Sharon said.

“He was home. I was with him. He knew he was home. His family was with him all the time.”

The grieving process is terrible, she said. She’s planning to put the house up for sale this summer. At night, she looks at pictures of David that she keeps on a coffee table. The memories remain.

“David was fun to be married to. He was so easygoing, and life was an adventure with David,” Sharon said. “He was the love of my life.”

Tags: news, health, duluth, updates

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Rare disease leads to Minnesota man's drastic personality change

Tai chi may help ease Parkinson's symptoms

Article posted: 2/27/2012 6:00 AM

The ancient Chinese exercise tai chi, shown here at the Oregon Research Institute in Eugene, Ore., improved balance and lowered the risk of falls in a study of people with Parkinson?s disease.

 

Courtesy of the Oregon Research Institute

NEW YORK — The ancient Chinese exercise of tai chi improved balance and lowered the risk of falls in a study of people with Parkinson?s disease.

Symptoms of the brain disorder include tremors and stiff, jerky movements that can affect walking and other activities. Medications and surgery can help, and doctors often recommend exercise or physical therapy.

Tai chi, with its slow, graceful movements, has been shown to improve strength and aid stability in older people, and has been studied for a number of ailments. In the latest study, led by Fuzhong Li of the Oregon Research Institute in Eugene, tai chi was tested in 195 people with mild-to-moderate Parkinson?s.

The participants attended twice-weekly group classes of either tai chi or two other kinds of exercise — stretching and resistance training, which included steps and lunges with ankle weights and a weighted vest.

The tai chi routine was tailored for the Parkinson?s patients, with a focus on ?swing and sway? motions and weight-shifting, said Li, who practices tai chi and teaches instructors.

After six months of classes, the tai chi group did significantly better than the stretching group in tests of balance, control, walking and other measures. Compared with resistance training, the tai chi group did better in balance, control and stride, and about the same in other tests.

Tai chi training was better than stretching in reducing falls, and as effective as resistance training, the researchers reported. The improvements in the tai chi group continued during three months of follow-up.

Li said the study showed tai chi was safe. It?s easy to learn, and there?s no special equipment, he added.

?People are looking for alternative programs, and this could be one of them,? he said.

Estimates vary, but at least 500,000 people in the United States have Parkinson?s.

The findings appeared in the New England Journal of Medicine. The study was paid for by the National Institute of Neurological Disorders and Stroke.

Dr. Chenchen Wang, who is studying tai chi for arthritis and fibromyalgia, said the results of the Parkinson?s research were ?dramatic and impressive.? She heads the Center for Complementary and Integrative Medicine at Tufts Medical Center in Boston.

One of the study?s strengths: Researchers could measure the results directly instead of relying on the patients? own reports, she said. But a placebo effect can?t be totally discounted, she said, since the participants knew which exercise program they were assigned and that could have influenced results.

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Tai chi may help ease Parkinson's symptoms

Tai chi may help ease Parkinson’s symptoms

Article posted: 2/27/2012 6:00 AM

The ancient Chinese exercise tai chi, shown here at the Oregon Research Institute in Eugene, Ore., improved balance and lowered the risk of falls in a study of people with Parkinson?s disease.

 

Courtesy of the Oregon Research Institute

NEW YORK — The ancient Chinese exercise of tai chi improved balance and lowered the risk of falls in a study of people with Parkinson?s disease.

Symptoms of the brain disorder include tremors and stiff, jerky movements that can affect walking and other activities. Medications and surgery can help, and doctors often recommend exercise or physical therapy.

Tai chi, with its slow, graceful movements, has been shown to improve strength and aid stability in older people, and has been studied for a number of ailments. In the latest study, led by Fuzhong Li of the Oregon Research Institute in Eugene, tai chi was tested in 195 people with mild-to-moderate Parkinson?s.

The participants attended twice-weekly group classes of either tai chi or two other kinds of exercise — stretching and resistance training, which included steps and lunges with ankle weights and a weighted vest.

The tai chi routine was tailored for the Parkinson?s patients, with a focus on ?swing and sway? motions and weight-shifting, said Li, who practices tai chi and teaches instructors.

After six months of classes, the tai chi group did significantly better than the stretching group in tests of balance, control, walking and other measures. Compared with resistance training, the tai chi group did better in balance, control and stride, and about the same in other tests.

Tai chi training was better than stretching in reducing falls, and as effective as resistance training, the researchers reported. The improvements in the tai chi group continued during three months of follow-up.

Li said the study showed tai chi was safe. It?s easy to learn, and there?s no special equipment, he added.

?People are looking for alternative programs, and this could be one of them,? he said.

Estimates vary, but at least 500,000 people in the United States have Parkinson?s.

The findings appeared in the New England Journal of Medicine. The study was paid for by the National Institute of Neurological Disorders and Stroke.

Dr. Chenchen Wang, who is studying tai chi for arthritis and fibromyalgia, said the results of the Parkinson?s research were ?dramatic and impressive.? She heads the Center for Complementary and Integrative Medicine at Tufts Medical Center in Boston.

One of the study?s strengths: Researchers could measure the results directly instead of relying on the patients? own reports, she said. But a placebo effect can?t be totally discounted, she said, since the participants knew which exercise program they were assigned and that could have influenced results.

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Tai chi may help ease Parkinson's symptoms

Multiple sclerosis walk attracts 700

John Slattery wasn't at the Walk MS fundraiser this year, but a loyal group of students stepped up to honor the Suncoast High School teacher by walking for his charity.

The computer science teacher died about two weeks ago from a heart attack, so Christina Yannette tied a green ribbon around her head for the proudly Irish man and showed up at CityPlace early Sunday for the 3.1 mile fundraiser with about 20 members of the school computer club.

"He'd want us to be here," the Suncoast senior said.

"Today it was a priority," fellow senior Taylor Wilber said.

About 700 people gathered in the shopping center's courtyard, all supporting the National MS Society's South Florida Chapter, which is holding walks throughout the 10 counties it serves to raise money and awareness of multiple sclerosis. Another walk is scheduled in Boca Raton March 11. The MS Walk the Palm Beaches had reached nearly 60 percent of its $85,000 goal.

Herbert Hartman, whose team Cindy's Heroes is named for his wife who has had the disease for 10 years, said the $7,555 his team raised before the walk will receive matching funds from his company, Morgan Stanley, as well as other last-minute donations. "That number will continue to rise," he said.

Cindy's Team was by far the top fundraiser, and many team members have walked for years. In fact, Hartman is on the volunteer committee to organize the race, drafted "because I kept showing up."

So do Hartman's co-worker Harvey Siegel and daughter Amy Siegel, who gets her tradeoff when dad does the Komen race with her.

In the team's light blue shirt, Sean Quinn explained that the friends and co-workers want to support Cindy and raise money for the organization that helps her and other people affected by MS.

Hartman said the local chapter provides information to MS patients and their families, such as when new drugs are coming on the market or where to go for treatment, as well as an annual women's retreat and support groups. It offers health programs such as Tai Chi and financial assistance and equipment to those in need.

"They support us so we support them," Hartman said. "They make people aware."

Joel Kozlowski of Lake Park said he has held fundraisers for the group for several years, but this is the first year he decided to do the MS Walk.

"I have multiple sclerosis," said the owner of Brown Baggin' It. "It's not really knowing what can happen in the future: Live for today."

He's had MS for 11 years, and formed the Brown Baggers with girlfriend Lisa Mann. They raised $1,500.

While the two sported the entry T-shirt given to all walkers, Erin Russell and Bianca Ciceraro, friends from Palm Beach Gardens, made customized orange T-shirt with puffy paint to say "MS Walk 2012." The two raised about $100 each and walked to show support of Ciceraro's mom, who has the disease, and Russell's aunt who does.

"I'm sure everybody on my Facebook knows I'm doing this walk today," said Ciceraro, who hopes to raise awareness of the disease.

As the Santaluces High School band set a rousing beat for the participants starting through the inflatable start-finish marker, Andy Stein led Team Hope with a smile on his face and slight hobble to his gate. He admits the disease makes walking hard, but he likes to walk.

"I'm doing great and I think I'm going to stay that way," he said.

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Multiple sclerosis walk attracts 700

Multiple sclerosis: Damaged myelin not the trigger, study finds

ScienceDaily (Feb. 27, 2012) — Millions of adults suffer from the incurable disease multiple sclerosis (MS). It is relatively certain that MS is an autoimmune disease in which the body's own defense cells attack the myelin in the brain and spinal cord. Myelin enwraps the nerve cells and is important for their function of transmitting stimuli as electrical signals. There are numerous unconfirmed hypotheses on the development of MS, one of which has now been refuted by the neuroimmunologists in their current research: The death of oligodendrocytes, as the cells that produce the myelin sheath are called, does not trigger MS.

Neurodegenerative hypothesis obsolete

With their research, the scientists disprove the so-called "neurodegenerative hypothesis," which was based on observations that certain patients exhibited characteristic myelin damage without a discernable immune attack. In the popular hypothesis, the scientists assume that MS-triggering myelin damage occurs without the involvement of the immune system. In this scenario, the immune response against myelin would be the result -- and not the cause -- of this pathogenic process.

The aim of the research project was to confirm or disprove this hypothesis based on a new mouse model. Using genetic tricks, they induced myelin defects without alerting the immune defense. "At the beginning of our study, we found myelin damage that strongly resembled the previous observations in MS patients," explains Burkhard Becher, a professor at the University of Zurich. "However, not once were we able to observe an MS-like autoimmune disease." In order to ascertain whether an active immune defense causes the disease based on a combination of an infection and myelin damage, the researchers conducted a variety of further experiments -- without success. "We were unable to detect an MS-like disease -- no matter how intensely we stimulated the immune system," says Ari Waisman, a professor from the University Medical Center Mainz. "We therefore consider the neurodegenerative hypothesis obsolete."

Focus on immune system

The teams involved in the study want to continue researching the cause and origins of MS. "In light of these and other new findings, research on the pathogenesis of MS is bound to concentrate less on the brain and more on the immune system in future," says Professor Thorsten Buch from the Technischen Universität München.

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The above story is reprinted from materials provided by University of Zurich, via AlphaGalileo.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Journal Reference:

Giuseppe Locatelli, Simone Wörtge, Thorsten Buch, Barbara Ingold, Friederike Frommer, Bettina Sobottka, Martin Krüger, Khalad Karram, Claudia Bühlmann, Ingo Bechmann, Frank L Heppner, Ari Waisman, Burkhard Becher. Primary oligodendrocyte death does not elicit anti-CNS immunity. Nature Neuroscience, 2012; DOI: 10.1038/nn.3062

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

See the rest here:
Multiple sclerosis: Damaged myelin not the trigger, study finds

Multiple sclerosis: Damaged myelin not the trigger

Public release date: 27-Feb-2012
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Contact: Burkhard Becher
burkhard.becher@neuroimm.uzh.ch
41-446-353-701
University of Zurich

Millions of adults suffer from the incurable disease multiple sclerosis (MS). It is relatively certain that MS is an autoimmune disease in which the body's own defense cells attack the myelin in the brain and spinal cord. Myelin enwraps the nerve cells and is important for their function of transmitting stimuli as electrical signals. There are numerous unconfirmed hypotheses on the development of MS, one of which has now been refuted by the neuroimmunologists in their current research: The death of oligodendrocytes, as the cells that produce the myelin sheath are called, does not trigger MS.

Neurodegenerative hypothesis obsolete

With their research, the scientists disprove the so-called "neurodegenerative hypothesis", which was based on observations that certain patients exhibited characteristic myelin damage without a discernable immune attack. In the popular hypothesis, the scientists assume that MS-triggering myelin damage occurs without the involvement of the immune system. In this scenario, the immune response against myelin would be the result ? and not the cause ? of this pathogenic process.

The aim of the research project was to confirm or disprove this hypothesis based on a new mouse model. Using genetic tricks, they induced myelin defects without alerting the immune defense. "At the beginning of our study, we found myelin damage that strongly resembled the previous observations in MS patients," explains Burkhard Becher, a professor at the University of Zurich. "However, not once were we able to observe an MS-like autoimmune disease." In order to ascertain whether an active immune defense causes the disease based on a combination of an infection and myelin damage, the researchers conducted a variety of further experiments ? without success. "We were unable to detect an MS-like disease ? no matter how intensely we stimulated the immune system," says Ari Waisman, a professor from the University Medical Center Mainz. "We therefore consider the neurodegenerative hypothesis obsolete."

Focus on immune system

The teams involved in the study want to continue researching the cause and origins of MS. "In light of these and other new findings, research on the pathogenesis of MS is bound to concentrate less on the brain and more on the immune system in future," says Professor Thorsten Buch from the Technischen Universit?t M?nchen.

###

Further reading: Giuseppe Locatelli, Simone W?rtge, Thorsten Buch, Barbara Ingold, Friederike Frommer, Bettina Sobottka, Martin Krueger, Khalad Karram, Claudia B?hlmann, Ingo Bechmann, Frank L. Heppner, Ari Waisman and Burkhard Becher. Primary oligodendrocyte death does not elicit anti-CNS immunity. Nature Neuroscience. February 26, 2012. Doi: 10.1038/nn.3062

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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

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Multiple sclerosis: Damaged myelin not the trigger

Doctors 'acting like vets with dementia patients': Damning report reveals communication failure of medical staff

Some doctors believe sufferers 'don't suffer pain in the same way' Nurse found by researchers reprimanding elderly dementia sufferer for losing more weight

By Sophie Borland

Last updated at 11:29 PM on 27th February 2012

Doctors and nurses caring for dementia patients often ‘make it up as they go along’ because they have no idea how to treat them, a study has revealed.

The shaming research lifts the lid on attitudes to dealing with vulnerable patients and reports a series of disturbing admissions about how little regard some health professionals have for those suffering in later life.

One consultant admitted to using a ‘veterinary approach’ towards the sick.

Shaming: The report on dementia care exposes doctors' attitudes to the elderly and is based on lengthy interviews with medics in Nottingham (picture posed by models)

Another said dementia patients are ‘hugely sapping of our scarce resources’ as ‘they can’t do anything for themselves’.

Others have disclosed that, although many of their patients have dementia, they have not ‘ever, ever had any teaching’ in how to properly look after them.

 

Some even believed that people with dementia do not suffer pain in the same way as those without the condition.

The candid admissions have been made to academics undertaking an extensive study on attitudes of hospital staff towards the elderly with dementia.

On one occasion, researchers watched in horror as an old man was reduced to tears by a nurse who reprimanded him for losing too much weight.

Over the past three years, Professor John Gladman and his colleagues at Nottingham University have carried out lengthy interviews with 60 doctors, nurses and other staff at the Queen’s Medical Centre and Nottingham City Hospital.

Their findings have been presented to the authors of a major joint report to be published tomorrow by the NHS Confederation, Age UK and the Local Government Association.

It will demand that patients are treated with respect, in line with the Mail’s Dignity for the Elderly campaign.

One consultant admitted during an interview: ‘Sometimes you’re more veterinary in your approach.

‘And then you perhaps may not be treating them in the same way as someone else that you can talk to.’

In another of the interviews – which each lasted 40 minutes – a consultant said that dementia patients ‘can’t do anything for themselves. They won’t feed themselves, they can’t get out of bed themselves, you can’t be sure they’re drinking, they’re often incontinent.

‘The more of that patient group you have, the less care the others are going to get. They are hugely sapping of our scarce resources.’

The researchers, who began their study in 2008 and will publish it in full later this year, also made detailed notes on how patients were being looked after on wards.

On one occasion, they saw an elderly man with dementia in tears being ‘reprimanded’ by a nurse for losing more weight.

The researchers wrote: ‘He is agitated and frightened, crying with tears down his face.

‘Not one member of staff offers any comfort or reassurance. The staff nurse tuts and reprimands him for losing more weight.’

They also interviewed a young woman whose grandmother was in hospital, who said: ‘We were told by the doctor that people with dementia don’t feel pain as much as somebody who hasn’t got dementia.’

Professor Gladman, who specialises in care of the elderly, said most of the staff had not been trained to look after dementia sufferers and often ‘make it up as they go along’.

But he added that figures show half of patients in hospital over the age of 70 have dementia and half of those who fracture their hip have the illness.

Care: Doctors often simply 'make it up as they go along' - and one doctor admitted taking a 'veterinary approach' towards the sick (picture posed by model)

‘Some people said they had never had any training at all,’ said Professor Gladman. ‘People said they knew the causes of dementia – they could tell you microscopic changes that happen to patients – but they didn’t know what to do. They sort of make it up as they go along.’

He added: ‘The only people who said they were confident had not had training but had experience elsewhere – [they had] worked in a care home or looked after their own parents or grandparents.’

Although the study involved staff in only two hospitals in Nottingham, Professor Gladman said he believes the problems they identified exist across the NHS.

He said that although increasing numbers of patients going to hospital would have dementia in the future – because of the UK’s ageing population – the NHS ‘hasn’t really got to grips with the problem’. ‘The system isn’t prepared for the job it’s got to do,’ he said.

The Mail has consistently called for an improvement in the treatment of older patients as part of our Dignity for the Elderly campaign.

Katherine Murphy, chief executive of the Patients Association, said: ‘It brings shame on the NHS that a consultant can say, in the course of this research, that he avoids talking to dementia patients.

‘Dementia patients need to be treated with dignity and respect.

‘But people contacting us tell us about dementia patients that are being ignored by clinicians, and who they feel are being treated as second-class citizens.

‘It brings shame on our society that so many elderly people, with and without dementia, are treated so poorly in our hospitals.’

 

See more here:
Doctors 'acting like vets with dementia patients': Damning report reveals communication failure of medical staff

Doctors ‘acting like vets with dementia patients’: Damning report reveals communication failure of medical staff

Some doctors believe sufferers 'don't suffer pain in the same way' Nurse found by researchers reprimanding elderly dementia sufferer for losing more weight

By Sophie Borland

Last updated at 11:29 PM on 27th February 2012

Doctors and nurses caring for dementia patients often ‘make it up as they go along’ because they have no idea how to treat them, a study has revealed.

The shaming research lifts the lid on attitudes to dealing with vulnerable patients and reports a series of disturbing admissions about how little regard some health professionals have for those suffering in later life.

One consultant admitted to using a ‘veterinary approach’ towards the sick.

Shaming: The report on dementia care exposes doctors' attitudes to the elderly and is based on lengthy interviews with medics in Nottingham (picture posed by models)

Another said dementia patients are ‘hugely sapping of our scarce resources’ as ‘they can’t do anything for themselves’.

Others have disclosed that, although many of their patients have dementia, they have not ‘ever, ever had any teaching’ in how to properly look after them.

 

Some even believed that people with dementia do not suffer pain in the same way as those without the condition.

The candid admissions have been made to academics undertaking an extensive study on attitudes of hospital staff towards the elderly with dementia.

On one occasion, researchers watched in horror as an old man was reduced to tears by a nurse who reprimanded him for losing too much weight.

Over the past three years, Professor John Gladman and his colleagues at Nottingham University have carried out lengthy interviews with 60 doctors, nurses and other staff at the Queen’s Medical Centre and Nottingham City Hospital.

Their findings have been presented to the authors of a major joint report to be published tomorrow by the NHS Confederation, Age UK and the Local Government Association.

It will demand that patients are treated with respect, in line with the Mail’s Dignity for the Elderly campaign.

One consultant admitted during an interview: ‘Sometimes you’re more veterinary in your approach.

‘And then you perhaps may not be treating them in the same way as someone else that you can talk to.’

In another of the interviews – which each lasted 40 minutes – a consultant said that dementia patients ‘can’t do anything for themselves. They won’t feed themselves, they can’t get out of bed themselves, you can’t be sure they’re drinking, they’re often incontinent.

‘The more of that patient group you have, the less care the others are going to get. They are hugely sapping of our scarce resources.’

The researchers, who began their study in 2008 and will publish it in full later this year, also made detailed notes on how patients were being looked after on wards.

On one occasion, they saw an elderly man with dementia in tears being ‘reprimanded’ by a nurse for losing more weight.

The researchers wrote: ‘He is agitated and frightened, crying with tears down his face.

‘Not one member of staff offers any comfort or reassurance. The staff nurse tuts and reprimands him for losing more weight.’

They also interviewed a young woman whose grandmother was in hospital, who said: ‘We were told by the doctor that people with dementia don’t feel pain as much as somebody who hasn’t got dementia.’

Professor Gladman, who specialises in care of the elderly, said most of the staff had not been trained to look after dementia sufferers and often ‘make it up as they go along’.

But he added that figures show half of patients in hospital over the age of 70 have dementia and half of those who fracture their hip have the illness.

Care: Doctors often simply 'make it up as they go along' - and one doctor admitted taking a 'veterinary approach' towards the sick (picture posed by model)

‘Some people said they had never had any training at all,’ said Professor Gladman. ‘People said they knew the causes of dementia – they could tell you microscopic changes that happen to patients – but they didn’t know what to do. They sort of make it up as they go along.’

He added: ‘The only people who said they were confident had not had training but had experience elsewhere – [they had] worked in a care home or looked after their own parents or grandparents.’

Although the study involved staff in only two hospitals in Nottingham, Professor Gladman said he believes the problems they identified exist across the NHS.

He said that although increasing numbers of patients going to hospital would have dementia in the future – because of the UK’s ageing population – the NHS ‘hasn’t really got to grips with the problem’. ‘The system isn’t prepared for the job it’s got to do,’ he said.

The Mail has consistently called for an improvement in the treatment of older patients as part of our Dignity for the Elderly campaign.

Katherine Murphy, chief executive of the Patients Association, said: ‘It brings shame on the NHS that a consultant can say, in the course of this research, that he avoids talking to dementia patients.

‘Dementia patients need to be treated with dignity and respect.

‘But people contacting us tell us about dementia patients that are being ignored by clinicians, and who they feel are being treated as second-class citizens.

‘It brings shame on our society that so many elderly people, with and without dementia, are treated so poorly in our hospitals.’

 

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Doctors 'acting like vets with dementia patients': Damning report reveals communication failure of medical staff

Ataxia – Ataxic gait – Video

04-11-2011 12:01 Amy has a diagnosis of spinocerebellar ataxia and lennox Gastaut Syndrome-Spinocerebellar ataxia (SCA) is a progressive, degenerative, genetic disease with multiple types, each of which could be considered a disease in its own right. Spinocerebellar ataxia (SCA) is one of a group of genetic disorders characterized by slowly progressive incoordination of gait and often associated with poor coordination of hands, speech, and eye movements. Frequently, atrophy of the cerebellum occurs, and different ataxias are known to affect different regions within the cerebellum.

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Ataxia - Ataxic gait - Video

Rare disease strikes family

ALEXIA JOHNSTON

RARE CASE: Joanne Illingworth, 46, has NARP, a disease that attacks the nervous system. Despite its rarity, it is hereditary and her three siblings also contracted the disease.

Timaru woman Joanne Illingworth is likely to be one in a million, if not more.

Ms Illingworth, 46, suffers from neuropathy ataxia and retinitis pigmentosa (NARP), a disease that affects very few people in the world.

A report suggests the condition is so rare that its prevalence is unknown.

NARP, which is in the multiple sclerosis "family", attacks the nervous system, causing muscle weakness, numbness, tingling or pain in the arms and legs, and loss of balance and co-ordination.

Ms Illingworth had a normal start to life. As a young girl she would run around and play like other children.

However, at 13 all of that changed.

"I was sick in bed with the flu. I got out of bed and I collapsed on the ground because I couldn't feel anything." She was admitted to hospital, but then sent home without a diagnosis. It took another 17 years before she found out what she was suffering from.

Despite the rarity of NARP, it was to become a common condition in Ms Illingworth's family after her three younger siblings, including a half-sister, also contracted the disease, all within about three years of each other. Ms Illingworth was the first in the family to get the disease, a hereditary condition passed down by females.

Her brother has since died of NARP. Her two younger sisters live in Oamaru. The family does not know anyone else with the condition.

NARP affects people differently, depending on the severity of their case.

"It affects your eyes, your speech and I shake quite a lot," Ms Illingworth said.

Her life had been full of frustrations. People often assumed she was drunk because of the way she talked. Ms Illingworth had lost count of how many doctors she saw before getting a diagnosis, but she hoped her determination would inspire others.

Rare Disease Awareness Day will be marked tomorrow – leap day – one of the rarest days of the year. For more information about the day visit rarediseaseday.org.nz

- © Fairfax NZ News

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Rare disease strikes family

Change in definition of ‘autism’ has parents worried

HARTFORD, Conn. (MCT) -- When Caleb Geary was diagnosed with autism at age 3, he had never spoken or eaten solid food.

Now 6, the boy speaks and tests at his first-grade level -- progress that his parents attribute to insurance-based services at home and intensive behavioral intervention at the boy's school in Hamden, Conn.

But they worry what will happen to Caleb's diagnosis -- and the services that have come with it -- if the American Psychiatry Association's proposal to change the definition of autism is adopted.

Lori Geary said she has already fought to get her son the help he needs. Tom Zwicker, Caleb's father and the director of an autism center for the Easter Seals of Coastal Fairfield County, Conn., said he believes insurance companies will start requesting annual diagnostic evaluations if the definition is revised. As a result, his son -- and many other children -- will lose out on services to treat their conditions.

"You have an entire group receiving services that would be left out in the cold," said Zwicker, who lives in Branford, Conn. "We're going to lose a whole generation of children."

The autism community has been embroiled in a heated debate for the past few weeks over the proposal to dramatically change the criteria for autism diagnosis in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The DSM-5, scheduled to be published in 2013, is the first revision since 1994.

The revision would create an umbrella category known as "autism spectrum disorder" that would include traditional autism, as well as Asperger's Syndrome, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified (PDD-NOS) -- which currently are considered separate disorders. A new category, social communication disorder, would also be created.

"What became very apparent is that there aren't clear boundaries, and that they really are all on a spectrum," said Darrell Regier, director of research for the APA. The current criteria, he said, is "fuzzy" and as a result some people have been mislabeled as autistic, while others who need treatment can't get it because their symptoms don't match the current criteria.

"The thing that we tried to do is be a little more clear about the different deficits that these people have," Regier said.

But some experts worry that the revision's main effect will be to drastically reduce the number of people who are diagnosed with autism and who now qualify for services to treat it.

Fred Volkmar, director of the Child Study Center at Yale School of Medicine, is the lead author of a study that found that 44 percent of people previously diagnosed with autism would not meet the proposed new criteria for the diagnosis. The study was based on data collected about individuals in the early 1990s.

"We went back and re-analzyed the data and recoded it," said Volkmar, who was a member of the DSM task force committee but since has resigned. The methodology was "not perfect," Volkmar said, "but I don't think it's horribly bad either."

Periodic revisions and refinements of diagnoses are necessary, he said. "Certainly, you could make (the definition of) Asperger's better. The problem is, how do you justify change and how do you justify major change? It's an interesting discussion."

According to Volkmar's study, to be published in April in the Journal of the American Academy of Child and Adolescent Psychiatry and online later this month, about one-fourth of those diagnosed with autism would not meet the new criteria and nearly three-fourths of those with Asperger's also would not be diagnosed.

Also, 84 percent of those diagnosed with Pervasive Developmental Disorder-Not Otherwise Specified also would no longer meet the criteria.

"More and more people are doing better and better, so we have more people who are out and self-sufficient and independent," Volkmar said. "And there's a bit of worry that if you take away services, that that's the group that will suffer, not just in terms of losing a label but in terms of losing services."

"Schools have to do a re-assessment every three years. So in three years' time they say, 'Oh, this kid no longer qualifies.' Is that going to be a rationale for no more services?"

Shannon Knall, a mother in Simsbury, Conn., said her son was diagnosed with autism when he was 2.

"I was on the phone every single day with Birth to Three with the state of Connecticut to get 20 hours of early intervention services -- and I can tell you, with that advocacy and that constant staying on it, I've never gotten 20 hours, and that was eight years ago," Knall said.

Her son, now 10 and a fifth-grader, has Asperger's syndrome and is considered high-functioning, at least intellectually.

"I cannot at all comprehend the level of difficulty that will follow without that (autism) diagnosis," said Knall, the Connecticut advocacy chairwoman for Autism Speaks. "It's very scary. For us as a community, we are constantly facing an uphill battle to get whatever we can get for our kids. There is always a block in the road, and this is another one. Or could be."

Knall also worried that a change in criteria could exclude her family and others from the benefits of a state mandate that took effect in 2010. The law requires insurers to cover specialized treatment for children with autism, such as applied behavioral analysis, which can run into the tens of thousands of dollars in a matter of months.

In Caleb's case, Lori Geary said, she and Zwicker spent $600 a week for four hours of daily ABA therapy before insurance started paying for it last year. The outlook for her son before treatment, she believes, was grim: "I fear he'd be in a group home setting for the rest of his life."

The boy couldn't speak. Caleb would explode at changes to his routine. If Geary was driving and made a left turn when he expected a right, there would be "hair pulling, shoes flying, kicking the seat," she said. Caleb's work with a therapist involves positive reinforcement to target impulse control, stimming -- repetitive movements -- and other behaviors.

"It's how we got him to talk, how we got him to eat, how we got him to sit on a stool at school," said Geary, a senior project manager at Yale's Center for Outcomes Research and Evaluation, which studies the effects of health care. Caleb now gets at-home therapy for two hours nearly every day for his social skills.

With the proposed change to the autism criteria, Geary said, "I'm nervous."

After news about Volkmar's study came out, Darrel Regier said his email inbox was "flooded." He's received 10,000 emails and counting.

"These are legitimately concerned parents who are worried that their kids are going to be dumped from these services," said Regier, who serves as research director for the American Psychiatry Association.

The data in the Yale study is old, Regier said, and the diagnoses of the subjects were made at a time when the criteria for autism were still very much in flux. "And (the data) had a high number of very high-functioning people who are not necessarily representative of the general population" of people with autism, Regier said.

Regier cites two field studies that were recently completed that used new data and got very different results. One concludes that the new criteria would decrease diagnoses by only 5 percent and the other concludes that it would actually increase diagnoses by 1 percent. He said the data is still being prepared for publication, so he couldn't release details of the results.

He said the DSM task force committee agreed on the new criteria 11 to 1, with Volkmar the only member to object. Regier also noted that for much of his career Volkmar has focused on Asperger's, so he likely would be interested in keeping it as a separate diagnosis.

Gary Greenberg, a New London psychologist working on a book about the making of the DSM-5, said the DSM has lost a fair amount of credibility.

The Connecticut Department of Education has been following the APA's proposal, spokesman Mark Linabury said, and does not expect a revision to change how special services are offered in the public schools.

The state's most recent data show that 5,866 K-12 students with autism received special education services in 2010-11 -- about 1.1 percent of the total public school population in Connecticut. Among special education students, those with autism made up 9.2 percent.

While schools take into account a diagnosis of autism, they conduct their own evaluation of a student's "functional or academic abilities" to determine whether one is eligible for special education, Linabury said. "The type of services, their frequency, intensity, duration and the personnel assigned would be driven by the student's needs and not the clinical diagnosis."

In West Hartford, Conn., 154 students this year get special education services because of autism, said Glenn McGrath, the school system's pupil services director. Last year, there were 140 students, up from 128 in the 2009-10 year. According to state data, 78 town students with autism received services five years ago.

McGrath said it was too early to tell whether a redefinition would have an impact in the town schools, although he believed a child currently diagnosed on the autism spectrum "would still need supports in their educational program to address their social skill deficit."

But Nelson Rivera, a lead psychologist in the Hartford schools whose responsibilities include students with autism, said it was possible that fewer students would receive special services.

As of Oct. 1, 229 students in the city school system had a diagnosis of autism, Rivera said, of whom 168 are considered higher-functioning on the spectrum and are placed in classrooms with non-disabled peers.

If there is a revision, the objective instruments that schools use to determine a student's placement could be updated, Rivera said. "It's going to make the whole area of autism more specific, less vague, in terms of symptoms and behaviors."

The task force committee has until December before anything is finalized, and the new criteria will be subject to three independent reviews in the meantime.

"We just don't think at this point in time that the study that Fred (Volkmar) is about to release is one with a good database to make these dramatic projections," Regier said.

"I don't mind using old data and doing what Fred did, but you need to call that a hypothesis-generating study," he said. "To come out and say definitely that you're going to lose 40 (percent) is just not a justifiable claim, based on that dataset."

Dr. Deborah Fein, a neuropsychologist and psychology professor at the University of Connecticut, has mixed feelings about the proposed new criteria.

"The point about collapsing everything into the autism spectrum disorder, I do think that makes sense because I don't think there's adequate evidence that there's a significant difference between them."

Fein said she has her doubts that the effect would be as dramatic as Volkmar's study suggests. "I think he was looking at a particular slice of the pie," she said.

"The population I'm most concerned about is toddlers."

A study that she recently worked on found that 20 percent to 25 percent of the toddlers currently diagnosed as having Autism Spectrum Disorder would not qualify under the new criteria. Many of these children would likely develop additional autism-related symptoms a few years later, as is common, and then meet the criteria.

But by that time, she said, they would have missed out on a few years of services, and early intervention is crucial in treating autism.

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Change in definition of 'autism' has parents worried

Possible change in autism definition worries some

HARTFORD, Conn. — When Caleb Geary was diagnosed with autism at age 3, he had never spoken or eaten solid food.

Now 6, the boy speaks and tests at his first-grade level — progress that his parents attribute to insurance-based services at home and intensive behavioral intervention at the boy's school in Hamden, Conn.

But they worry what will happen to Caleb's diagnosis — and the services that have come with it — if the American Psychiatry Association's proposal to change the definition of autism is adopted.

Lori Geary said she has already fought to get her son the help he needs. Tom Zwicker, Caleb's father and the director of an autism center for the Easter Seals of Coastal Fairfield County, Conn., said he believes insurance companies will start requesting annual diagnostic evaluations if the definition is revised. As a result, his son — and many other children — will lose out on services to treat their conditions.

"You have an entire group receiving services that would be left out in the cold," said Zwicker, who lives in Branford, Conn. "We're going to lose a whole generation of children."

The autism community has been embroiled in a heated debate for the past few weeks over the proposal to dramatically change the criteria for autism diagnosis in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The DSM-5, scheduled to be published in 2013, is the first revision since 1994.

The revision would create an umbrella category known as "autism spectrum disorder" that would include traditional autism, as well as Asperger's Syndrome, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified (PDD-NOS) — which currently are considered separate disorders. A new category, social communication disorder, would also be created.

"What became very apparent is that there aren't clear boundaries, and that they really are all on a spectrum," said Darrell Regier, director of research for the APA. The current criteria, he said, is "fuzzy" and as a result, some people have been mislabeled as autistic, while others who need treatment can't get it because their symptoms don't match the current criteria.

"The thing that we tried to do is be a little more clear about the different deficits that these people have," Regier said.

But some experts worry that the revision's main effect will be to drastically reduce the number of people who are diagnosed with autism and who now qualify for services to treat it.

Fred Volkmar, director of the Child Study Center at Yale School of Medicine, is the lead author of a study that found that 44 percent of people previously diagnosed with autism would not meet the proposed new criteria for the diagnosis. The study was based on data collected about individuals in the early 1990s.

"We went back and re-analzyed the data and recoded it," said Volkmar, who was a member of the DSM task force committee but since has resigned. The methodology was "not perfect," Volkmar said, "but I don't think it's horribly bad either."

Periodic revisions and refinements of diagnoses are necessary, he said. "Certainly, you could make (the definition of) Asperger's better. The problem is, how do you justify change and how do you justify major change? It's an interesting discussion."

According to Volkmar's study, to be published in April in the Journal of the American Academy of Child and Adolescent Psychiatry and online later this month, about one-fourth of those diagnosed with autism would not meet the new criteria and nearly three-fourths of those with Asperger's also would not be diagnosed. Also, 84 percent of those diagnosed with Pervasive Developmental Disorder-Not Otherwise Specified also would no longer meet the criteria.

"More and more people are doing better and better, so we have more people who are out and self-sufficient and independent," Volkmar said. "And there's a bit of worry that if you take away services, that that's the group that will suffer, not just in terms of losing a label but in terms of losing services.

"Schools have to do a re-assessment every three years. So in three years' time they say, 'Oh, this kid no longer qualifies.' Is that going to be a rationale for no more services?"

In Caleb's case, Lori Geary said, she and Zwicker spent $600 a week for four hours of daily ABA therapy before insurance started paying for it last year. The outlook for her son before treatment, she believes, was grim: "I fear he'd be in a group home setting for the rest of his life."

The boy couldn't speak. Caleb would explode at changes to his routine. If Geary was driving and made a left turn when he expected a right, there would be "hair pulling, shoes flying, kicking the seat," she said. Caleb's work with a therapist involves positive reinforcement to target impulse control, stimming — repetitive movements — and other behaviors.

"It's how we got him to talk, how we got him to eat, how we got him to sit on a stool at school," said Geary, a senior project manager at Yale's Center for Outcomes Research and Evaluation, which studies the effects of health care. Caleb now gets at-home therapy for two hours nearly every day for his social skills.

With the proposed change to the autism criteria, Geary said, "I'm nervous."

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Possible change in autism definition worries some

'Toolkit' Makes Bedtime Less Stressful for Children with Autism

Newswise — The Vanderbilt Kennedy Center has created a resource with Autism Speaks to help improve sleep for children and teens affected by autism spectrum disorders. This new toolkit, titled “Sleep Strategies for Children with Autism: A Parent’s Guide,” offers strategies to help families whose children with autism have difficulty falling asleep and staying asleep through the night.

Beth Malow, M.D., M.S., Burry Chair in Cognitive Childhood Development and co-developer of the sleep guide, says that sleep is a common struggle for many children with autism. This new sleep guide can help families select ideas that have the best potential to work well with their lifestyle. Developers of the guide say that with consistent routines and persistent effort, families often see changes in their child’s sleep patterns over several weeks.

“My colleagues and I are excited about having the opportunity to develop this parent toolkit for sleep and are appreciative to Autism Speaks for disseminating it to families in need of this information,” Malow said. “Sleep problems in children with autism can be overwhelming for families, and we hope that this information makes a difference in their day-to-day lives.”

A professor of Neurology and Pediatrics and Vanderbilt Kennedy Center Investigator, Malow is an expert on the interface of sleep and neurological disorders and directs the Vanderbilt Sleep Division. She developed the sleep strategies guide with colleague Kim Frank, M.Ed., educational consultant for the Treatment and Research Institute for Autism Spectrum Disorders(TRIAD) at the Vanderbilt Kennedy Center and experts from the Autism Speaks Autism Treatment Network (ATN) and the Autism Intervention Research Network on Physical Health (AIR-P).

The Vanderbilt Kennedy Center has developed other toolkits with Autism Speaks, including “Taking the Work Out of Blood Work” and “Visual Supports and Autism Spectrum Disorder.” These and other resources are available on the Autism Speaks website.

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'Toolkit' Makes Bedtime Less Stressful for Children with Autism

‘Toolkit’ Makes Bedtime Less Stressful for Children with Autism

Newswise — The Vanderbilt Kennedy Center has created a resource with Autism Speaks to help improve sleep for children and teens affected by autism spectrum disorders. This new toolkit, titled “Sleep Strategies for Children with Autism: A Parent’s Guide,” offers strategies to help families whose children with autism have difficulty falling asleep and staying asleep through the night.

Beth Malow, M.D., M.S., Burry Chair in Cognitive Childhood Development and co-developer of the sleep guide, says that sleep is a common struggle for many children with autism. This new sleep guide can help families select ideas that have the best potential to work well with their lifestyle. Developers of the guide say that with consistent routines and persistent effort, families often see changes in their child’s sleep patterns over several weeks.

“My colleagues and I are excited about having the opportunity to develop this parent toolkit for sleep and are appreciative to Autism Speaks for disseminating it to families in need of this information,” Malow said. “Sleep problems in children with autism can be overwhelming for families, and we hope that this information makes a difference in their day-to-day lives.”

A professor of Neurology and Pediatrics and Vanderbilt Kennedy Center Investigator, Malow is an expert on the interface of sleep and neurological disorders and directs the Vanderbilt Sleep Division. She developed the sleep strategies guide with colleague Kim Frank, M.Ed., educational consultant for the Treatment and Research Institute for Autism Spectrum Disorders(TRIAD) at the Vanderbilt Kennedy Center and experts from the Autism Speaks Autism Treatment Network (ATN) and the Autism Intervention Research Network on Physical Health (AIR-P).

The Vanderbilt Kennedy Center has developed other toolkits with Autism Speaks, including “Taking the Work Out of Blood Work” and “Visual Supports and Autism Spectrum Disorder.” These and other resources are available on the Autism Speaks website.

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'Toolkit' Makes Bedtime Less Stressful for Children with Autism

Autism not diagnosed as early in minority kids

WASHINGTON — Early diagnosis is considered key for autism, but minority children tend to be diagnosed later than white children. Some new work is beginning to try to uncover why — and to raise awareness of the warning signs so more parents know they can seek help even for a toddler.

"The biggest thing I want parents to know is we can do something about it to help your child," says Dr. Rebecca Landa, autism director at Baltimore's Kennedy Krieger Institute, who is exploring the barriers that different populations face in getting that help.

Her preliminary research suggests even when diagnosed in toddlerhood, minority youngsters have more severe developmental delays than their white counterparts. She says cultural differences in how parents view developmental milestones, and how they interact with doctors, may play a role.

Consider: Tots tend to point before they talk, but pointing is rude in some cultures and may not be missed by a new parent, Landa says. Or maybe mom's worried that her son isn't talking yet but the family matriarch, her grandmother, says don't worry — Cousin Harry spoke late, too, and he's fine. Or maybe the pediatrician dismissed the parents' concern, and they were taught not to question doctors.

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It's possible to detect autism as early as 14 months of age, and the American Academy of Pediatrics recommends that youngsters be screened for it starting at 18 months. While there's no cure, behavioral and other therapies are thought to work best when started very young.

Yet on average, U.S. children aren't diagnosed until they're about 4½ years old, according to government statistics.

And troubling studies show that white kids may be diagnosed with autism as much as a year and a half earlier than black and other minority children, says University of Pennsylvania autism expert David Mandell, who led much of that work. Socioeconomics can play a role, if minority families have less access to health care or less education.

But Mandell says the full story is more complex. One of his own studies, for example, found that black children with autism were more likely than whites to get the wrong diagnosis during their first visit with a specialist.

At Kennedy Krieger, Landa leads a well-known toddler treatment program and decided to look more closely at those youngsters to begin examining the racial and ethnic disparity. She found something startling: Even when autism was detected early, minority children had more severe symptoms than their white counterparts.

By one measure of language development, the minority patients lagged four months behind the white autistic kids, Landa reported in the Journal of Autism and Developmental Disorders.

It was a small study, with 84 participants, just 19 of whom were black, Asian or Hispanic. But the enrolled families all were middle class, Landa said, meaning socioeconomics couldn't explain the difference.

One of the study's participants, Marlo Lemon, ignored family and friends who told her not to worry that her son Matthew, then 14 months, wasn't babbling. Boys are slower to talk than girls, they said.

"I just knew something was wrong," recalls Lemon, of Randallstown, Md.

Her pediatrician listened and knew to send the family to a government "early intervention" program that, like in most states, provides free testing and treatment for young children's developmental delays. Matthew was enrolled in developmental therapy by age 18 months, and was formally diagnosed with autism when he turned 2 and Lemon enrolled him in Kennedy Krieger's toddler program as well. In many of his therapy classes, Lemon says, Matthew was the only African-American.

Now 7, Matthew still doesn't speak but Lemon says he is making huge strides, learning letters by tracing them in shaving cream to tap his sensory side, for example, and using a computer-like tablet that "speaks" when he pushes the right buttons. But Lemon quit working full-time so she could shuttle Matthew from therapy to therapy every day.

"I want other minority families to get involved early, be relentless," says Lemon, who now works part-time counseling families about how to find services early.

For a campaign called "Why wait and see?" Landa is developing videos that show typical and atypical behaviors and plans to ask Maryland pediatricians to show them to parents. Among early warning signs:

Not responding to their name by 12 months, or pointing to show interest by 14 months. Avoiding eye contact, wanting to play alone, not smiling when smiled at. Saying few words. Landa says between 18 and 26 months, kids should make short phrases like "my shoe" or "where's mommy," and should be adding to their vocabulary weekly. Not following simple multi-step commands. Not playing pretend. Behavioral problems such as flapping their hands or spinning in circles.

Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Autism not diagnosed as early in minority kids