Before consultation, Please if possible fill the two forms , form 1 and form 2 below and send the filled report copy paste as whatsapp to 9869405747 and for free genetic counselling and advice for genetic test, click here Visit bottom of page for payment. QR code . Also watch and understand the video talk on this page.
Click here to Listen / watch the Talk by Dr Kondekar on Autism reversal with DSM 5 Perspective
One fb live session by Dr Kondekar on Autism
Click here for more such talks by Dr Kondekar
Key principles in Autism reversal:
Dr Kondekar's ten commandments on Autism reversal:
GOAL DIRECTED COGNITIVE APPROACH
1.Dont be Special, turn into social
2.To make social, switch from object world based teaching to people and action based teaching
3.To develop communication; switch from screen based learning to body language based learning
4.To develop language, switch from seeing-doing activities to listening talking activities
5.Sitting tolerance increases by sitting activities with sensory breaks as per childs requirement. Making a child continuously jump and run will make him expert in jumping and running
6.Constant hugging kissing and carrying skin to skin, make the child get physically pampered and stubborn. keeping your child 2 feet away face to face helps develop eye contact and social communication
7. If you dont make rules for child behaviour, child will start ruling you and throw tantrums to change your behaviour.
8.Children copy what they see, hear and feel. Dont let them see ,hear and feel what u dont want them to learn, for example saying no or physically handling the child or shouting to grab attention.
9.Dont teach letters and alphabets,or what is this type of teaching; they are for picture recognitions. Teach in sentences, it means language. Dont ask questions, just go on narrating.
10.Music/rhymes is good only for momentary solo pleasure. Switch to lyrics and language if you wish the time to be utilized for learning and communication.
Dr Kondekars ten commandments on Autism reversal
AUTISM DSM 5 CRITERIA: DR KONDEKAR MUMBAI 98694-05747
A: social communication and interaction: persistent deficit: one each of a1 a2 a3 is must
A1: any 1 of following is enough: social emotional reciprocity-1. Social approach Abnormal,2. Abnormal back forth conversation, 3. Reduced sharing of interest Emotion/ affect,4. Failure to initiate or respond to social interactions
A 2: any 1 of the deficit in nonverbal communication –1. Poor verbal / nonverbal Communication, poor eye contact, 2. Poor body language,3. Deficit in gesture use or 4.Total lack of facial expressions or non verbal communication
A3: 1. Deficit in developing maintaining and understanding relationships 2. Difficuty Adjusting behavior to suit various social context 3. Difficulty in sharing imaginative Play or making friends 4. Absence of interest in peers
B: any 2 of the following: restricted, repitive patterns of behaviour, or interest, or activities
B 1: any 1 of stereotyped or repititve motor movements anyy one of: 1.use of objects 2.Simple motor stereotypes 3. Lining up toys 4. Flipping objects 5. Echolalia 6. Idiosynchratic phrases
B2: any 1 of sameness / rigidness/ inflexibility/ rituality verbal or non verbal: 1.Extreme distress at small changes 2. Difficulty ith change or transition 3. Rigid thinking
Pattern 4. Greeting rituals 5. Need to take same route 6. Eat same food every day
B3: any 1 of restricted fixatd interest of abnormal intensity / focus: 1. Strong Attachment / preoccupation with unusual objects 2. Excessive circumscribed or Perservative interests
B4: hyper or hypo reactivity to sensory input or unusual interest in sensory aspects Around 1. Apparent indifferrence to pain and temperature 2. Adverse response to sound Or texture 3. Excessive smelling or touching of objects 4. Visual fascination with light Or movement
C: must be present since below age 6 year, may be masked in later age, may not be Manifest unless demand or stress
D: clinically significant impairment in social occupational functioning
E.if associated developmental delay or intellectual disability; social communication Should be age inappropriate for developmental age
Symptoms and/or behaviors that have persisted ≥ 6 months in ≥ 2 settings (e.g., school, home, church). Symptoms have negatively impacted academic, social, and/or occupational functioning. In patients aged < 17 years, ≥ 6 symptoms are necessary; in those aged ≥ 17 years, ≥ 5 symptoms are necessary
Inattentive Type Diagnosis Criteria
Displays poor listening skills • Loses and/or misplaces items needed to complete activities or tasks • Sidetracked by external or unimportant stimuli • Forgets daily activities • Diminished attention span • Lacks ability to complete schoolwork and other assignments or to follow instructions • Avoids or is disinclined to begin homework or activities requiring concentration • Fails to focus on details and/or makes thoughtless mistakes in schoolwork or assignments
Hyperactive/ Impulsive Type Diagnosis Criteria
Hyperactive Symptoms: • Squirms when seated or fidgets with feet/hands • Marked restlessness that is difficult to control • Appears to be driven by “a motor” or is often “on the go” • Lacks ability to play and engage in leisure activities in a quiet manner • Incapable of staying seated in class • Overly talkative
Impulsive Symptoms: • Difficulty waiting turn • Interrupts or intrudes into conversations and activities of others • Impulsively blurts out answers before questions completed
Symptoms present prior to age 12 years • Symptoms not better accounted for by a different psychiatric disorder (e.g., mood disorder, anxiety disorder) and do not occur exclusively during a psychotic disorder (e.g., schizophrenia) • Symptoms not exclusively a manifestation of oppositional behavior
Tests in Autism
Autism is not diagnosed by tests, scans, imaging or blood levels. Diagnosis of autism is purely based on assessment by neurodevelopmental pediatrician or pediatric neurologist through question-answers, history taking and observation of the child. There are various scales like ISAA,CARS,TABC, etc but most are based on diagnostic criteria before 2013.
Actually Dr Kondekar Does not advise any tests in Autism. Actually in most cases of autism, tests are not needed for diagnosis or monitoring or treatment.
Diagnosis of Autism is by questionnaires. For process of certification the ISAA questionnaire or INCLEN _AIIMS is recommended in Indian Law. Actually most questionnaire based tests are based on DSM IV criteria for autism, which is actually outdated after 2013 when DSM V is proposed.. In DSM V severity was decided by scores of DSM IV based tools like ISAA CARS ADOS 3di etc
There are very few questionnaires based on DSM V [ form 2 as above ] are available. AIIMS has modified its INCLEN tool as per DSM V.
As per new guidelines, The severity is not decided by scores but by level of disability.
actually test results are reports based answers to questions and observation by a pediatrician or therapist or psychologist. the test reports may change as per the answers given by parents and also often its natural for parents to go defensive when a question points out at some disability. Remember a level of development that is not consistent age appropriate and reciprocable will not be taken as positive development during that assessment.
So results may be different from person to person taking the test.
I RECOMMEND NOT TO GO BY TEST RESULTS BUT USE THEM FOR DOCUMENTATION and COUNSELLING ONLY.
OTHER TESTS :
OFTEN ARE FOR RESEARCH PURPOSES.>>>
1. BIOCHEMICAL BLOOD TESTS FOR RARE DISEASES ; THERE IS A LIST, OFTEN IN SEARCH OF ACCIDENTAL RARE METABOLIC DISEASE OF MENTAL RETARDATION REALTED ISSUES. RARELY OF SOME HELP IN GIVING SPECIFIC COCKTAIL MEDS. Like say thyroid profile, homocysteine, CPK, TTG, b12, lead,etc I don't ask any of them on routine basis.
2. GENETIC TESTS - DEPENDING ON CLINICAL PICTURE, ITS OFTEN LIKE SAY FRAGILE X, MECP2 ETC DNA/MLPA / MUTATION STUDIES OR KARYOTYPE, CHROMOSOMAL MICRO ARRAY, EXOME SEQUENCING WES/CES, AND TRIPLE TEST MAINLY THESE WILL BE OF HELP IN PREVENTING AUTISM IN NEXT PREGNANCY. CHK THE PDF ON THIS PAGE FOR WHY GENETIC.
3.NEUROIMAGING & EEG - FOR RESEARCH PURPOSES AND IN CASES OF EPILEPSY OR SYNDROME SUSPECTED. DR KONDEKAR PREFERS MRI BRAIN MRS WITH TRACTOGRAPHY OR PET, PRE AND POST TREATMENT OF SIX MONTH.
4. TESTS DONE FOR IMMUNITY FUNGUS TOXIN METALS AND MICROBIOME ASSAY --- NOT RECOMMENDED AT ALL FOR DIAGNOSIS OF AUTISM..
FOR ANY TESTS RELATED INFORMATION WHATSAPP 9869405747 FOR FREE ADVICE
Click here to Listen / watch the one hour Talk by Dr Kondekar on Autism reversal with DSM 5 Perspective another 30 min talk on autism
Another fb live session by Dr Kondekar on Autism
Click here for more such talks by Dr Kondekar
Epilepsy video talk by Dr Kondekar
Please if possible fill the two forms , form 1 and form 2 below and send the filled report copy paste as whatsapp to 9869405747 and for free genetic counselling and advice for genetic test, click here Visit bottom of page for payment. QR code
After 2013, the revision of criteria is made to call is DSM V Diagnostic Criteria for autism, see form 2 link above. Accordingly we have devised a scoring system and classification for autism, click here for same.
DSM 4 based scoring system for self use and understanding
DSM 5 based scoring system for self use and understanding
*Understanding-Goal Directed Cognitive Approach :GDCA*
Dear Parents Make a list of all things u feel will be impossible in your kid and work towards it.
If you believe nothing is impossible, list things or issues your kid has difficulty in and list what all you did for your kid for same issue for last 3 months.
List what all you made possible. if you can list all changes you brought in last 3 months, discuss with expert about next step and how rapidly it can be achieved.
If you are stuck at a step for more than 3 months, we are losing time and raise an alarm.
*Accept autism, don't accept disability, work towards enabling same*.
Hard talk on autism for autism parents
Understand and re understand the issue differently and work towards it.
Its true that you know best for your kid, but *its equally true that u don't know what is best for others kids*
Parenting an autism kid since ages, doesn't make you an expert for others kids unless you get through details of thousands of cases.
So unless you are expert *don't start teaching other parents,* you may be giving some information halfway which is true only for your kid. work on your kids not others'.
It's not a routine parenting issue in autism.
*Dont give up your desire to learn and do something new every day.*
its true that home BASED therapy is needed, but *don't make your house a therapy center with various toys and activities.*
Home therapy in true sense will mean practicing tricks with home based day to day objects and acts.
if you feel you have learnt all tricks of OT etc , and you can teach OT to any kid with autism or take care of your autism kid for years, *you are wrong*; it just means that you dont know the next step.
Sometimes it's good to accept we are wrong, then only we can *see the ray of hope.*
When we work with medicines and therapy *we develop connections and cross connections to processing centers;* which shows extended level of communications in the form of development in various *domains of understanding* including knowledge, nonverbal communication, behavior, emotions, socialization, interactive games and talking and writing skills apart from physical things. **
*Leaving things half way will develop connections half way and loose connections always die.* ** Often with a spark.
*Development is decided by connections, speed is decided by myelination.*
At least keep a *minimum goal of readiness for primary school* admission over 2 year phase.
Then divide them into steps.
*Later the age of intervention or medicines harder will be recovery or development of milestones.*
Work towards reducing severity of level, A child who can take main stream schooling for primary usually is *independent* and can be educated and trained to take care of family responsibly , when he or she grows up.
*Remember every one has limits.. even God too does.. we all are attempting to look beyond the perceived limit and find a higher achievable limit, in the best interest of the child, when we walk towards horizon attempting to touch the limit, the limit too moves ahead.
*giving us hopes to improve further every month Dr Kondekar #MakingSense
I want all parents to understand when we are looking for improvements, what all changes we may look for.
A keen parent would like to note down minor details about every change on weekly basis rather than saying sir no improvement.
Other parents may have similar ideas but if u don't note down In details, it's not easy to compare the improvement across time line.
See the monitoring chart available at www.neuropediatrician.com for getting a serious idea to see objective change.
The improvements can be minor when we expect changes every week , it's always better to note down.
*Try to list changes as per gains since last visit and goals till next visit* Also you have headings activities - living, household,, skills and gross /fine motor, Communication, Interaction, Academics Langauge concepts, Pre match concepts Story concept, Math concept Abstract concepts etc.
Medicines : As I told u most of them are raw material used for building block for forming bridges in brain... its not just repairing wires or filling the potholes on the raods of brain with raw material, but its like building more roads, new connections, new bridges, remoulding brain to re learn, improving internal connectivity and data trafficing and data processing brain, and improving cognition so that the sensory overload doesnot result in sensory and behavioural issues. These combinations will reduce or change every month after every weekly titration across whatsapp. After first positive response we follow gradual reduction in some medicines...systematically. Half hearted efforts will give incomplete response, more so in a situation where world say nothing can be done except exercises. Exercises only effect the input but has no major role in processing connections inside the brain. Changing environment alone is not a solution here, but we do need to change the processing speed of CPU of brain. Dr Kondekar
GF DIET TOXINS CHELATION AND STEM CELLS ARE WASTE OF TIME AND RESOURCES IN AUTISM AT PRESENT.
Speech delays are very common among children with autism, but they are also common in children without autism. In autism often hearing is normal, but the child doesnt seem to listen.
Speech delay can often be associated with hearing deficit. Hearing deficit can be commonly due to ear infections like ASOM, CSOM, Otitis Externa, Ear wax, damage to auditory labyrinth or cortex of brain following meningitis or antibiotic use and rarely due to congenital otosclerosis,congenital absence of any crucial part of hearing apparatus.
Speech delays can also be due to speech understanding, processing, formation and expression of speech. Various disorders of speech expression like cortical dysphasia/ aphasia and speech articulation like dysarthria and also various disorders of brain and disorders of speech apparatus manifesting as specific speech types like scanning speech, stacacto speech, explosive speech, slurred speech are also responsible for speech delay.
Communication is a two way reciprocation of interpersonal relationship. It can be non verbal or body language or expressional and verbal that is with use of language of words/ sounds/voices.
Communication involves understanding and processing of actions/ words i.e. receptive communication and expressing by actions of various types that is expressive communication.In social and communication disorders both these may be affected.
In autism, often the socialization and social communication is primarily affected but in addition to this autism has other key features which are absent in social communication disorder.
Whatever may be the reason for speech delay; following is the course of evaluation and management for speech delay.
1. Confirm hearing is not affected: It can be confirmed by a BERA test. Although clinically many people will be able to tell hearing is affected or not; the tests will help understand severity and level of hearing affection, whether in ear: outer ear canal or middle ear; or inner year or cochlea or nervous system. Test can at times be false; and may need repeat.
2.If hearing is affected; ear examination; ear cleaning and treatment of ear infection may be needed in cases of ear wax, otitis and adenoiditis. significantly affected /damaged ears with speech delay may need hearing aids. If the hearing is affected at cochlea or at Central nervous system the child may be considered for cochlear implant or devices like hearing aid.
3. Those cases who have no major hearing deficit; and good receptive speech and understanding of speech and have difficulty in talking; these kids will need to be started with speech therapy earliest for modulations of speech apparatus.
4. Children who hear but may not listen; children who may not understand or follow speech or have central speech affection or have difficulty having age appropriate eye contact and response to commands are often likely to be autism; in which only speech therapy may get a very slow or delayed response; unless the prime symptoms of autism are tackled with medicines and occupational therapy.
At our center, most kids establish eye contact and response to commands in 1-3 months
whatsapp 91- 9869405747 for further details.
Common Genetic Syndromes of AutIsm:
Fragile x syndrome FMR1
Tuberous sclerosis TSC1 TSC2
Rett syndrome MECP2
Prader willi syndrome deletion of paternal allel at 15q11-q13
Angelman Syndrome del/mut in maternal UBE3A
WilliamsBeuren Syndro,e 7q11.23 del
Smith Magenis syndrome 17 p11.2 del
velocardiofacial/ Digeorge syndrome 22q11.2 del
PhelanMcDermid Syndrome 22q13.3 del
Untreated PKU PAH
map for clinic address
format of certificate for income tax benefitFORM NO. 10-IA[See sub-rule (2) of rule 11A] Certificate of the medical authority for certifying ‘person with disability’, ‘severe disability’, ‘autism’, ‘cerebral palsy’ and ‘multiple disability’ for purposes of section 80DD and section 80U Certificate No. Date: 1. This is to certify that Shri .......................................... son/daughter of Shri ............................., age years male/female residing at Mumbai, Registration No: is a person with AUTISM as per DSM V criteria with disability/severe disability* suffering from autism, with intellectual disability and speech delay and hyperactivity.and needs substantial support for this year. 2. This condition is progressive/non-progressive/likely to improve/not likely to improve*. 3. Reassessment is recommended/not recommended after a period of 3 months/years*. He/She had shown substantial improvement in understanding and communication over last 2 months of Goal directed cognitive appro Genetic / syndromic / metabolic association of the symptom complex is not evaluated. He/she is physically fit to join a special school or institution for supportive services,. He /she needs specific set of daily medicines, occupational therapy, spech therapy, ABA therapy for two years which may need titration on monthly basis.
Sd/- (Neurologist/Pediatric Neurologist/Civil Surgeon/Chief Medical Officer*) Name: Dr. Santosh Kondekar MD DNB DCH FCPS FAIMER DDN CDC KERALA, FELLOWSHIP PEDIATRIC NEUROLOGY AND EPILEPSSY MUHS /TNMCAddress of Institution/Government hospital: Qualification/designation of specialist: