Complementary and alternative medicine in developmental disabilities

Intra-Rater and Inter-Rater Reliability Analysis of Muscle-Tone Evaluation Using a Myotonometer for Children with Developmental Disabilities

Assessing muscle tone is an essential component of the diagnosis, prognosis, and treatment planning of developmental disabilities (DD) in children and is of great help in developing clinical diagnosis patterns. The purpose of this study was to investigate intra-rater and inter-rater reliability using the myotonometer, which is an assessment tool to measure muscle tone in children with DD. This study included 26 children diagnosed with DD. Two physical therapists measured the children's muscle tone using a myotonometer. For all the muscles measured, reliability was determined using the intra-class correlation coefficient (ICC), the standard measurement error (SEM), and the minimal detectable change (MDC). The intra-rater reliability for all muscles was excellent (ICC = 0.75~0.78), except for the biceps brachii (ICC = 0.68). The inter-rater reliability was also excellent for all muscles (ICC = 0.75~0.95), and the SEM and MDC showed small measurement errors. Therefore, the intra-rater and inter-rater reliability of measurements by the myotonometer was found to be good or excellent. This suggests that the myotonometer is a tool that can objectively assess muscle tone, and it can be utilized in clinical practice to quickly and conveniently measure muscle tone in children with DD.

Traditional Korean Medicine Usage and Perception: a comparative study between the general population and the disabilities

Objectives

This study is a comparative analysis of the satisfaction and recognition characteristics for traditional Korean medicine (TKM) in people with disabilities and the general population of Korea.

Methods

Here, 5,000 subjects were categorized into two groups based on a disability rating using the data from the 2017 National Survey for the Usage of Korean Medicine. The relationships among the sociodemographic characteristics, TKM usage status, recognition of TKM usage, and recognition of the effectiveness of the TKM treatment were analyzed based on the disease. The response reliability was verified using the chi-square test analysis method.

Results

Disabilities corresponded with low rates of high school or higher education (44%, 83.5%) and no jobs (56.9%, 33.5%), mostly the status of the low-income class with a monthly household income of < 1,500 USD (50.9%, 10.5%), poor health conditions (55.2%, 9.8%), high chronic disease prevalence rate (69.0%, 19.9%), high medical care rate (11.2%, 0.5%), and low commercial health insurance subscription rate (44%, 74.2%). Furthermore, people with disabilities visited TKM institutions more often (88.8%, 74.1%) with a high frequency TKM usage rate of ≥ 1-2 times a month (26.2%, 15.3%). They also reported that the cost of using the TKM was very high (14.7%, 8.8%) and that primarily the application of insurance benefits should be improved (52.6%, 47.5%). The treatment effectiveness for diseases was high for musculoskeletal disorders for both people with disabilities and the general population.

Conclusion

Preferential application of insurance benefits for musculoskeletal diseases must be extended to the TKM treatment as well, as people with disabilities have a high recognition for these conditions with TKM. It is difficult to perform randomized controlled trials on people with disability. Therefore, large-scale observational and cohort studies should be conducted. We hope this study will help establish a suitable TKM policy for people with disabilities.

Complementary and Alternative Medicine Use in Children with a Developmental Disability and Co-occurring Medical Conditions

OBJECTIVE

The primary aim of this study was to evaluate differences in the prevalence of complementary and alternative medicine (CAM) usage among children with and without developmental disabilities (DD). Secondarily, the association between CAM usage and comorbid chronic medical conditions was explored among children with DD.

DESIGN

Data come from the 2012 Child Complementary and Alternative Medicine Supplement of the National Health Interview Survey, a nationally representative sample of children in the United States between the ages of 4 and 17 (n = 10,218).Main outcome measures Multiple logistical regression models provided insight into the relationships between parent-report CAM usage, DD, and chronic medical conditions.

RESULTS

Children with developmental disabilities were more likely to use CAMs compared to their typically developing peers (21% vs 16%). Children with DDs and comorbid chronic medical conditions used CAMs at even higher rates (23% vs 18%).

CONCLUSIONS

Results indicated that children with DD, especially those with a co-occurring chronic medical condition, use CAMs more often that typically developing children. Given scarcity of information on safety and effectiveness, clinical providers need to be alert to which children may be more likely to be exposed to CAMs. Communication between parents and providers needs to include discussion of CAM treatments.

Contextualizing geneticization and medical pluralism: How variable institutionalization of traditional, complementary, and alternative medicine (TCAM) conditions effects of genetic beliefs on utilization

As genetic models are increasingly incorporated in medicine, health service users seem to accept these models to varying degrees. To appreciate these differences, this paper examines how health service users' genetic beliefs of health are associated with their use of traditional, complementary, and alternative medicine (TCAM) via responses from 31 countries in the 2011 ISSP survey. It finds an interesting contrast between East Asian countries and other countries in the world. The negative association between genetic beliefs and TCAM use is strong in the latter, whereas it is weak in the former. More intriguingly, the analysis demonstrates significant cross-national differences within East Asian countries. Chinese and Koreans reveal a negative relationship between genetic beliefs and TCAM use, while Japanese show a positive relationship. The paper provides an explanation to these cross-national differences by drawing on comparative studies of medical systems. When TCAM is institutionalized as valid and distinct medical resources, and when TCAM is practically available to everyday use, health service users who subscribe to genetic beliefs are likely to use TCAM as well. These findings contribute to revealing the pragmatic nature of health-seeking action and the institutional context in which geneticization and medical pluralism are conditioned to form.

Utilization of Complementary and Alternative Therapies in Youth with Developmental Disabilities

Oxidative stress is understood to be involved in the ontology and maintenance of different developmental disabilities. Some complementary and alternative medicine (CAM) therapies have been proposed to modify this relationship by affecting oxidative stress pathways. However, it is unclear which of these CAM therapies are used among children with different developmental disabilities. This study examines the use of these therapies among 10,218 children between the ages of 4 and 17 using the 2012 Child Complementary and Alternative Medicine (CAM) Supplement of the National Health Interview Survey (NHIS) to highlight a potential avenue for intervention and prevention efforts. The results suggest that children with developmental disabilities are more likely to utilize particular CAM therapies that may alter oxidative stress pathways. Future work is needed to assess the potential moderating effect of these CAM therapies and oxidative stress levels among children with different developmental disabilities.

Use and Nondisclosure of Complementary Health Approaches Among US Children with Developmental Disabilities

OBJECTIVES

Many US children use complementary health approaches (CHAs), including some modalities that may be ineffective, unsafe, and/or costly. Yet, little is known about the prevalence and correlates of CHA use among children with developmental disabilities (DDs), as well as parent nondisclosure of CHAs used for children with DDs to health care providers. We, therefore, aimed to profile the use and nondisclosure of CHAs among US children with DDs.

METHODS

We analyzed data from the 2012 National Health Interview Survey, which included the most recent Child Complementary and Alternative Medicine Supplement. The study sample was comprised of 2141 children with DDs aged 4 to 17 years.

RESULTS

Nearly one-quarter (23%) of US children with DDs used CHAs. Among those with a personal health provider, 42% of parents did not disclose some or all CHAs used to the child's provider. The adjusted odds ratios of using CHAs were greater among those with female sex, higher household income, residences not in the South, difficulty accessing care, or comorbid conditions. CHA was most commonly used because "it is natural." Nondisclosure was associated with female sex, older age, having no functional limitations, less conventional services use, and use of fewer CHAs. The most common reason for nondisclosure was that the child's provider did not ask.

CONCLUSION

Complementary health approach use is prevalent among US children with DDs, and nondisclosure is likely among those who use CHAs. Future intervention targeting education and communication about CHAs for parents of children with DDs and their health care providers may promote disclosure.

Sugar-Sweetened Beverage Consumption Is Adversely Associated with Childhood Attention Deficit/Hyperactivity Disorder

Attention deficit/hyperactivity disorder (ADHD) is one of the most common childhood neurobehavioral conditions. Evidence of the negative effects of sugar-sweetened beverages (SSBs) on mental health has not been convincing, although a few studies have found an association between high SSB levels and attention problems in children. This study aimed to test the hypothesis that SSB consumption is associated with ADHD among children. Doctor-diagnosed ADHD cases (n = 173) and non-ADHD controls (n = 159) between age 4 to 15 were recruited. SSB consumption, socio-demographic and lifestyle characteristics of the children, as well as of their mothers' characteristics during pregnancy, were collected using a questionnaire. Blood lead levels and polymorphisms of two commonly verified dopaminergic-related genes (the D4 dopamine receptor gene DRD4 and the dopamine transporter gene DAT1) were also analyzed. There was a dose-response relationship between SSB consumption and ADHD. After covariates were adjusted, children who consumed SSBs at moderate levels and high levels had 1.36 and 3.69 odds, respectively, of having ADHD, compared with those who did not consume SSBs (p for trend < 0.05). Similar results were obtained when females were excluded. Our findings highlighted the adverse correlation between SSB consumption and ADHD and indicated a dose-response effect even after covariates were adjusted.

Use of complementary and alternative medicine in children and adolescents with autism spectrum disorder: A systematic review

Despite limited evidence, complementary and alternative medicine treatments are popular in autism spectrum disorder. The aim of this review was to summarize the available evidence on complementary and alternative medicine use frequency in autism spectrum disorder. A systematic search of three electronic databases was performed. All research studies in English or German reporting data on the frequency of complementary and alternative medicine use in individuals with autism spectrum disorder were included. Two independent reviewers searched the literature, extracted information on study design and results, and assessed study quality using an established quality assessment tool. Twenty studies with a total of 9540 participants were included. The prevalence of any complementary and alternative medicine use ranged from 28% to 95% (median: 54%). Special diets or dietary supplements (including vitamins) were the most frequent complementary and alternative medicine treatments, ranking first in 75% of studies. There was some evidence for a higher prevalence of complementary and alternative medicine use in autism spectrum disorder compared to other psychiatric disorders and the general population. Approximately half of children and adolescents with autism spectrum disorder use complementary and alternative medicine. Doctors should be aware of this and should discuss complementary and alternative medicine use with patients and their carers, especially as the evidence is mixed and some complementary and alternative medicine treatments are potentially harmful.

Prevalence and Predictors of Complementary and Alternative Medicine Use in a Large Insured Sample of Children with Autism Spectrum Disorders

PURPOSE

The purpose of the present study was to examine the prevalence and predictors of complementary and alternative medicine (CAM) use as well as parental perceptions of CAM efficacy in a large, geographically diverse sample of children with Autism Spectrum Disorders (ASD).

METHODOLOGY

Data were obtained from a web-based survey administered to parents of children with ASD at four sites participating in the Mental Health Research Network (MHRN). The web survey obtained information about services and treatments received by children with ASD as well as the caregivers' experiences with having a child with ASD.

RESULTS

Approximately 88% of the sample had either used CAM in the past or had recently used some type of CAM. The following characteristics were associated with CAM use: greater parental education, younger child age, a mix of regular and special classroom settings and prescription drug use in the past three months.

CONCLUSIONS

The use of CAM was very prevalent in this large, geographically diverse sample of children with ASD. It is critical that providers be prepared to discuss the advantages and potential side effects with families to help them make well-informed health care decisions and prevent possible CAM-drug interactions.

Concurrent Complementary and Alternative Medicine CAM and Conventional Rehabilitation Therapy in the Management of Children with Developmental Disorders

Background. We investigated the concurrent use of conventional rehabilitations and complementary and alternative medicine (CAM) therapies for the long-term management of children with developmental disorders (DDs). Methods. The parents or caregivers of 533 children with DDs (age range, 1-19 years) who visited the rehabilitation centers were surveyed using in depth face-to-face interviews. Results. Of the 533 patients enrolled, 520 completed the questionnaire (97% response rate). A total of 292 (56%) children were receiving multiple therapies, more than two conventional rehabilitations and CAM, at the time of the interview. A total of 249 (48%) children reported lifetime CAM use, 23% used CAM at the time of the interview, and 62% of the patients planned to use CAM therapy in the future. Conventional rehabilitation therapies used at the time of the interview included physical therapy (30%), speech therapy (28%), and occupational therapy (19%), and the CAM therapies included herbal medicine (5%) and acupuncture or moxibustion (3%). The respondents indicated that in the future they planned to use acupuncture or moxibustion (57%), occupational therapy (18%), cognitive behavioral therapy (16%), speech therapy (10%), and physical therapy (8%). Conclusion. Concurrent management as conventional rehabilitations and CAM therapies is widely used by children with DDs.

Pursuit of Complementary and Alternative Medicine Treatments in Adolescents With Cerebral Palsy

This study determined the extent to which parents of adolescents with cerebral palsy seek out complementary and alternative medicine services. A regional sample of 166 adolescents (15.5 ± 2.4 years) with cerebral palsy were recruited. Parents completed a questionnaire identifying the complementary and alternative medicine services received over the past year. Most (73.2%) did not currently utilize any of the listed services; 7.3% used 2 or more services. The most commonly used services were massage (15.4%), hyperbaric oxygen (9.6%), and osteopathy (5.7%). Youth with limited hand function were more likely (P = .01) to undergo hyperbaric oxygen. Massage therapy services were more frequent in youth with greater activity limitations (P < .005). Sociodemographic factors were not predictive of use. Approximately one quarter of families sought out these services for their adolescents with cerebral palsy. Many are expensive privately funded treatments. Physicians should openly discuss these options with families, highlighting the current state of knowledge on their efficacy.

Proposed remedies for some developmental disorders

Developmental disorders (DDs) are important leading cause of disability in developed countries and also in the United States. DDs are a group of individual conditions that result from abnormal nervous system development and cause altered function. They can begin at any time from prenatal to 22 years of age and the disability usually presents itself throughout a person's life time. Down syndrome, autism, neural tube defects, schizophrenia, cretinism, and attention-deficit hyperactivity disorder are among the most common DDs that currently plague numerous countries and have varying incidence rates. Their occurrence may be partially attributable to the lack of certain dietary nutrients. Notably, essential vitamins, minerals, and ω-3 fatty acids are often deficient in the general population of America and developed countries and are exceptionally deficient in patients suffering from mental disorders. Typically, most of these disorders are treated with prescription drugs, but many of these drugs cause unwanted side effects. Therefore, psychiatrists recommend alternative or complementary nutritional remedies to overcome the adverse effects of those drugs. Studies have shown that daily supplements of vital nutrients, such as that contain amino acids, often effectively reduce symptoms of the patients, because they are converted into neurotransmitters that alleviate depression and other mental disorders. The aim of this article is to discuss the role of dietary imbalances in the incidence of DD and to emphasize which dietary supplements can aid in the treatment of the above-mentioned DD.

Down syndrome and dementia: a randomized, controlled trial of antioxidant supplementation

Individuals with Down syndrome over age 40 years are at risk for developing dementia of the Alzheimer type and have evidence for chronic oxidative stress. There is a paucity of treatment trials for dementia in Down syndrome in comparison to Alzheimer disease in the general (non-Down syndrome) population. This 2-year randomized, double-blind, placebo-controlled trial assessed whether daily oral antioxidant supplementation (900 IU of alpha-tocopherol, 200 mg of ascorbic acid and 600 mg of alpha-lipoic acid) was effective, safe and tolerable for 53 individuals with Down syndrome and dementia. The outcome measures comprised a battery of neuropsychological assessments administered at baseline and every 6 months. Compared to the placebo group, those individuals receiving the antioxidant supplement showed neither an improvement in cognitive functioning nor a stabilization of cognitive decline. Mean plasma levels of alpha-tocopherol increased ~2-fold in the treatment group and were consistently higher than the placebo group over the treatment period. Pill counts indicated good compliance with the regimen. No serious adverse events attributed to the treatment were noted. We conclude that antioxidant supplementation is safe, though ineffective as a treatment for dementia in individuals with Down syndrome and Alzheimer type dementia. Our findings are similar to studies of antioxidant supplementation in Alzheimer disease in the general population. The feasibility of carrying out a clinical trial for dementia in Down syndrome is demonstrated.