Autism Doctor Answers Viewers' Questions

A neurologist responds to questions about brain imaging and autism therapy.

May 20, 2008 — -- Neurologist Dr. Fernando Miranda takes a radically different approach to behavioral disorders. Using high-tech scanning imagery he looks inside people's brains to diagnose and treat autism and attention deficit disorder.

After discussing his groundbreaking research on "Good Morning America," we asked viewers to send in their questions for Miranda and received hundreds of emails. Answers to selected questions are below.

Viewers can also visit Bright Minds Institute for more information.

What are the signs one should look for in a child (who has been diagnosed with autism) to see if it could be something else like seizures? And can it be hereditary?

E., Whittier, Calif.

Dr. Miranda: Day dreaming, staring spells, abnormal awakenings at night, sleep terrors and family history of seizures.

I have a 5-year-old son with autism who had a 30 minute EEG when he was 4. We suspected silent seizures but in the 30 minutes none were noted. Is this enough time? Should we pursue more extensive testing? If so, what testing would you recommend?

A.M., Little Rock, Ark.

Dr. Miranda: Yes, you should. Please have a long recording or a 24 hour one.

My son was diagnosed with autism at 3 years old. He's 14 now and is having a lot of behavior problems due to his extreme anxieties. Is it too late to give him an MRI to see if he may be having seizures that are undetected?

B.J., Venice, Calif.

Dr. Miranda: No, although is better to have children worked up while very young, the brain continues to adapt through life. If he has seizures, then treatment ought to be considered.

My sister has fraternal twins that were recently diagnosed with mild autism. Additional testing was done on their hearing and it was found that both kids are supposedly hearing impaired. Could it be the hearing problem that gives the same observations as autism?

R.H., Mount Laurel, N.J.

Dr. Miranda: Very much so.

"My son Ben just turned 5 years old on May 10 -- each year putting me into a deeper depression that my son is still non-verbal. I just recently got our pediatrician to refer us to a pediatric neurologist ... What information should I bring up to the neurologist? What should I push for? What should I ask them to do to make sure I get a clear diagnosis and help find answers to why my child is not talking. He was diagnosed at 3 years old with PDD/autism, but there has to be more."

J.V.; La Porte, IN

Dr. Miranda: The best information that you can bring to your pediatric neurologist should be some of the same information that you have just provided us in this e-mail, paying special attention to the onset and duration of symptoms that you would consider unusual. You should push for the pediatric neurologist to order an MRI scan of the brain, and an EEG. These should be standard tests to request when searching for an accurate determination of what may be ailing your child. Results from these tests should provide a clearer indication of what course to take to help.

"My 15-year-old son has Aspergers Syndrome and I was wondering if this type of brain scan would help to verify this diagnosis, and if it isn't really Aspergers ... It is getting harder to deal with my son as he gets older. Thank you very much."

C.T.; Manchester, NH

Dr. Miranda: Unfortunately, Aspergers is a behaviorally laden diagnosis. As a result, many children may present Asperger-like symptoms when, in fact, another problem is responsible or also present. In this case, a competent professional, such as a pediatric neurologist, should be consulted to make such a determination. To ensure an accurate diagnosis, an MRI scan of the brain, coupled with an EEG, should be performed.

"Do you believe there is a relationship or connection between autism and ADHD? Why, or why not?"

C.J L.; Boise, Idaho

Dr. Miranda: While the actual causes of autism are unknown, we know that when it presents, it affects the language centers of the brain at the cellular level. Attentional deficit can be caused by sleep disorders or frontal lobe problems, with many other potential causes in-between. Truthfully, despite great gains in methods of treatment/diagnosis of autism and ADHD, their causes, as well as how, and if they are linked to one another, still remains a mystery. This is, unfortunately, a complex subject that we could discuss for a whole day and still not scratch the surface of.

"I heard you mention that these tests can be used to diagnose ADHD as well. My son was diagnosed with PDD (an autism spectrum disorder) along with ADHD. I never thought he had either. Would this type of test be helpful, and where could I find out about the test? What is it called and is it covered by insurance?"

T.N.l; Manassas, VA

Dr. Miranda: The two primary neurological tests that can be used for accurate diagnosis are MRI with an EEG. Both of these tests are extremely helpful in making an accurate determination of precisely what may be affecting your child, neurologically. There are a few locations in your general area that can perform these tests competently and effectively. Both Children's Hospital in Boston, as well as Kennedy Krieger at Johns Hopkins are very skilled at working up these kinds of tests. Bright Minds will likely be opening an office in the Virginia area in the next six months. Unfortunately, insurance coverage varies so widely from plan to plan that it would be impossible to determine what an individual's benefits would encompass without specific information.

"Hello! I have two boys with autism, ages four and six. Both are non-verbal. Both of the boys' heads have increased head circumference. My question is: what are some of the symptoms of the children who have had success with the anti-seizure medicine, physical and developmental?"

M.S.; Sevierville, TN

Dr. Miranda: Unfortunately, it is extremely difficult to give specifically relevant information about the potential benefit of medications without knowing more details about your childrens' case. In many cases, children may have similar symptoms while the areas of their brain affected, differ. This is the reason why behavioral measures alone are often not sufficient to determine precisely what is ailing children. One would have to know more specifically about your children to help you effectively. However, I can advise that if you have two children with autism, a series of genetic testing for you and your husband may be of great value in gaining more insight into the potential causes of your childrens' autistic presentation. This testing may also aid in determining what medication regimen would provide the greatest benefit for your two sons.

Click here to visit the Bright Minds Institute.