Bringing Neuroscience Breakthroughs Home:

Advanced Pediatrics at the 2010 International Meeting on

Evidence-Based Cognitive Training

Advanced Pediatrics at the Forefront of Neuroscience

On September 24, 2010, some of the world’s leading neuroscientists, doctors, and psychologists gathered at the annual Cogmed Conference, held this year in Chicago, to review recent research on evidence-based cognitive training. 

            Advanced Pediatrics was pleased to once more take its place as the first clinical office in the United States to offer Cogmed working memory training, widely regarded as the most substantial form of evidence-based cognitive training to date.

            Every year, the Cogmed Conference has drawn an increasing level of attendance and level of expertise.  This year was no exception.  The number of professionals present was double the prior year’s total.  Clinicians from Korea, Singapore, Sweden, Costa Rica, South Africa, and from over 100 sites across the United States were present.

TOPICS DISCUSSED 

What is evidence-based cognitive training?

Evidence-based cognitive training is any program that has the brain conduct exercises that improve the function of the mind enough to significantly improve the person’s life.  Many programs make such claims, but evidence-based cognitive training are only those programs that can point to research published in well-regarded peer-reviewed journals.

What is Cogmed Working Memory Training?

Cogmed working memory training is perhaps the evidence-based cognitive training with the most evidence of successful impact.  The program is the result of many years of highly regarded neuroscience research at the Brain Institute of the Karolinska Institute in Stockholm.  Its founder, Dr. Torkel Klingberg, received the Philips Award as one of the world’s leading neuroscientists in 2008(?).  After spending years in careful development and evaluation, many thousands of people have completed Cogmed Working Memory Training with results very consistent with the research findings: 80% of those trained have improvement in cognitive function large enough to improve the lives of those trained.  Improvements cited include better attention, organization, and success at school, work, and home.  Centers that have studies and published their findings on Cogmed Working Memory Training include Harvard, Stanford, New York University, Notre Dame, York University (UK), and the Karolinska Institute (Sweden), among a very rapidly growing list of the world’s leading centers of research on the brain.

What is working memory?

Working memory is the ability of the mind to consciously hold more than one piece of information at one time and do something with those bits of information. 

And so, working memory is not really memory as we think of memory.  Memory is about remembering something from the past. Working memory is about doing something with information at hand in the present.

Perhaps the best way to appreciate this idea is to think of the brain’s job falling into three connected goals:

1.To take in information

2.To understand information it takes in

3.To do something, complete a task, with information it understands

 Working memory is the function of the mind that connects understanding and doing. 

 Once you know something, working memory appears to be the most important function of the conscious mind that translates knowing into doing.

How important is working memory?

As noted above, Dr. Alan Baddely developed the concept of working memory about 40 years ago.  Ever since then, neuroscientists have found more and more proof that working memory may be at the root of many of the most common problems in thinking, namely:

·   Getting something done

·   Understanding complex directions

·   Completing assignments on time

·   Remembering what you were asked to do

·   Being socially successful

·   Doing well in school

·   Doing well at work.

WHO PRESENTED? 

Present were some of the world’s leading experts on how the mind generates attention.  These included:

Dr. Susan Gathercole, head of the British lab where some of the most important work on defining the core element of attention, working memory, has been done.  She presented recent studies that demonstrate how nearly all children who struggle in school have a deficit in working memory, and, further,  enhancing working memory can improve nearly all children’s level of academic achievement.  www.yorkU.edu.en

Dr. Mark Rapport, one of America’s leading researchers on ADHD, from Florida, presented just published ground-breaking work on exactly what in the mind of a person with ADHD.  Key to his findings was the actual causes of the impairments that ADHD causes, namely school failure, social isolation, disorganization. www.childrenslearningclinic.com

Dr. Rosemary Tannock, widely regarded as one of the top authorities on the management of ADHD, presented her recent findings on the impact of evidence-based cognitive training on school performance and the symptoms of ADHD.  www.

WHO BENEFITS FROM EVIDENCE-BASED COGNITIVE TRAINING?

The conference also featured presentations from a wide variety of practitioners across the US and the world sharing their experiences on the impact of evidence-based cognitive training.  Their observations offered proof that evidence-based cognitive training has a positive impact in these settings:

Schools.    Several schools presented their findings that students who undergo evidence-based cognitive training do better in their studies- more organized, calmer, more confident, less distracted, better able to follow directions and expectations, more homework completed, with improved grades.  As noted above, one study demonstrated such improvements for children with and without working memory deficits.

Traumatic Brain Injury (TBI).   Adults who had evidence-based cognitive training noted improvements  on task completion, occupational performance, and satisfaction with performance, overall health.  The adults described being more alert, more awake, more aware of what is happening, lifting the fog, better able to help their children with homework, more focused, and overall more confident.

Down Syndrome.   This presentation was also from Dr. Gathercole’s group, the leading authorities on the working memory in the world.  They found that initial observations on a group of children with Down Syndrome, with intellectual level of function averaging at the five year old level, responded well to evidence-based cognitive training. Teachers of these students, who were unaware of their training, spontaneously reported to parents that these children seemed calmer, more focused.  Parents agreed and also noticed decreased hyperactivity, less frustration, and that they remembered instruction sets better.  Based on the strength of these observations, the group will be conducting a randomized controlled trial to prove and measure the impact of evidence-based cognitive training in children with Down Syndrome.

Depression in the Elderly.  This study from Georgia demonstrated that evidence-based cognitive training can reduce the burden of depression in the elderly.

Cognitive Loss from Cancer Treatment.  Children whose brains are exposed to chemotherapy or radiation lose cognitive abilities an often suffer a loss of ability to concentrate or focus.  This team from Duke presented many years of work demonstrating that evidence-based cognitive training can restore enough of this lost function to make a significant difference.

BOTTOM LINE

·         An explosion of understanding of how the brain actually works is just now leading to applications that can help each of us think better and more effectively.

·         Evidence-Based Cognitive Training represents the best of those applications.

·         Cogmed represents the best of the evidence-based cognitive training protocols.

·         Advanced Pediatric is the first clinical office in the United States to offer Cogmed Training to its patients and to the general public of all ages.

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Advanced Pediatrics Earns the Respect of Angies' List Customers

Advanced Pediatrics Earns the Respect of 

Angie's List Customers

We wanted to share some very good news, and thank everyone in the practice 

for their good words.

This week I received notification from Angie's List that Advanced Pediatrics has an "A" rating in their Health Category.

We are thrilled to have earned your respect, appreciation, and trust, and will continue to work hard to earn it.

Some of the comments were quite moving, we are truly very grateful to be able to help out.

Here are two sample comments from families:

"Dr. Lavin has been our family's pediatrician since we moved to Cleveland over 15 years ago. He has helped me raise my three kids into healthy teenagers. He almost always leaves time to just chat and usually listens well to our concerns."

"My daughter had been sick and I took her into Advanced pediatrics They saw her immediately, we got a "same day" appointment. Kelly (the P.A.) listened to my daughter's breathing, then sent her literally next door for an x-ray. How convenient! Then the x-ray walked us back to Advanced Pediatrics and handed the radiologist's diagnosis off to the office. We got a prescription and were on our way, in less than an hour. Then I was concerned that my daughter wasn't recovering at a good rate. They got me in immediately with Dr. Lavin, he listened to my concerns, then checked out my daughter. He let me his opinion and backed it up with research and a personal anecdote, which was reassuring. Neither Dr. Lavin nor Kelly makes me feel silly when I have a worry, they value my opinion and work with me toward my daughter's best health!"

Thanks to all once more,

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Great Site for Caregivers http://nfcacares.org/

Great site for Caregivers  http://nfcacares.org/

This is a posting for any family that has a child with special health care needs.

Last month I was honored to present at a national conference of an organization devoted to the 

understanding and care of a very rare metabolic disorder, metachromatic leukodystrophy (MLD).

At this conference, I was introduce to an organization that helps parents of children with 

any disabling or complex condition.

The National Family Caregivers Association is a treasure chest of great ideas to help families find support, namely:

• thinking about how to obtain benefits to support care
• finding approaches to care that make a huge difference
• managing family time away, together and apart

In short, a very, very valuable source of ideas that make a real difference.

Hope you find it helpful whenever you may need it.

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

New Vision and Hearing Tests at Advanced Pediatrics

 New Vision and Hearing Tests at Advanced Pediatrics


Advanced Pediatrics is very pleased to announce that we have now updated our
approach to testing for vision and hearing.    

Effective immediately, we are now using state-of-the-art technology to precisely determine if your child's vision or hearing is normal.  Each test takes less than 5 seconds, and does not require the child's input.

For the vision test, a tiny beam of light is pointed at the eye and within seconds a determination of the child's ability to focus in that eye is made by a rapid scan of the fovea, the center of vision of the retina.  The test can determine if vision is normal or not beginning at age one.

For the hearing test, small sounds are sent into the ear, and, again, within seconds, the device can actually measure if the small hairs on the nerves of hearing are working properly.  This is the same technology used by hospitals to screen newborns for hearing function.  Our device will also be able to screen for hearing normalcy as early as the first days of life.approach to testing for vision and hearing.   

Determining normal vision is important during throughout childhood and adolescence.  Early in life, differences in visual ability in the eyes can cause long-term loss of vision, a problem called amblyopia.  And from ages 5-16,  a large percentage of people develop abnormalities of vision that require correction with glasses or contacts.  Our new vision screening system can determine if vision problems are developing beginning at age one.  

Hearing once was an issue mainly at birth, if your hearing was normal at birth, chances are that it would remain so until later in adult life.  This is no longer the case.  The explosion of use of headphones and earplugs has led to an epidemic of hearing loss by early teen years.  Some estimates put the risk of hearing loss as high as one in four teens!  Our new hearing screening system can now determine if a trend towards hearing loss is happening before the loss of hearing becomes significant.       

A key point to remember, both of our hearing and vision screening systems are screens.  That means an abnormal result does not mean your child has a hearing or vision problem, but that a more detailed measure is needed.  It does mean, with very good reliability, that a normal result means vision and/or hearing is indeed functioning well.    

We are very pleased to be bringing the latest in vision and hearing measurement to Advanced Pediatrics.  Gone are the frustrations of asking very young children to read charts or raise hands, now we can determine if your toddler, child, or adolescent's vision or hearing is normal with great reliability, in very short time. approach to testing for vision and hearing.         

Dr.  Arthur Lavin

*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Flu Vaccines for 2010-2011

Flu Vaccines for 2010-2011

Dear Family,

Every year a virus called the influenza virus appears in our community.  This usually happens in a regular, predictable manner, appearing in late December or early January, and leaving our area altogether by May.

Last year, as you know, an influenza virus appeared off this schedule and thereby earned the name pandemic influenza virus.  

Every species of influenza virus that appears can also be described as a type, usually by giving the H and N proteins on the virus each a number.  The pandemic virus of last year was H1N1.

This year we are expecting to see only the seasonal influenza viruses, appearing in late December or early January until May.   There is no indication that any other influenza viruses will be here.

With that in mind, we anticipate a very calm delivery of flu vaccine this fall.

There are no reported shortages, and in marked contrast to last year, there is only one flu vaccine (in shot or mist form) that needs to be given.  Everyone over 9 years of age, and everyone under 10 years of age who got the H1N1 and seasonal flu vaccine last year, just needs one dose of flu vaccine this year.

Advanced Pediatrics will be making special times available for flu vaccine in an orderly fashion, as we receive our supplies.

Please know that we anticipate having plenty of flu vaccine available well before the time it is needed (around January 1).

That means, if your child gets the flu vaccine in early October, late October, early November, or even late November, the level of protection for the January-May influenza infections will be the same.

So that means there is no rush, plenty of vaccine, and so stay tuned to your emails as we announce the days and times of our flu vaccine clinics.

We appreciate your trust, and are very, very glad that this year the provision of protection via flu vaccines will be far simpler than last year, and that no shortages are expected.  We are so pleased we will be able to protect your child(ren) in plenty of time.

Thank you once more,

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Enjoy your soy!

Image via WikipediaEnjoy your Soy

For many years a debate has been brewing about whether soybeans contain compounds that could alter human puberty and sexual development.  Evidence now clearly proves it does not.

The specific concern has been that the soybean contains compounds called isoflavones, and at times phytoestrogens, that look suspiciously like estrogen.

Now, clearly eating estrogen could dramatically disrupt normal human pubertal development.  Eating compounds that have estrogen powers could lead to very early puberty onset in women, and could delay puberty in men, decrease their ultimate sperm count, and cause infertility.

But one thing to keep in mind is that truly tiny differences the estrogen molecule can create rather massive differences in what the molecule does.  For example, if you take actual human estrogen and only take away 3 atoms, all on the outside boundaries of this large molecule, you end up with a compound that looks almost exactly like human estrogen, except it is now called testosterone.  As you all know, estrogen is the central hormone of human femininity and testosterone of human masculinity.  How much more different can you get, and yet the molecules are only 3 atoms different.

Now lets consider the isoflavones, also known as phytoestrogens, found in soybeans.  They look like human estrogen, but what do they actually do in the human body?

It turns out, not much.

Perhaps the most dramatic proof of this statement comes from a 2009 study 

http://www.ncbi.nlm.nih.gov/pubmed/19819436

They gave young men rather massive quantities of pure soy isoflavone for nearly two months and then looked at their sperm.  They made sure the men took their medicine by measuring each man's isoflavone level in their urine- all the men had a huge rise in their soy isoflavone level.

And yet, by many, many measure of sperm health (count, motility, semen quality, etc.), there was no impact from the soybean isoflavone.  Soy isoflavone levels went up and absolutely nothing happened to the sperm.

It really does look like soy isoflavone may do something for soybeans but does nothing to people.

So enjoy your soy sauces, your tofu and its mimicry products, your edamame, and soy lecithin!

Bon Appetit,

Dr. Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Acetaminophen: A Serious Question Leads to the Recommendation to Suspend Use

Acetaminophen: A Serious Question Leads to the Recommendation to Suspend Use

Over the last several years, a growing body of evidence has raised a troubling question about the use of acetaminophen (Tylenol™, Feverall™). A number of studies have proven an association between the use of acetaminophen and the risk of developing asthma. These studies have approached the issue from a number of different perspectives and in each instance have found an association.

            A recent study has tracked the use of acetaminophen in children (ages 6-7 and 13-14) over many years Their most recent publication described the experience of 320,000 young adolescents from 50 countries. What they observed was that if a child took acetaminophen once a month or more, that child had double the risk of developing asthma.

            Other studies have found:

1.  The more acetaminophen a child uses, the greater the risk of developing asthma. In some series, the risk has gone as high as sevenfold. That is, a group of children taking acetaminophen has been observed to have seven times the risk of developing asthma as children who do not take acetaminophen.

2.  As countries have adopted the use of acetaminophen, the rate of asthma in those countries has gone up.

3.  The risk of developing asthma in association with taking acetaminophen has been observed in utero, in infancy, in early childhood, in school age children, and in adolescence.

Advanced Pediatrics has been following these studies and our initial reaction was disbelief. How is it possible that something so widely used as acetaminophen could cause such a serious problem as asthma, and no one noticed? Further, if acetaminophen causes asthma, why doesn’t everyone have asthma, since nearly every child in the US has taken acetaminophen? And, what harm could be caused if Advanced Pediatrics sounded a false alarm? What if acetaminophen turns out to be harmless and we have obstructed access to a very helpful medicine?

One story that may turn out to be quite relevant is the story of aspirin and Reye’s syndrome; both obscure concepts to most parents since almost no children take aspirin anymore, and almost nobody has heard of Reye’s syndrome. But prior to 1980, nearly every child in the US took aspirin when they had a fever. And at that time in most major children’s hospitals in the US, there was often a child with Reye’s syndrome in their ICU in any given month. Reye’s syndrome was a rare but devastating collapse of the liver due to a very severe metabolic problem that would often lead to death. The idea that somehow Reye’s syndrome and aspirin use might be connected seemed far-fetched when first observed. After all, aspirin was used like water, all the time, and with no serious resultant problems. In stark contrast, Reye’s syndrome was a very rare problem, characterized by a very complex set of metabolic errors leading to the death of a vital organ. How could these two problems be related?

When the first observations were published suggesting that those who took aspirin had a higher risk of Reye’s syndrome, the observations were met with nearly unanimous skepticism. Millions took aspirin, only hundreds got Reye’s syndrome. Aspirin is safe and common; Reye’s syndrome is deadly and rare.

But the observations kept rolling in. Eventually the question of a link could no longer be ignored and studies were set up in which very large numbers of children did not take aspirin, and wonder of wonders, none of them got Reye’s syndrome. Soon the FDA began warning that aspirin use in children, especially those with flu or chickenpox, could cause Reye’s syndrome. Parents suddenly stopped giving their kids aspirin. Since that moment, Reye’s syndrome has virtually ceased to exist. This last step was the final and definitive proof that aspirin caused Reye’s syndrome. Astounding as it was to all involved, the cessation of aspirin use by children saved many, many lives.

What about the question, if acetaminophen causes asthma, why doesn’t everyone have asthma? Well, consider the possibility that children run a 1 in 20 risk of developing asthma, which is indeed true, since about 5% of kids have asthma in the US. Now, if acetaminophen doubled the risk of developing asthma, the incidence would go from 5% to 10%. That would be a stunning level of harm. That would mean that of the 4 million kids born in the US every year, an additional 200,000 children would develop asthma, every year. And yet, 90% of children would still not develop asthma, even if they took acetaminophen.

            We are not yet at the point where we know that acetaminophen causes asthma to develop. But enough information has been gathered to say we should find out.

            It is in light of the Aspirin/Reyes Syndrome experience, the quality of the current studies on acetaminophen and asthma, and the fact that ibuprofen adequately covers the same medical needs, that Advanced Pediatrics has taken its position of not endorsing the use of acetaminophen for children of any age for the foreseeable future.  .  Please note that for the rare circumstance in which a child faces a danger from fever and cannot use ibuprofen for medical reasons, acetaminophen may still be a reasonable choice to use, but only under a doctor’s recommendation.




Addendum:
The New York Times has published an article, December 19, 2011 supporting the concern that acetaminophen may cause asthma to develop:
http://www.nytimes.com/2010/08/17/health/research/17risk.html

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.