A Fireside Chat with Dr. Goh: Part 2 of 5

We asked our community to send in their questions for Cortica's Chief Medical Officer and Co-Founder, Dr. Suzanne Goh. Covering COVID-19, anxiety, handling screen time effectively, strategies for learning at home, and more, we are pleased to share the second video in our fireside chat series.

Transcript from the Video:

Questions about COVID-19

The first question comes from a parent wanting to know what preventive measures might help to reduce the risk of COVID-19, especially for children with neurodevelopmental differences. The parent writes, "What vitamins would you recommend for someone who, because of their work environment in an essential job or for other reasons, is a high risk for exposure and intervention with COVID-19." That's a great question, and while there's still a lot that the medical community doesn't yet know about COVID-19 — because it is a novel virus and a lot of key research hasn't been done yet — we do know enough to be able to take a whole set of actions that are protective and can very likely reduce risk of infection.

But, before we talk about vitamins specifically, I think it's a good idea just to briefly review all the preventive measures that are also very important to carry through with, as best as we possibly can. That includes, as you've heard many times already, washing hands throughout the day frequently and for 20 to 30 seconds at a time. And, if you or your child can tolerate what's called nasal irrigation, this can help a lot with nasal and respiratory health too. Eating unprocessed whole foods as always, and organic when possible, and avoiding sugar, also when possible. There are some good foods to incorporate in your diet like garlic, bone broth, ginger, cumin, turmeric, and a variety of different spices and herbs like oregano, sage, thyme. Those can all have benefits to overall health and the immune system. Getting plenty of sleep and daily exercise is always important. Just taking a brisk walk or a bike ride in sunlight is wonderful. Also important are trying different practices that can help to reduce stress and anxiety, like yoga and meditation, as well as fun activities with loved ones.

As far as vitamins and other supplements, there are many that can provide some level of defense against viruses and general immune support. Most vitamins and supplements are, of course, available over-the-counter and felt to be safe enough to not require direct physician oversight. But, in my experience, they're much more effective when they are used under the guidance of a qualified medical provider. At Cortica, all of our medical providers do work with vitamins and other supplements as part of their practice. We consult with each other and refer to each other when needed for more specific expertise. And for vitamins and supplements that support the immune system, our nurse practitioner Erin Hildebrandt and I are available for telehealth consultations directly with you, or we can provide guidance by working with your main Cortica medical provider at your home site who can refer and consult with us anytime. There are dozens of different supplements to consider. The most common ones are Zinc, Vitamin D, Vitamin C, Quercetin, Curcumin, and N-acetylcysteine. If you'd like any help managing these, dosing these, or getting assistance from our team, just give us a call.

Another parent asked, “For children with neurodevelopmental differences, how might coronavirus affect them differently? Are they more prone to it? Are there more preventive measures we should be doing at home to protect them?” Because COVID-19 is a new type of viral illness, the state of research is not as far along as it is for other types of illnesses. The current state of knowledge does not look like children with neurodevelopmental differences, as a group, are at a higher risk. In fact, all children, as a whole, seem to be at a lower risk of severe infection from COVID-19. If your child has had unusual responses to other types of viral illnesses or has a harder time recovering from viral illnesses, then there is a greater chance that they might respond that way to COVID-19 as well. But, children as a whole, with or without neurodevelopmental differences, are not considered a high-risk group for COVID-19. The groups that are at higher risk for severe infection are people ages 60 and older, especially those who might live in a nursing home or long-term care facility, and people with underlying medical conditions of any age, particularly if the underlying medical conditions are not well controlled. The specific underlying medical conditions that this applies to are chronic lung disease that might also include moderate to severe asthma, serious heart conditions, conditions that can cause a person to have immunocompromise, severe obesity, diabetes, chronic kidney disease, and chronic liver disease.

Another parent wrote, “We understand ordering takeout is okay. However, presuming a food preparer might be infected, wouldn't that put us at risk as the consumer?” That too is a great question that I think a lot of people are wondering. The way to think about it is really in terms of the degree of risk. So, if someone who is preparing or packaging the food does have COVID-19, it is true that there would be some risk of the virus being passed on through food or packaging. But the reason that ordering takeout is still felt to be acceptable is because the risk level, though it may not be zero, is still extremely low. There are some ways to reduce that risk even further. One step is to remove food from the container that it came in, dispose of the container properly, and then wash your hands thoroughly. Reheating the food, for example in a microwave or on the stove, could potentially reduce some of the risk. But there really aren't clear guidelines on how high a temperature or for what period of time would be needed. So, the takeaway message is that there could be some low risk from takeout food, but because that risk is extremely low, it’s still felt to be overall safe. We do know, of course, that COVID-19 is really spread mainly from person to person through close contact. So, avoiding contact with other people when you are picking up food or having it delivered is a good idea as well.

Question about Anxiety

Another parent asked, “What has been the single most effective treatment for anxiety in those with autism?” I think that's an especially important question at this point in time because many people are experiencing more anxiety since the start of the coronavirus pandemic. The way that I approach treatments for anxiety is to think about many different categories of potential treatments. So, let's walk through each of those categories.

One very effective category is what I would call “sensory-motor approaches.” This category includes modifications in the sensory environment that could help reduce anxiety such as simplifying the physical environment — whether it's simplifying visual stimuli, auditory stimuli, or any other types of sensory input. It can also include movement-based approaches like physical activities and exercises that are enormously effective for reducing anxiety.

There's another category that I refer to as cognitive or behavioral approaches. As you can imagine, for some people, anxiety is connected to specific thoughts or worries. Counseling or psychotherapy can be very helpful. Behavioral types of approaches can help in modifying aspects of the environment, including how others are interacting with and responding to the individual that can also help to reduce feelings of anxiety. One of the strategies we found to be extremely effective is providing information — especially information that establishes predictability — because, as we know, the more predictable our environment is, the more that can help with anxiety.

Another major category is diet and nutrition. There is, of course, no “one-size-fits-all” approach to diet. But, if you'd like to explore ways that diet can help your child reduce anxiety, we have two incredible nurse practitioners, Erin Hildebrandt and Meaghan O'Dea Johnson, who specialize in nutrition for children

Another big category of therapy for anxiety is nutritional supplementation. There are many, many different nutritional supplements, vitamins, minerals, amino acids, and other nutrients to consider. There are, as well, device therapies such as biofeedback and cranial electrotherapy stimulation that specifically can help to target anxiety.

And then, of course, there's also a very big category of treatment called pharmacotherapy, which refers to medications. The medications that we use most often, and with the greatest success for anxiety, are those that help to reduce the body's fight or flight response. And also medications that can help to balance neurotransmitter levels in the brain.

The good news is that there are lots and lots of different steps that can help to reduce anxiety. There is not one single treatment that's the most effective for everybody. Anxiety, we know, comes in many different forms, and the best approach is one that is personalized and tailored to the unique individual and that takes a multi-pronged approach. Anxiety, we know, can be a very uncomfortable and even paralyzing symptom, and there's so much that we can do to help. So, please let us know if you feel that anxiety is posing challenges for your child.

Question about Screen Time

One of the other changes brought about by COVID-19 is an increase in screen time that many children and adults are experiencing. So, one parent wrote to us, “With all the work we, as parents, have done to find alternate activities for our children to limit screen time, how do we adjust to expectations now that our children receive their learning through a computer screen for hours a day? What if my child gets headaches from too much screen time?” That is something that has changed in a really sudden way for many of us. That, because of stay at home orders, many children and adults alike are spending more time looking at screens.

The way that I'd encourage you to think about it is: what is the right balance of screen time and non-screen time for my child's regulation, learning, and overall physical and mental health? Computers can be a wonderful tool for learning, when balanced with plenty of opportunities for other types of activities such as: gross motor movement activities and exercise, especially outdoors. The right balance may be different for each child. There's also a balance between interacting with people virtually and in-person. Also, it's important to keep in mind that not all screen time is equal. Playing the same videos or video games, again and again, is different from using a screen for appropriate, structured learning opportunities with a skilled therapist or teacher.

Some people are more sensitive to the blue light from screens. There are ways of filtering the blue light, either by adjusting settings on your device or even by wearing glasses that can filter out blue light. There isn't consensus from the medical community on how beneficial these are, but, in our experience, many people that we've worked with do find them to be helpful.

Question about Learning at Home

I love this particular question from a parent, “What is the most important thing to remember when instructing our kids?” I believe the most important thing when teaching children, is that they know we care about them and that we believe in their potential. We can convey this in so many different ways, both verbally by the way we speak to them, and non-verbally by our body language, our attention to them, how we act in their presence. One of the most important ways is to choose the goals and skills that represent just the right challenge and the next step for your child's development. And then to scaffold the learning opportunities to help your child succeed in reaching those goals.

Question about Restarting In-person Services

Finally, our last question for today is: “When do you anticipate it to be safe to begin services again? I’m worried that my daughter won't understand why she doesn't see her therapist in person anymore. I also worry that she'll feel she did something which resulted in not being able to connect with them in person. So far things are going well with telehealth.” The first thing I would say is to tell your daughter the reason why she doesn't see her therapist in person right now: and that is because, right now, people are staying at home in order to stay safe and healthy because there's an illness that can spread easily when people are close together. Tell her that it is something everyone is having to do, not just her. Then, let her therapists at Cortica know this so that they can also deliver the message to her when they meet with her through telehealth.

At this point in time, it is not possible to know when the stay-at-home orders will be lifted. It's possible that it will be done in phases where certain in-person activities and services will resume in a gradual way. I think that the current state will likely be in effect for another month or two, but even within that time, there are ways to conduct some very limited in-home and in-center services safely. We are working on creating those safety procedures and protocols that will allow us to do that. Please let us know if you're interested in participating and we can talk with you about how it can be done safely.

As you can see, we've gotten so many important and thoughtful questions. For our next virtual fireside chat, I'll be asking other members of our clinical leadership team to answer some of those questions as well. I hope you'll listen in again. Thank you!