In honor of Autism Acceptance and acceptance of neurodiversity, I invited Dr Tamar Nazarian Chorbadjian, a Developmental and Behavioral Pediatrician.

We discuss the following:

• The role of a Developmental and Behavioral Pediatrician in taking care of neurodiverse children
• The current statistics of autism and why we think we are seeing higher rates now
• Known risk factors
• How the diagnosis is made
• Misinformation regarding autism
• The importance of establishing services early for a child.

00;00;08;25 – 00;00;23;25

Dr. Mona

Hello and welcome to this episode where I’m so excited to welcome Doctor Tamar Nazarian Chorbadjian, who is a developmental behavioral pediatric and mother. And we’re going to be talking about autism today. Thank you so much for joining us.

 

00;00;23;27 – 00;00;26;16

Dr. Tamar Nazarian

What I’m so glad you have me on. Thank you.

 

00;00;26;19 – 00;00;43;10

Dr. Mona

And we actually know each other from before. This is really exciting to have her on. We actually go way back to undergrad, so this is very, very cool. So, thank you for joining us. Like I said, and what do you do as a developmental behavioral pediatrician and why did you choose a specialty?

 

00;00;43;16 – 00;01;07;27

Dr. Tamar Nazarian

Yeah, I’m going to I mean, it’s so great. Back from UCLA. And then even in med school as summer presidents, we had some amazing trips. It’s so good to reconnect. So as a developmental behavioral pediatrician, get to work so much closely with families, I do assessments and recommend treatments regarding the medical and psychosocial aspects of children’s and adolescents developmental and behavioral problems.

 

00;01;07;27 – 00;01;37;24

Dr. Tamar Nazarian

This can be a wide array of diagnoses and issues ranging anywhere from like learning disorders, attention on behavioral disorders like ADHD, developmental disorders like autism, spectrum disorders, intellectual disabilities, or even just issues like sleep issues, feeding problems, toilet training challenges, get the luxury of time and opportunity to work closely, not just with the parents and the patients, but also the entire family and schools as I get to dive into deeper histories.

 

00;01;37;24 – 00;01;49;18

Dr. Tamar Nazarian

So I do that work right now, at Kaiser Permanente Southern California. And it’s just a pleasure to get to do all the early intervention and work towards educating all and helping the patients.

 

00;01;49;20 – 00;02;03;23

Dr. Mona

Yeah. And I don’t think many people know of a developmental behavioral pediatrician until maybe their child has to go see one. Or maybe a friend had to go see a developmental pediatrician. So you do three extra years beyond residency, correct?

 

00;02;03;29 – 00;02;31;04

Dr. Tamar Nazarian

Yes. We are definitely a rare breed. So we do our medical school with a three year, pediatric residency, just like you did. And then we go on to do three years of fellowship or specialty training in developmental behavioral pediatrics. Believe it or not, most of the recent studies show like 800 of us in the whole country in 2018, they surveyed us and about a third of them are retiring in the next 3 to 5 years, which is like now.

 

00;02;31;04 – 00;02;34;20

Dr. Tamar Nazarian

So you can just imagine how few we are available.

 

00;02;34;23 – 00;02;51;27

Dr. Mona

Well, and yeah, what you do is so important. I mean, I rotated in developmental behavioral pediatrics, most of my followers on my Instagram. No, I actually thought of developmental behavioral pediatrics because of how much I love everything that you mentioned. Right. Being able to, talk to families about their child’s development behavior, potty training, sleep issues like you mentioned.

 

00;02;51;28 – 00;03;01;13

Dr. Mona

Obviously, we’re going to be talking about autism, which you see a lot of. Is there a certain niche of patients that you work with, or do you see the the broad range of what you mentioned?

 

00;03;01;16 – 00;03;20;04

Dr. Tamar Nazarian

I did not specialize in anything particular. I see the whole gamut. My passion is an early intervention. So I love that 0 to 3, 0 to 5 population where I can really make a big difference. But, you know, I get to see the whole gamut from at least, you know, newborns, that being the director of our high risk infant follow up clinic.

 

00;03;20;04 – 00;03;24;21

Dr. Tamar Nazarian

And I also get to see them all the way up to like 21 sometimes.

 

00;03;24;24 – 00;03;46;16

Dr. Mona

That’s great. I’m so glad that we’re reconnected. Like I said, from our old UCLA days and then in medical school, from the conferences that we did, and it’s just so nice, you know, being able to have this contact for this podcast and then for the future. I’ve already talked to you how I would love to have you back on for other topics, but we chose autism to discuss today in honor of World Autism Day on April 2nd.

 

00;03;46;16 – 00;04;11;24

Dr. Mona

I’m releasing this episode around then for anyone listening. I also released two other episodes. One is with a mother, from an autism family, and then the other one is with a speech therapist who works closely with autism families. So I wanted to kind of get the perspective of many different people. So with Doctor Tamar, we are talking more about the statistics, diagnoses, broad kind of therapies, things like that.

 

00;04;11;24 – 00;04;27;05

Dr. Mona

Some things that you may have heard of that aren’t always true, like the misinformation regarding autism. So we’re going to be doing more of that on this episode. So, thank you again. Let’s start off with what are the current stats of autism in the US or the world, whatever you’re able to give our listeners?

 

00;04;27;05 – 00;04;50;17

Dr. Tamar Nazarian

Well, right now, according to the CDC data, about 1 in 54 children in the US has been identified with an autism spectrum disorder, according to the World Health Organization, the estimation is about 1 in 160 children with an autism spectrum disorder. We know that it’s about four times more common in boys and girls, but it spans all racial, ethnic, and socio economic groups pretty evenly.

 

00;04;50;20 – 00;05;23;09

Dr. Tamar Nazarian

But I will say this, Mona, don’t be surprised when the 2020 report finally comes out and the statistic looks worse because in 2010, the American Academy of Pediatrics started recommending universal screening. As, you know, as a pediatrician for specifically for autism in the US. And so those kids that were screened in 2010 at age 18 months or two years old and on, will be the group that turns eight years old come 2016 or 17, and therefore they’ll be reported in the next round of data that’s released.

 

00;05;23;10 – 00;05;30;00

Dr. Tamar Nazarian

Now that 2020 is over. So this data set, I anticipate, is going to look a little worse for children diagnosed with autism.

 

00;05;30;07 – 00;05;49;14

Dr. Mona

So a lot of the questions I get asked, obviously as a general pediatrician, is why do we think it’s going up? Is it truly that the incidence is going up? Or is it that it’s better screening? What are your thoughts on why those numbers may be increasing? I know you mentioned, the better screening that was being done, but what are some other thoughts about why it’s increasing?

 

00;05;49;17 – 00;06;12;22

Dr. Tamar Nazarian

I mean, I think it’s a huge variety of reasons. You know, there’s many factors. There is a lot of changes in diagnostic practices, the age of screening like we talked about, and also just more public awareness of the condition and availability of services. There’s less stigma around it. And so more parents are encouraged to now seek help when they have suspicions of developmental delays in their children.

 

00;06;12;22 – 00;06;35;02

Dr. Tamar Nazarian

Also, you know, we are seeing a higher rate of survival for serious illness or severe illness with kids surviving from extreme prematurity those under 26 weeks old, they tend to be at a higher risk of developing autism as well. And you know, there’s also just this whole idea, you know, that I can’t help but wonder sometimes if it’s also just because we are doing more screening.

 

00;06;35;02 – 00;06;57;12

Dr. Tamar Nazarian

And so more and more of these late talking, maybe 2 or 3 year olds are being identified as having autism, but they may not truly have autism. You know, how many times have you seen like a two, three or even a four year old who’s like spinning, ignoring verbal commands, lining toys up or covering their ears when you sing a song, being very routine oriented and throwing tantrums, I mean, you see it daily.

 

00;06;57;12 – 00;07;21;11

Dr. Tamar Nazarian

I see it in my own kid, and these are all symptoms of autism that can stand out to people. But many don’t actually have autism. In fact, one would argue that these are rather pretty typical behaviors to an extent during like the terrible twos or the three major stage toddlers may soon grow out of. So you want to make sure that you are recognizing these signs and symptoms, but also when you’re seeking a diagnosis that they’re doing a very thorough job.

 

00;07;21;18 – 00;07;42;01

Dr. Mona

Yeah. And the other episode I released today with Mrs. Speech, she is again a speech therapist who does early intervention work with, autism families. We actually talk about more of the diagnoses in terms of, you know, different characteristics, things like that. So again, we I wanted to divvy up the episode. Do you know of any other risk factors?

 

00;07;42;01 – 00;07;46;20

Dr. Mona

We talk about being, you know, ultra premature, but any other risk factors that we know of right now?

 

00;07;46;23 – 00;08;06;20

Dr. Tamar Nazarian

Yes. So autism has no single known cause. There’s likely many causes. And it’s definitely some link between genetics and environment both playing a role. You know, it’s been played up a lot by genetics more so than environment. But now we’re seeing kind of combination. So just like I mentioned, the boys are four times more likely. So just the sex of the child makes a difference.

 

00;08;06;20 – 00;08;28;18

Dr. Tamar Nazarian

The prematurity issue like we talked about. Then there’s also you’ll see it runs in families, which is again part of that genetic component. Many times when you diagnose a child with autism, the parents or they may mention that their relatives have some minor problems in social communication skills themselves, or engage in certain atypical behaviors similar to autistic symptoms.

 

00;08;28;18 – 00;08;54;19

Dr. Tamar Nazarian

Children with certain medical conditions are at higher than normal risk, like those who have fragile X syndrome and boys tuberous sclerosis or rat syndrome, and girls. And then, you know, things that are more environmental factors. There are some viral illnesses that are being looked at as possible associations, medications and complications during pregnancy. The main one of which that we’ve seen the most is gestational diabetes.

 

00;08;54;19 – 00;09;09;27

Dr. Tamar Nazarian

And also we’re looking at air pollutants. One of the things that we do know for sure, you know, is time and time again, that there is no childhood vaccine that increases the risk of an autism disorder. There is no linkage between autism and vaccines.

 

00;09;09;29 – 00;09;28;25

Dr. Mona

Oh, yeah. And I think we’ll get into more information about that because, you know, that has become such a hard thing for general pediatricians. I know you probably deal with it in your in your subspecialty practice as a developmental behavioral pediatrician, but as a general pediatrician, when we are, you know, offering these preventative vaccines, you know, we offer it because we know they’re helpful, we know they’re going to save lives.

 

00;09;28;25 – 00;09;45;27

Dr. Mona

And yes, as you know, we’ve been met with a lot of pushback or the, you know, anti-vaccine movement for pediatrics that has been founded in this. It causes autism. It causes this, you know, and it’s been really hard. I mean, I’ve actually spoken to a lot of families with autism who actually are kind of offended by it, right?

 

00;09;45;27 – 00;10;02;10

Dr. Mona

Because they’re like, wait, like, why are you one? Why are you so upset about your child having autism? I mean, this is such a, you know, it’s a kind of a slap in the face for these families when they’re like, so you’re so afraid of autism. When my child, this beautiful child has this and it’s a part of them and you’re so afraid of it.

 

00;10;02;10 – 00;10;21;28

Dr. Mona

And then the other part of it is that it’s not founded. I mean, I have a lot of families with autism who are pro-vaccine, so most of the people who are anti-vaccine saying it causes autism are families that don’t even have anyone with autism. Like they don’t even know the reality. Right? And it’s just hard for me. It’s hard for me to see because we know it’s not true.

 

00;10;21;28 – 00;10;27;24

Dr. Mona

And it’s just it’s really hard for a lot of the autism families when I talk to them, you know, I don’t I’m sure you hear that too.

 

00;10;27;28 – 00;10;37;08

Dr. Tamar Nazarian

Yes, definitely. I mean, look at us. We’re two educated women, mothers, pediatricians, you know, and we vaccinate our children, right? If it dangerous, why would we do it to our own kids?

 

00;10;37;11 – 00;10;55;19

Dr. Mona

Yeah, and you know that right? There is what we commonly say, you know, and I think sometimes with this, podcast episode is not about the anti-vaccine movement, but it’s important that we bring it up when we talk about autism, because when I bring that up, you know, it’s almost as if it’s not registered. It’s like, well, you know, like it’s like they don’t even hear it or whatever it is.

 

00;10;55;19 – 00;11;20;16

Dr. Mona

And it’s it’s hard because like you said, perfectly, as pediatricians, our job is to keep children healthy, and our job is to make sure to avoid these life threatening illnesses that vaccines prevent. And if we ever thought it would cause anything in a negative way, we would obviously not promote it. And absolutely, there are tons of research studies, actually more than we probably needed funding for, because we should be using that money for other things.

 

00;11;20;16 – 00;11;42;03

Dr. Mona

And I’ll link it on from the Healthy Children’s website, which is the AARP website. Tons of research studies showing that vaccines do not cause autism. And it is very important that people read this, and I will absolutely attach it to my show notes, because we are talking about a diagnosis that is independent of vaccines, and it’s an important diagnosis that we have to make.

 

00;11;42;03 – 00;11;59;05

Dr. Mona

And I don’t want people to be afraid of vaccines or kids in fear of this diagnosis, you know, because it’s not true. You know, the purpose of this episode is to promote awareness of autism, to not promote fear of autism, because if we’re afraid of it, then you’re not going to be embracing it if you meet and other families with autism.

 

00;11;59;05 – 00;12;00;27

Dr. Mona

And that’s the purpose of this.

 

00;12;01;00 – 00;12;24;10

Dr. Tamar Nazarian

Right? Right. And, you know, I’m gonna just to kind of put the whole autism vaccine thing topic to rest for our podcast today. You know, if truly there was a link between vaccines and autism, and they tell all this like mercury or aluminum and the thimerosal in the vaccines, well, guess what? California did this a lot earlier. But across the US, as of 2000, all of that was removed from vaccines.

 

00;12;24;10 – 00;12;46;01

Dr. Tamar Nazarian

So technically we should have been seeing a decrease in the numbers. But we’ve actually been seeing an increase over the years. So how could there be this potential association that we’ve already proven over and over again that it’s not there? You know, I think in a big part of the reason why it does get propagated so much is because of the timing of these vaccines, particularly the MMR vaccine.

 

00;12;46;01 – 00;13;08;05

Dr. Tamar Nazarian

Right. The measles vaccine that everyone is so worried about. And I think it’s because they’re usually given at like the one year and the four year mark. Right. And those are the times when kids are usually the most obvious with their symptoms, because they have to be more social, they’re put in more social environments, whether it’s daycare or preschool or kindergarten readiness and things like that.

 

00;13;08;05 – 00;13;28;06

Dr. Tamar Nazarian

And so they start looking a little different than their peers, or they don’t progress necessarily, or maybe even have a regression in some of their developmental milestones. But if we dive in deeper into the history, there were likely earlier signs pointing towards autism even before this kid got that vaccine.

 

00;13;28;09 – 00;13;40;12

Dr. Mona

Yeah. And you talked about the risk factor is one of the biggest things that I’ve always been curious about. And I’m not sure if there’s any data or, you know, if we’ve seen this is anything with advanced maternal or paternal age.

 

00;13;40;15 – 00;13;50;28

Dr. Tamar Nazarian

Yes. So advanced maternal and paternal age have both been linked, but more so. Fathers 40 and older at the time of conception is the higher risk factor.

 

00;13;51;00 – 00;14;08;27

Dr. Mona

I want more research around this because just from my practice I see a lot of that, right? I see a lot of that advanced paternal age, and even more so than 40. I’m talking fathers who are 50 plus, that are fathering children. You know, it’s not to say that every advanced maternal age that a father will fathered a child with autism.

 

00;14;08;27 – 00;14;23;29

Dr. Mona

That’s not what we’re saying. It’s a risk factor. When we say risk, it means maybe there’s a percentage increase. And, you know, it has maybe a lot to do with the sperm quality. If we’re looking at events, maternal age quality. But I agree with you, and I’m happy that you’ve also seen that trend, too. I have seen that in my office.

 

00;14;23;29 – 00;14;42;16

Dr. Mona

And, you know, I tell families I’m like, there’s a risk we don’t know numbers right now, right? Yeah, but it’s just something to think about. And it doesn’t mean that we don’t have children. It just means, hey, there is an understanding that this could be something, and we need more information. And this is what we know now. Like anything in medicine, there’s always going to be updates, right?

 

00;14;42;16 – 00;14;55;28

Dr. Mona

When every specialty we’re going to learn more. And what we know now, like you said, is that vaccines don’t cause autism. But we are also going to learn more about maybe a certain gene. Right. Like if we can isolate something or you know, more about the genetic and environmental factors.

 

00;14;56;02 – 00;15;13;07

Dr. Tamar Nazarian

What we’ve already identified, like over 100 genes that we know have some link to an autism disorder, they’re not 100%, you know, but and it doesn’t mean that if your genetic test comes back negative, you don’t have autism. It just means we haven’t found that one yet, you know? So just like you said, it’s going to come. It’s just going to take time.

 

00;15;13;07 – 00;15;20;13

Dr. Tamar Nazarian

And maybe we can stop researching vaccines and start researching these other things that put the money where we need it to go, like you were mentioning.

 

00;15;20;15 – 00;15;34;06

Dr. Mona

Yes. And that is what I just frustrates me so much that, yeah, we need to put the money in the right places so that we can get more education and awareness. Like I said, oh, this is such a great discussion about that because it’s so important that people know, you know, about the vaccines and the risk factors and models.

 

00;15;34;09 – 00;16;09;18

Dr. Tamar Nazarian

Sorry to interrupt. I was just going to say piggybacking on what you were saying earlier. You know, a lot of people these days have also chosen to wait longer to have their first child or whatnot. You know, you and I are perfect examples. We’ve pursued our education and our careers, and many in our generation have done that. So kids who are being born to more parents of advanced age, as much as I hate that word, you know, but that’s also probably a likely reason why we’re seeing higher numbers now compared to when people were having kids at like 16 or 25, you know, their eggs and sperm were just better quality back then,

 

00;16;09;19 – 00;16;11;25

Dr. Tamar Nazarian

you know, because they were younger.

 

00;16;11;28 – 00;16;28;17

Dr. Mona

Yeah. And also if you look at if you look at it, I mean, when you look at industrialized or developed countries, right, like the United States, Europe, these are usually people like me and you and maybe a lot of people listening who have gone through a lot of schooling, like you said. So yes, the the rates are higher in advanced countries.

 

00;16;28;17 – 00;16;49;21

Dr. Mona

It’s not because of likely environment, because our environment usually high educated families, you know, their environment is probably pretty appropriate. They’re not doing a lot of toxins or, you know, pollution, but your genetics is there. The advanced age. And I completely agree. And I’m actually happy we’re talking about this. This wasn’t actually something we were planning on discussing, but it’s so important because I agree.

 

00;16;49;21 – 00;17;05;06

Dr. Mona

I think there is some understanding there that we have put off childbearing. It doesn’t mean that we should not try to have children or do it, but with that comes changes in our genetics. With that comes changes in our egg and sperm quality. So yeah, Tamara, I 100% agree with you on that. Now, like I was saying earlier.

 

00;17;05;06 – 00;17;10;16

Dr. Mona

So we talked about a little bit about the risk factors. But now how is the diagnosis officially quote unquote made.

 

00;17;10;23 – 00;17;31;10

Dr. Tamar Nazarian

Well you know, it would be great if we could just do a simple blood test or imaging and say, hey, you have autism or hey, you don’t have autism. But unfortunately, it’s not that easy. The autism spectrum disorder diagnosis is typically a clinical diagnosis based on a pretty thorough history of the child’s development, paired with careful observations of certain behaviors and interaction.

 

00;17;31;10 – 00;18;15;08

Dr. Tamar Nazarian

There are gold standard, you know, quote unquote assessments, which I’ll get to. But the clinical diagnosis is usually the most important, the done or most commonly done when a physician takes a full developmental behavioral history from early childhood to present, asking questions about eye contact, ways the child makes request when they start speaking, or how they play or interact, etc., followed by, you know, a medical and neurological exam and assessments of maybe the child’s cognitive or speech abilities and then just observing their behavior, you know, talking about those gold standard assessments for autism, you know, it’s usually the combination of what’s called the Adas two or the, autism diagnostic Observation schedule, second

 

00;18;15;08 – 00;18;43;04

Dr. Tamar Nazarian

edition, and the ADR, which is the Autism Diagnostic Interview Revised Edition. The Adas involves an interactive, kind of play based activities that provide the opportunity to observe the presence or absence of specific behaviors related to autism spectrum disorders, whereas the ADR pairs that with a detailed parent interview really digging deep into early infancy and toddlerhood, etc. certain signs and symptoms.

 

00;18;43;04 – 00;19;04;04

Dr. Tamar Nazarian

And ideally you want to have an interdisciplinary or at least a multidisciplinary team assessment like I have at my clinic, where it’s great because then the practitioners from all the different disciplines usually a physician, a psychologist, a speech therapist and an occupational therapist can all observe at the same time and have time to discuss their findings and conclusions.

 

00;19;04;04 – 00;19;13;28

Dr. Tamar Nazarian

They make an informed decision all together, and then you get a comprehensive set of recommendations regarding treatments and therapies that can lead to a lot better coordination of care in the future as well.

 

00;19;13;29 – 00;19;29;20

Dr. Mona

Well, that kind of leads me to just another question, because obviously, general pediatricians, we can help make that diagnosis or, you know, lead families to the right early intervention services. But with a developmental behavioral pediatrician, like you said, the benefit would be that you have a team approach at your disposal, correct?

 

00;19;29;22 – 00;19;52;27

Dr. Tamar Nazarian

Yes. You know, not all developmental behavioral pediatricians have them. Like we mentioned, we’re few and far apart. You know, it’s hard to find us. And when you do, we have long waitlists and even longer for these types of team appointments. But we do a lot of times, like I have the luxury of having that opportunity. So I do diagnosing both ways just on my own and also with my team, depending on the situation.

 

00;19;53;01 – 00;20;06;05

Dr. Mona

And in terms of the approximate age we make the diagnosis. You know, obviously we do screenings in the pediatric office, but when do you kind of see the average in the United States of that child officially getting that diagnosis?

 

00;20;06;09 – 00;20;33;08

Dr. Tamar Nazarian

Well, you know, a reliable diagnosis is usually able to be made at two years old by most trained professionals, including pediatricians. But it can be detected as early as 12 to 18 months. And there’s actually a separate kind of diagnosis for that called early onset autism spectrum disorder. But the unfortunate thing is that many children don’t actually get their final diagnosis until much older, usually school aged, especially those with more subtle symptoms.

 

00;20;33;08 – 00;20;48;29

Dr. Tamar Nazarian

And so there’s that big kind of critical period that we miss with early intervention opportunities sometimes. And that doesn’t mean that these kids aren’t going to improve or aren’t going to be able to be helped. It just means it may take a little longer. It might be a slower progression.

 

00;20;49;05 – 00;21;09;13

Dr. Mona

What do you think it is? Do you think that as general pediatricians, we should be following their development a little more closely? Or do you think it’s, you know, is it that watch and wait that we’re kind of, you know, how we were saying earlier that a lot of these things can be normal toddler development or do you just think that it’s just kind of natural that way, that, hey, a pediatrician is watching these things, the parent is watching these things.

 

00;21;09;13 – 00;21;17;18

Dr. Mona

And of course, we realize that things aren’t maybe changing or improving. What do you think we can do differently to kind of move down that age of diagnosis?

 

00;21;17;23 – 00;21;34;11

Dr. Tamar Nazarian

You know, I always tell parents, trust your gut, you know, and and as great as all of us pediatricians are, and we try to be, we’re always working towards the best interest of our patients. But we get to see only a snippet of time, and we get to only hear those answers to those questions that maybe we’ve asked them.

 

00;21;34;11 – 00;21;57;17

Dr. Tamar Nazarian

Maybe a parent doesn’t know they’ll bring something up or doesn’t realize something is atypical in the moment, you know? And so it’s very hard for you guys in the general pediatrics world to be able to do all this. But that’s also why every state, you know, under the idea or the Idea act, you know, the federal law that gives federal funding to states to do early intervention programs exists.

 

00;21;57;17 – 00;22;20;19

Dr. Tamar Nazarian

Right? So I know here in California, I used to tell parents when I was doing my general pediatric residency, even if you have the slightest suspicion, call your local early intervention program. For us, it’s the regional centers here in California, you know, and just tell them, hey, I’m worried about my kid’s development. I want something done. You know, your pediatrician does a great job of it also.

 

00;22;20;19 – 00;22;36;19

Dr. Tamar Nazarian

And they can make these referrals as well. But that’s the beauty of these early intervention services, is that you also have that second opinion if you need it. Who at least here in California, they’re able to come into your home and see a child in a more naturalistic environment and make an assessment there, too.

 

00;22;36;19 – 00;22;59;16

Dr. Mona

Yeah, I will try to attach that to the show notes, because I live in Florida and I agree we have it as well. Early intervention services. I think you said every state should have it, in terms of coverage and cost. It may depend state to state, I think, but it’s very, very useful. I mean, my son had a stroke at birth, so he automatically qualified for early intervention services because of the stroke.

 

00;22;59;16 – 00;23;20;12

Dr. Mona

Right. So from meaning services, meaning evaluation. So we went initially, and then they did some evaluations when he was super young. And then finally, you know, we I was monitoring things. We saw that things were going well. So now we don’t go to those appointments one, because I want to keep them open for other families. But I cannot express enough how thorough of an evaluation this is, right?

 

00;23;20;12 – 00;23;38;24

Dr. Mona

We talked about how, as a developmental pediatrician, you do so much with so many different people like psychologists and other specialists, but they have so much time. I mean, he was only two months old and I was there for three hours at the center. Like, Doctor Tomar said, you can always come into your home, too. But this was right before Covid hit.

 

00;23;38;24 – 00;23;47;09

Dr. Mona

So they had it in the office and it was so impressive. Like I was really impressed by it. So yes, that is a great resource, right.

 

00;23;47;09 – 00;24;16;05

Dr. Tamar Nazarian

And just like I mentioned, every state has their own version of the program and a lot of states the services are free or at minimal cost to families and in-home. And so I think it’s a wonderful opportunity for all families. Back at our UCLA days, I used to work and I ran a family resource center, and so I used to tell even parents who had, you know, just for being a premature baby, just for having maybe born with albinism or other genetic conditions.

 

00;24;16;05 – 00;24;24;10

Dr. Tamar Nazarian

Hey, you know, there’s this resource out there, use it, take advantage, and just guarantee the best quality of life for your child. Why not?

 

00;24;24;12 – 00;24;45;21

Dr. Mona

Right. And you know, you talked about parents trusting their gut. And. Oh yes, I mean, that is exactly my message for this episode in pretty much any episode. But if you feel like something is not quite what you would expect, or maybe you’re not sure, you talk to your pediatrician. If they say, you know, let’s watch and you still feel upset or feel like I don’t feel something right?

 

00;24;45;21 – 00;25;03;17

Dr. Mona

Like Tamar said, you can absolutely reach out to these services and get an evaluation, and you can let your pediatrician know and say, hey, I really value you. I, I think you’re, you know, a great doctor. You don’t have to do it like behind their back, but just say, hey, I really appreciate you. I, you know, when you see them next time I did this evaluation.

 

00;25;03;17 – 00;25;17;09

Dr. Mona

You’re right. You know, everything look good. And I so appreciate you giving me this resource. Like, don’t feel afraid to tell your pediatrician how you feel. And you know how I advocate for that and say I have had to do this too, as a when I was pregnant. So, you know, I, I think you’re such a great doctor.

 

00;25;17;09 – 00;25;35;12

Dr. Mona

I really appreciate all you’ve done something. Does it feel right for me? What else can we do and keep that open? Communication. And your pediatrician, if they’re a great one, should say, you know what? I see it. Let’s let’s do this. You know, I do feel like some pediatricians are very hesitant to give referrals or they feel like, oh, you don’t need to.

 

00;25;35;12 – 00;26;00;14

Dr. Mona

It’s okay for, you know, anyone listening who’s a pediatrician to say, you know what? Why not? Why not have this other extra pair of eyes or hands beside me take a look at this child. I think it’s if a parent wants it. Yeah, if they want it. I think it’s totally warranted. You know, it’s not anything bad. It’s something that if a parent is expressing concern, I think our job as the front line general pediatrician is to say, look, I hear you.

 

00;26;00;16 – 00;26;13;06

Dr. Mona

Even though I may not be concerned, I hear that you’re concerned. And I think let’s why not? Why not get another developmental behavioral pediatrician, neurologist or whoever it is? Early intervention is to take a look at your child.

 

00;26;13;08 – 00;26;37;01

Dr. Tamar Nazarian

Right. And, you know, best case scenario, there truly is nothing wrong or nothing delayed in that child. And you have just now fortified your relationship with your patients. So and they’re now more confident in you as a physician as well. And parents, you know, you’re just building this partnership as you go along with your child’s doctor. And so just utilize everything and anything that you have at your hands.

 

00;26;37;03 – 00;26;53;17

Dr. Mona

Yeah. And in order to make the diagnoses, right, I mean, obviously we as pediatricians get concerned, based on development that we’re seeing, does it need to go through a certain subspecialists like, do you need to see a neurologist or developmental behavioral pediatrician to make the official diagnosis?

 

00;26;53;17 – 00;27;30;14

Dr. Tamar Nazarian

Well, if you’re going to use one of the gold standard measures or you want, you know it to be something that no one can really question, right. Then I do highly recommend, yes, you do go through a developmental behavioral pediatrician, pediatric neurologist with specialized training in autism, a child psychologist, psychiatrist with training in autism. Because not all of these neurologists or psychiatrists have the training as well as, you know, a psychologist, one with a PhD or somebody, preferably, you know, who has the training to do either the Ada or the HDI or some of the other testing measures out there.

 

00;27;30;14 – 00;27;51;16

Dr. Tamar Nazarian

And to do that. But because we are such a rare breed, there are so few of us available, it’s okay, you know, especially in those more obvious cases for a pediatrician to make that call. But I’m sure you’re going to talk about this in that other podcast. There are often times, not often, I would say sometimes where there are misdiagnoses made, and maybe it was something else.

 

00;27;51;16 – 00;28;11;24

Dr. Tamar Nazarian

That’s where also, you know, in the diagnostic process, these additional tests can come in handy. We don’t say do blood tests or MRIs or EEGs for every child that you suspect autism in. But when you’re suspecting other contributing symptoms or clinicians, then you can think about doing, hey, maybe I should do a hearing test, you know, for a speech delayed kid who has good social skills.

 

00;28;11;24 – 00;28;35;11

Dr. Tamar Nazarian

Maybe I need to do lead testing. Maybe this child, you know, has exposure to that or what’s that test if there’s concern for tuberous sclerosis and etc., etc.. Neuroimaging for like an MRI or an EEG, you know, if you’re suspecting seizures or anything like that. But these evaluations are not necessary unless there is suspicion for something contributing.

 

00;28;35;13 – 00;28;46;20

Dr. Mona

Now, we talked about the vaccines already, and the fact that they do not cause autism. But what other misinformation do you hear regarding autism? Mainly around therapies, things like this.

 

00;28;46;22 – 00;29;14;05

Dr. Tamar Nazarian

Oh, Mona, I, I it breaks my heart when I hear some of these stories. And, you know, I really want to put it out there for families to please, please, please avoid these dangerous treatments at all costs because the people that do provide these treatments are such good advertisers or marketers for their products. But I’ve heard such horror stories, you know, and parents spending thousands of dollars and then getting disappointed.

 

00;29;14;08 – 00;29;41;26

Dr. Tamar Nazarian

So some of these things are like chelation therapy, you know, is the process of using a chemical to strip metal from the blood? Well, if you truly, truly have mercury poisoning from some exposure, which is extremely rare, right? And almost all children with autism don’t unless they’ve had a known ingestion of it. Chelation therapy will lead to a serious issue, particularly stripping the body of other important minerals or ions like calcium, which your heart needs to keep beating.

 

00;29;41;26 – 00;30;04;13

Dr. Tamar Nazarian

And they’ve actually been reported deaths or serious injury. Other things, like the hyperbaric oxygen chamber is another one where you’re subjecting a child with autism to, quote unquote, oxygen therapy, which is not only a waste of money, but it can make the child feel really sick because there truly is something as too much oxygen, you know, and it can lead to oxygen poisoning, causing lung damage or vision damage or even worse.

 

00;30;04;19 – 00;30;25;12

Dr. Tamar Nazarian

And I’ve even heard of these chambers exploding. It’s scary, right? You know, and then we all heard about the whole bleach crisis with this Covid thing, and there’s actually, something out there called a miracle mineral solution, which is essentially a bleach enema, you know? So, please, you know, it sounds scary. And you can see what it does to clothing and surfaces when you use bleach.

 

00;30;25;17 – 00;30;46;14

Dr. Tamar Nazarian

Just imagine what that’s going to do inside your child’s stomach or intestines, you know, and there’s so many other things out there too. There’s, families are flying all around the world doing these stem cell treatments. And although there are legitimate studies ongoing in the U.S., I think it’s at Duke University. Right now. Or Dartmouth, one of those that’s doing this.

 

00;30;46;14 – 00;31;07;13

Dr. Tamar Nazarian

And there’s some promising results, but nothing really saying that this is going to be a good treatment just yet. And no FDA approval or evidence based just yet. But in other countries where maybe the stem cell therapy that they’re doing is nicer, as regulated or as safe, they’re touting these and families are traveling to these places and doing these.

 

00;31;07;13 – 00;31;10;02

Dr. Tamar Nazarian

And there have been a lot of complications with that as well.

 

00;31;10;05 – 00;31;36;00

Dr. Mona

I couldn’t agree more. I mean, it’s, it’s running rampant on like social like on social media. I mean, I’ve seen posts about different things, like you said, the deletion, these certain elimination of certain like certain food, certain dyes. I mean, it’s so much out there and it’s so hard for families. And you have to understand that when you’re consuming information, if someone is charging you an arm and a leg for their service and for a product that’s not evidence based, right?

 

00;31;36;00 – 00;31;54;13

Dr. Mona

I mean, you really need to be careful. You know, they’re saying that, yeah, we can do this injection or do this thing and they don’t have any scientific data to support it. You got to think about it. And this is why I think there’s this like not pitting but like, you know, we have traditional medicine, which is anyone who is board certified in pediatrics or developmental behavioral pediatrics.

 

00;31;54;13 – 00;32;12;26

Dr. Mona

And then there’s other people like functional medicine doctors that have become like this. You have to do this or that. You can talk to your medical doctor, the person who went through residency, and ask people like Doctor Tamara, what are the updates? Right? You obviously spend your whole life keeping up to date on all of the updates in therapies and whatnot.

 

00;32;12;26 – 00;32;36;15

Dr. Mona

So don’t dismiss your pediatrician or your developmental behavioral pediatrician or neurologist or whoever was helping you make that diagnosis and talking to them about what current therapies, if they tell you, you know, there’s no research on this and tell you, hey, this is actually potentially could be dangerous. I mean, you need to listen to that because, again, our job is to keep your kids safe and not have them, you know, be harmed by these things that have no evidence base to it.

 

00;32;36;18 – 00;32;54;18

Dr. Tamar Nazarian

Right. Mona and I always tell families, are they constantly like, okay, what can I do? What are alternative things I can do? So I tell them, let’s sit down. Let’s talk about it. What have you read? This is what I know. And let’s compare it right. The gluten casein free diet is another big one, right? That a lot of families with children with autism will say, hey, I did this.

 

00;32;54;18 – 00;33;18;05

Dr. Tamar Nazarian

And magically it all went away. Well, it doesn’t work for everybody. Certain people, yes, who have maybe a gluten or casein allergy, sure, it’s going to work for them, especially if they’re on that nonverbal autism spectrum where they can’t express when they’re feeling irritable or have a tummy ache or feel sick, you know, and so they are going to be worse in terms of their symptoms of autism when they’re so uncomfortable.

 

00;33;18;05 – 00;33;39;11

Dr. Tamar Nazarian

And when you meet them of that discomfort, they are going to magically be better, right? To an extent. But that doesn’t mean you’ve cured the autism. You’ve just made their tummy feel better. Or I tell parents, you know, hey, if you’re going to do something, let’s do something like omega three supplements, which have been proven time and time again to help with just a touch of an increase in maybe cognitive abilities.

 

00;33;39;11 – 00;33;44;07

Dr. Tamar Nazarian

But everything should come from more natural sources, like your food intake and not necessarily supplements.

 

00;33;44;14 – 00;33;57;17

Dr. Mona

Yep, I’m so glad we talked about that. That is so important. And, you know, we talked about the things that we should not be doing or be more wary of. But what are the things that can provide the most optimal outcomes for a child with autism?

 

00;33;57;19 – 00;34;22;21

Dr. Tamar Nazarian

Early intervention, early intervention, early intervention. You know, we know that early intervention has the biggest impact in improving the quality of life in the future. Because 80% of a child’s brain develops by age three and 90% by age five. And so we can make just so much change in those critical windows with intensive early services and, you know, have better quality of life and care.

 

00;34;22;22 – 00;34;51;28

Dr. Tamar Nazarian

Typically, what we do over treatment in kids with autism, it’s not medication. In fact, there is no medication specifically for autism. There are certain medications that we use to treat symptoms of autism when there are severe delays or aggressive behaviors causing physical harm and injury, but typical treatments include things like speech and language therapy to help promote not just their ability to speak verbally, but also their nonverbal communication, their understanding of jokes and sarcasm and things like that.

 

00;34;51;28 – 00;35;14;20

Dr. Tamar Nazarian

There is occupational therapy, which addresses self-care issues, toilet training. It can address sensory issues if they’re sensitive to sounds or textures or picky eaters. There’s infant stimulation, which is often done by those early intervention programs we’ve talked about and then there’s applied behavior analysis or ABA therapy that a lot of parents, you know, are just so thankful for.

 

00;35;14;27 – 00;35;37;27

Dr. Tamar Nazarian

It’s the most helpful, I would say, and those most severely impacted with autism or an intellectual disability. But basically these are the more typical treatments that are out there to give our children who do, who are on the autism spectrum disorder a chance to learn the skills that they may not have naturally, and just give your child an opportunity for social interaction and engagement with peers, of course.

 

00;35;38;03 – 00;35;59;00

Dr. Mona

Oh yeah, and I mean, we were recording this during the pandemic where so many of my families, you know, they’re they’re early intervention services or AB therapies either had to be go, go virtually or they had to be stopped. I mean, there was so much headache in Florida where I’m practicing, and I felt terrible. I mean, so many families struggling to get in with these services that they had.

 

00;35;59;00 – 00;36;16;01

Dr. Mona

Or there was there’s just so many waitlists and the time frame, I mean, we need better early intervention services in this country, and I’m sure all over the world, it’s it’s frustrating. I mean, as a general pediatrician in Florida, I mean, I don’t know how how bad it is in California, but here it’s just the waitlist is way too long.

 

00;36;16;01 – 00;36;18;22

Dr. Mona

I mean, I feel terrible for so many of my families.

 

00;36;18;25 – 00;36;41;07

Dr. Tamar Nazarian

Yes. I mean, even in California, where we actually have a lot of developmental pediatricians, they tend to kind of settle on the coasts more so in Middle America, unfortunately for them. But, even here, I mean, we have waitlists. If I want a team assessment, you know, in certain places, even when I where I used to work before I came to Kaiser, you know, it could take up to like six, nine months, a year.

 

00;36;41;07 – 00;37;05;17

Dr. Tamar Nazarian

Who knows? You know, it’s really depend. And so it’s really difficult. And like I said, with this pandemic, it’s been very hard for children with autism because you have to understand that their brain works very differently. Right. And so for them to understand virtual therapy versus real life therapy, already most of these kids have a hard time applying what they learn in one session, let’s say at a speech clinic to then apply that to their daily life.

 

00;37;05;17 – 00;37;27;12

Dr. Tamar Nazarian

Well, now you’re giving them virtual people and teaching, and these virtual people have to teach them how to be social. Well, you mean nothing to them when you’re just a screen, right? And so it’s been a real struggle, like you said, for these families, especially some of these that are in those critical periods to where we know we can make so much change, and it just breaks my heart that I haven’t been able to get those therapies to them, you know?

 

00;37;27;12 – 00;37;35;23

Dr. Tamar Nazarian

But, healthy and alive family is better than, you know, not. And so we had to be careful with this pandemic.

 

00;37;35;25 – 00;38;03;04

Dr. Mona

Yeah. And it really was, you know, killing me. I mean, I, I saw this happen and I saw it unfold, and I’m still. It’s getting better. But so many families either had to move, relocate their chasing services for their child, you know, to get the best outcome. And when I asked you, like, what is the most optimal outcome for a child with autism, like you said, all these services that we do with OT, speech, PT, these are so important, but it has to be done and it has to be consistent and it has to be quality.

 

00;38;03;04 – 00;38;27;02

Dr. Mona

And when there’s lack of funding, it’s just to me, not sure when I know the outcomes are better when we have those services at an early age. And we didn’t even speak about the socioeconomic disparity. Right? I mean, I work in Florida with a lot of low income, you know, low income families that have autism. And, I mean, it’s just so hard getting services for these families if you have money.

 

00;38;27;02 – 00;38;36;23

Dr. Mona

Thankfully, there may be a little bit more opportunity, but that’s not fair. I mean, that is not right that we have that sort of dichotomy for just how much you can pay, you know?

 

00;38;36;25 – 00;38;56;08

Dr. Tamar Nazarian

Right. And it’s same in California, even though we have these early intervention services and programs located in all parts of the state, the actual vendors are therapists are not. Even though we’re recommending it doesn’t mean that they’re necessarily going to get it. You know? And like you said, it just breaks my heart when I see that. And there’s so much potential.

 

00;38;56;08 – 00;39;14;03

Dr. Tamar Nazarian

And many of these therapies need not just the time spent within the therapy with the therapies themselves, but then the parents need that time at home to also be working with their children, getting on the floor, working with them, playing with them, trying to engage them with their eye contact, teaching them how to make requests, you know, teaching them how to interact socially.

 

00;39;14;03 – 00;39;35;12

Dr. Tamar Nazarian

But many of those families in lower socioeconomic, you know, areas have to work. They work 2 or 3 jobs and they don’t have that luxury of time. So the child may just be sitting in front of a screen or with a babysitter who is babysitting ten other kids you know and may not notice or have that opportunity to spend that extra effort with that child.

 

00;39;35;14 – 00;39;45;14

Dr. Mona

I’m so glad we were able to talk about this tomorrow. It’s just so nice to reconnect with you. Talk about this, and educate our listeners. What would be a final message you have to everyone listening today?

 

00;39;45;21 – 00;40;04;00

Dr. Tamar Nazarian

I already mentioned the whole early intervention is key. You know, I like to encourage all parents to observe your child, trust your gut, seek help if you feel something is not right, and don’t ever feel shame or embarrassment. It could be anything from like an odd behavior to a speech delay, or just not progressing with those expected developmental milestones.

 

00;40;04;00 – 00;40;29;18

Dr. Tamar Nazarian

Just remember, you know when you meet one child with autism, you’ve only met one child with autism. Meaning the way autism presents in every child is somewhat different. That’s why it’s called an autism spectrum disorder. Right. And the thing that people also don’t realize is that even during that child’s life course, the symptoms may wax and wane. And so therefore, their whole presentation of the disorder is also a spectrum, I say over the life course.

 

00;40;29;18 – 00;40;53;16

Dr. Tamar Nazarian

So just keep that in mind. You know, we don’t say high functioning, low functioning anymore. We talk about severity levels, but it’s more so to guide how much treatment a child needs, not necessarily what the prognosis of that child is going to be because it’s going to change over time. And please, please just trust science, vaccinate your children and don’t subject them to any dangerous or non evidence based treatments.

 

00;40;53;18 – 00;41;09;29

Dr. Mona

Couldn’t agree more. Thank you again. I’m going to be attaching a lot of resources in my show notes. And you also have to make sure you listen to the other episodes I released today. One is from a mama who, has a child with autism, and then the other one is with a early interventionist, speech therapist.

 

00;41;09;29 – 00;41;12;08

Dr. Mona

So thanks again for joining us, Tamar.

 

00;41;12;10 – 00;41;24;21

Dr. Tamar Nazarian

Thank you Mona. It was such a pleasure being on and catching up. Thank you for doing this. And I really look forward to joining the ranks of fellow female physicians like you on Instagram, helping educate and empower parents and fellow providers.

 

00;41;24;23 – 00;41;40;26

Dr. Mona

And I will be attaching her Instagram, which we are hoping to grow because she has so much amazing, as you can see, education for all of us. And like I said earlier, she’s also going to be back on the podcast hopefully this year. To talk about more topics that I’ve been asked for my followers. So thank you.

 

00;41;40;29 – 00;41;43;29

Dr. Tamar Nazarian

Yes, anytime. Thanks, Mona. It’s been great. Take care.

 

00;41;44;01 – 00;41;59;23

Dr. Mona

Thank you for tuning in for this week’s episode. As always, please leave a review. Share this episode with a friend. Share it on your social media. Make sure to follow me at PedsDocTalk on Instagram and subscribe to my YouTube channel, PedsDocTalk TV. We’ll talk to you soon.