NURSERY SCHOOLS COUNSELLORS PEDIATRICIANS

NICU HOSPITALS PRINCIPALS PHYSICIANS

TEACHERS PARENTS THERAPISTS

SENSE SOMETHING IS WRONG OR MAY GO WRONG COMPARED TO PEERS

IN DEVELOPMENT, BEHAVIOR, PERFORMANCE, COMMUNICATION

BEING A DEVELOPING BRAIN, DELAY UNINTERVENED IS DISABILITY CREATED,

Hidden Problems can be as simple as nutritional deficiency like iron, hormone issue like
thyroid or a disabling one like sequalae of birth insult, genetic disease, developmental or
seizure disorders or a neurological disease not yet manifested.

Neuro developmental
Pediatrician

1. FORMAL HISTORY TAKING AND EXAMINATION IN DETAILS

2. CONFIRMATION AND CLASSIFICATION OF THE PROBLEM
3. SPECIALISED TESTS/INVETSIGATIONS NEEDED IF ANY
4. MULTIDSCIPLINARY REFERRAL PLAN – priority and frequency
5. PHARMACOTHERAPY AND DRUGS
6. CERTIFICATION OF PROBLEMS
7. REASSESSMENT FOR IMPROVEMENTS /WORSENING/ COMPLICATIONS
8. PLAN REVISIONS: MAKE THE CHILD THERAPY-ABLE
9. MEDICOLEGALLY RESPONSIBLE FOR COMPLETE HOLISTIC CARE OF THE CHILD
10. EXPLAINING LAWS, DECLARING CURED; DECIDING DISCHARGE PLAN,
COUNSELING CHILD- PARENTS AND PREVENTING /PREDICTING
OUTCOMES.

Planning to and fro references, periodic follow up and decision to start stop a therapy is a legal responsibility of neuro-developmental pediatrician.

School-ing skills: Remedical and Special Educators, Tution teachers, psychologists for coping skills

Speech issues: Functionality Of Walking Gait Behavioral issues Behavioral Therapist

quality, fluency Living Schooling Locomotion
paucity, errors Activities And Senses Devices Other referrals:vision, hearing,
SPPECH OCCUPATIONAL PHYSICIAL deformities-orthopedic, gut
THERAPIST THERAPISTS THERAPIST nutrition,endocrine,etc as per Dr.

Referrals are not a dead end. WWW.AAKAARCLINIC.COM Dr Kondkear 9869405747 MD DNB FAIMER [DDN FELLOW NEURO ]
No satisfactory change with any system/referral/medicines in 1-3 months, needs plan revisions by Neuro developmental pediatrician.
 DR KONDEKAR FOR AUTISM WWW.NEUROPEDIATRICIAN.COM 9869405747

Neurodevelopmental Pediatrician, Autism Dr Mumbai

A ray of hope in children with social communication, speech, learning, activity, understanding and behaviour issues
Dr Kondekar’s PLACE: Pediatric Ld Autism-ADHD Cerebral palsy and Epilepsy Care Services click for more details :
Neuro Developmental Pediatrician Mumbai
Every child has Right to Understand Learn Talk Read and write. Donot deprive them by saying God has made them
special. Help the child understand and communicate with the environment and the society; saving years of disability
by chanelising and reactivating the neuroplasticity of the brain. #TimeIsTheKey. #NeedForSpeed #AutismSpeaks
Please feel free to read, share and ask questions at www.autismdr.wordpress.com
Autism in Mumbai: Frequently asked Questions.
Remember Diagnosis label is not important, certification is also not important. What’s is important is how to bring a
change in the symptom in a given kid in months.
My Child started speaking late, why the doctor calling it Autism?
Most autism Kids speak late or are nonverbal not because their speech apparatus is faulty but because the
neurological circuits required for communication are likely to be faulty. In addition to this social and communication
delay [noted before age 5 years], if the kid has any other signs of autism like restless, fixed ideas, repetitiveness and
sensory issues; your child is more likely to be labelled as autism spectrum disorder.
My therapist feels my child is hyper; why the Dr is calling it as Spectrum disorder?
Restless ness like “On the Go” like a Motor is a feature of autistic kids, Which in non medical language is called
hyperactivity. Medical diagnosis of hyperactivity has a specific criteria. You may find details at neuropediatrician.com
A confusion may make autism kids labelled as hyperactive or mixed diagnosis. There is a difference in hyperactivity of
autism kids and hyperactivity ADHD kids.
Can my child with AUTISM go to normal school? is it a permanent handicap? Severity of disability, age of child, extent
of communication inability and level of mental sub normality and response to medicine and therapy; help one decide
when and how the child may be able to go in a school or a special school. Kids with autism well controlled with
medicine and therapy and kids with high functioning autism usually are able to join normal schools. Some Autism kids
do suffer from learning disorder which will need care.
Do I really need to spend heavy diagnosing Autism?
Diagnosis of Autism is easy with a Neurodevelopmental pediatrician, who will be able to diagnose using some
questionnaire and clinical observation fitting in DSM 5/ ICD 11 criteria. Most standard tests are based on old criterias
for which one need not spend heavily. instead, one may reserve money for spenidng on therapy, medicines and
genetic tests/ MRI brain or EEG as suggested by Dr in some cases.
What are the chances that diagnosis of autism of my child as wrong?
He looks just like normal kids. In autism spectrum conditions, its the software and not hardware is often faulty. So
most these kids may look normal. Diagnosis of autism is based on questions asked during examination and clinical
observation of the child by neuro pediatrician. As diagnosis of autism is by exclusion of other diagnoses, one may
investigate for other hidden diagnoses that may present with disorders of speech behaviour and communication.
How many years do I have to give medicines or therapy to my child?
Depending on severity of symptoms and age of starting structured therapy and medicines, the time taken for control
of key features of autism will decide how long the therapy or medicines may be continued. So it needs periodic
/monthly adjustments in therapy and medicines. most kids when settled may have independent life and some level of
education. These kids need tutions [therapy] for activities of daily living; so its likely that they may need OT support till
adulthood or beyond in certain cases.
My parents say that I was similar when i was young and i was not on any medicines and therapy. Can i just wait and
watch?
As this is a very gross observation, it is likely to be untrue in exact time frame by recall. Also, once the age of
developing brain passes away, one may not be able to bring about major improvements in communication and
behaviour of the child. As early intervention is key to all neurodevelopmental disorders; it will be foolish to wait and
watch even if advised by some Dr. early Therapy or support never goes waste. List the symptoms and go for
symptomatic therapy if you donot agree with diagnosis.
What happens to these kids after 10 years?
As mainstreaming-inclusion and not isolation is the law for these kids. Most kids with good communication being
established may be able to go to normal or special schools depending on IQ test and level of learning disorder;
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depending on the improvement noted. Neglected children [without therapy/ medicines] are unlikely to improve
significantly.
Who will be my Primary Dr treating;
Psychologist, Therapist, Pediatrician or Psychiatrist? A Neuro Developmental Pediatrician will be able to plan the
whole & holistic management for childhood autism. So it’s prudent to visit and get a plan for referral follow up and
modification of plans as suggested by the specialist paediatrician. Adult neurologists and adult psychiatrists have a less
role to play and plan management in these kids.
What is the pathology in autism?
As the exact pathology is not known, the theory of sensory chaos explains the concept of autism well in current
context. it is a onetime damage or insult that had happened in developing brain; by which the information gathered
by various senses from periphery are not gathered/processed or communicated correctly within the brain. As
different brain structures have reduced communication within brain; the child has issues with communication and
behaviour.
This “theory of sensory chaos”, is based on “theory of sense and action“. Whole nervous system works on the theory
of sense and action. in simple words an output is always based on input. when input is vague and uncomposed, the
out put too will be vague and meaningless.
In autism, there is probability of minor damage in critical areas of brain that are responsible for sense of
understanding and communication. if there were major damage, the kid will manifest with major manifestations like
handicap.
The parts of the brain that may probably have suffered some minor damage in autism kids are probably cerebellium,
hippocampus, thalamus, sensory cortex, temporal lobe and cingulate gyrus. Actually these parts are not damaged but
dissociated from each other so as to give a concrete action or response of this dissociated sense.
Dr Kondekar proposes that the reticular formation network of the brain, also called reticular activating system [RAS] of
central nervous system that is supposed to connect all these areas is deficient or ill formed due to its highly complex
network often formed based on the inputs received. When RAS is deficient, sensory chaos occurs. RAS is internal
communication. When brain fails to communicate internally, child fails to communicate externally. Dr Kondekar’s
“neuronal nutrition hypothesis” primarly works helping form the RAS internally by bridging all unformed connections,
creating more and more networks of bridging neurons eventually reducing the chaos of traffic due to poor
communication and regulation. This is bridging hypothesis that works by synaptic pruning. When we build bridges,
long and big bridges to tackle the chaos of sensory traffic; we need heavy doses of raw material and a good engineer
[doctor too, who has sense of this engineering] one who will plan the networks. This heavy raw material requirement
for neuronal extensions and bridges is actually the heart of neuronal nutrition hypothesis.
How does the treatment work?
Treatment works by stabilizing the child’s activity for facilitating learning and therapy. There are no proven medicines
for curing autism in children. but medicines are often required for controlling accessory features in autism. they are
also required to treat added neurological and psychiatric problems like anxiety, psychosis, epilepsy. neuro nutrients
does have a role but it is not defined. There is a need for a medicine that cures sensory chaos by building synaptic
bridges across the brain making the brain communicate within.
How does therapy work?
Therapy works by principles of regulation, structured disciplined training , motor / sensory activity /exercises and
stimulating release of adrenaline serotonin dopamine etc. if a child is not learnable or not able to sit at one place,
therapy may go unfruitful. Sensory integration and speech therapy are often key therapies in managing autism kids.
when you donot get a significant response with any therapy in 2 months, it is important to visit a neuro
developmental pediatrician to change plan.
Read further : sense action hypothesis in understanding autism and cerebral palsy.
Brain : Human and Humanoid PC Analogy
Sense and action:
Brain structure is made of multiple neurons that go from brain to various tissues including senses like skin, eyes,
hearing, balance, smell, touch, feel and also to muscles of action. Also the millions of neurons do travel from tissues of
sense and action to the brain. So there are many neurons that give input and there are many neurons that give
output.

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There are many neurons that connect in between for coordination and there is also a sensory processing unit. All this
can be considered something parallel to a computer where keyboard and mouse are sensory part and monitor -
display- speaker assembly is a motor / action part and CPU of PC is a sensory processing centre.
Human brain is much more complex than this. Despite this, this is the best way to understand how brain works.
So the whole neurology is primarily between sense and action; and sensory processing unit making sense of it.
The software and hardware of brain decides how slow fast or age appropriate brain may function.
Its an electrical chemistry that keeps various parts of brain continuously functioning.
This functioning of brain is needed for learning, developing skills, building intelligence and structured processing and
performance more like algorhythms of artificial intelligence for socialisation of humanoid robots.
Learning-skills –intelligence are never ending depending upon the attention oaid to inputs for the same. Each person
is a similar looking hardware and grossly unique edition of new software.
Before we know what is autism, I feel one should know and understand a cerebral palsy. Cerebral palsy is a case
usually due to some one time irreversible insult /damage or accident to a developing brain.
By insult it’s meant that something not so normal has happened to a developing brain. It can be as simple as child not
crying immediately after birth or at times trauma of a forceps or vacuum delivery or premature labour pains or
conditions affecting blood circulation, oxygen, sugar, electrolytes etc reaching the developing brain causing a minor or
at times major defect in structure or function of brain.
So for all technical reasons, when we say a child has cerebral palsy, we mean a one time damage to developing brain
affecting the motor or action group. Often at least two domains of development are affected in cerebral palsy.
What we mean by domains of development is the various areas of child development as below:
1. Gross motor / large joint actions, 2. fine motor- small joint actions, 3.language-speech and communication
4.socialisation
So in cererbral palsy, it is must that the child or person will have signs related to muscle actions, the form of hypotonia
or hypertonia interfering some way with day to day life. How severely it affects day to day life will be decided by the
extent of insult or damage as manifested. Considering the computer analogy we may see this as monitor
damaged/deformed , display damaged/deformed, screen is having errors of visualisation, flickering, bite loss, black
line, dancing screen, blurred screen etc
All these amount to cerebral palsy.
This means a child with cerebral palsy may have deformed limb or its part; deficit in movement of one or may muscle
groups or senses- vision / hearing etc or nerves; or a defective or altered performance or appearance which doesn’t
worsen but is not good for a good quality of life.
There always need not be a visible damage or defect. Performance not optimum for the age and stage of life is also
likely to be cerebral palsy; more so when no other easily explainable reason is found.
Dr kondekar
Diagnosis of autism is very simple. So is severity. What is difficult is ruling out other autism like diseases which may
have different line of treatment. Tell Dr what your child is not doing. Make a list to give goals to Dr.
Severity of autism is best classified as independent partially dependent and complete dependent with verbal/
nonverbal and with or without neuropsychiatric issues. Younger the age of diagnosis it’s worthwhile to make the child
near normal in three months with early meds. www.facebook.com/cdcmumbai Insist for DSM 5 BASED diagnostic
TOOLS, diagnosis of autism by ISAA CARS ADOS based on DSM 4 is no longer correct.
What is standard management or care of autism?
1. Define the problem, Donot delay visiting a neuro ped doctor. Agree the age inappropriatness in your kid. confirm on
free whatsapp chat with dr Kondekar 91-9869405747. Donot rely on the diagnosis by therapists / psychologist or
counselors alone, as they can only manage the components that are seen and wont be able to diagnose or treat the
neurological basis or associated symptoms which may have a neurological / developmental or metabolic issue. They
may not be aware of diagnoses beyond their speciality.
2. Therapy can be continued pending diagnosis, but delaying diagnosis and evaluation by ped neuro Dr is not advised.
3. Rule out other causes: often this is missed by many doctors that causes similar symptoms. Child may be mistaken as
minor delay in communication or speech; or just as minor behaviour issue.
4.Divide the issues in priority and short term easy to achieve goals .
5. Work on these with the help of neuro Ped Dr who may suggest some medicines as per international standards or as
per experience which help the child be receptive for therapy, by helping sit quiet give eye contact understand socialise,
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integrate senses and learn from brain to muscles from sense to action.
Therapy works like a train attaching trolleys next to each other so that they can be of help in building milestones and
base of learning. Medicines work like train engine making the child respond a lot faster to therapy. Medicines and
therapy do require titration.
6. There are different therapists possible for every abnormality u notice but practically in many places its not possible
to have every type of therapist. So continue with whatever therapist u can afford. Therapy is important to habilitate the
child. However, Many kids may improve without therapy too – takes years and we lose time, but waiting and watching
beyond 100 days is not recommended.
7.Whatever route u chose, your specialist should show a definite change in 100 days; if not rethink, revise the diagnosis
and management plan with your ped neuro DR.
8. Dont accept a handicap easily and give up hopes of improvement. any time clueless, Whatsapp Dr Kondekar for free
chat 91-9869405747 for a solid goal directed plan for 100 days.
9. Every child has potential and right to improve.
Trainings child to learn action language [ as is done for deaf children] will take the child away from verbal
communication, as we are stimulating motor/action cortex of brain to take over speech cortex. #drSK#Pedneuro#CDC
ITS A RULE OF NEUROPLASTICITY. When a part of brain functions sub-optimally, adjacent brain part may grow over
there and try to learn and take over action. At times its important to break this take over of action cortex over speech
cortex; because if not tackled in time, child will never be able to talk if he is totally into action language.
10. Parent is never at fault. Parents are the key to recovery. Don’t sacrifice your spouse, job, family or relationship. All
can be managed together.
Habilitation or re habilitation? :
Habilitation is a process aimed at helping disabled people attain, keep or improve skills and functioning for daily living;
its services include physical, occupational, and speech-language therapy, various treatments related to pain-spasticity
management, and audiology and other services that are offered in both hospital and outpatient locations. Habilitation
requires neurological connection to develop mature and improve, from scratch. Neuromodulators are group of drugs
that help achieve it faster though never close to normal. Normal habilitation of children below five years in affected in
kids with developmental disorders.
Rehab is rehabilitation to gain or develop or improve lost skills
*How much shall we expect from our autism kid?* www.facebook.com/cdcmumbai
Expectations, let’s rename as having newer capabilities is never wrong. We should plan some steps to reach that goal.
Suppose we make ten steps to achieve that expectation, we can start working from first.
Younger the child, immature is the brain, easy to train and shape. Elder children have their own maturity so need a
different strategy to tackle the expectations.
At times we do have some medicines that may make the brain little immature and receptive and then we can train the
child to achieve appropriate goals. It depends on the age of child and what expectation u r having. No expectations
should lead to stress spoiling peace of mind.– Dr Kondekar
Violent traits in autism?
Violent personality rage phenomena obsessions and behavioral issues are often mixed with autism in a good number
or cases. The personality may run in families. There is no point in blaming each other or kid. The frequency and
severity of these episodes will help us decide medicines which improve the quality of life with negligible side effects.
It’s worth while to save a family from stress which lasts for years than getting wary about side effects that are meagre.
Free WhatsApp advice and discussion at 91-9869405747
No Child is hopeless; when you dont see a change; its our duty to introspect and change the strategy .
Giving up gains nothing; persistence pays.
Expect a new positive change every month; note it down. Nutrition of brain and child; diet and quality of life of
parents both are equally important for positive outcomes.”
Special children’ is often a term used for children with issues of neuro development, social communication and
neurobehavioral adjustments.
Often these kids may look normal and settled in day to day living;but a great majority of these kids need emotional,
social and therapy support to cope up with stress, milestones, education, social survival and neuro- medical issues
including neuro disabilities.
Prima facie these issues appear like disability or a handicap like situation adding a lots of stress to the child , parent
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and family, affecting quality of living. book appointment

These children range from personality traits of mild autism to non verbal severe autism; terrible toddler tantrums, to
attention deficit or hyperactivity issues. Soft Neurological problems affecting gait, grips, concentration and defective
sensory processing of stimuli/ events are commonly associated. These issues ,may be noted in a child in varying
proportions, alone or mixed. Often these issues cause or are associated with learning disability and or social
disturbances of adjustments.
Some of these kids do have documentable brain damage , power deficit , tone issues , deformities or seizures. Many
need not have these issues. Some do have genetic basis, many wont.
*These all cannot be easily understood unless a detailed neuro pediatric evaluation is done for these kids before we
plan a random referral advice or suggestion.*
With appropriate diagnosis and zeroing down the key areas of improvement in a given child,in a time scaled fashion
can help the therapist and neuropediatrician plan together a collective approach for tackling the various issues
mentioned above.
A variety of specialists apart from above may be frequently consulted for advice, therapy, counselling and training
with continued occupational therapy and pediatrician assessment. Speech therapists, physiotherapists,educators,
remedial educationists, counsellers, psychologists do have a role when indicated.
With regular directed therapies like, NDT Neurodevelopmental therapy,SI Sensory integration, ABA i.e. applied
behavioral analysis and adjustments with time discipline, conditioning of events ,show results when individualised.
Some medications do help in a good number of children. An IQ test , BERA and EEG, MRI brain and genetic studies
may be needed in some cases.
In our experience we see major changes in speech behavior power tone and social adjustments in 100 days of goal
directed therapy.
Please do not hesitate to consult for detailed advise, understanding, treatment and therapy.
pedneuro whatsapp for doubts 7021713681
https://goo.gl/maps/4U3PHAReiqT2
When parents ask me “what book one should read for autism cure in their kid”:
dont go for reading books, ask me for free whatsapp tips: 91-9869405747
Starting to learn autism to treat Ur own kid, is like digging the well when u are thirsty. Remember “time is key for
developing brain, don’t waste it.”
Ask experts, Ask for help, save time. You may be carrying a wrong diagnosis label given by PHD doctors. Remember
medical diagnosis (& treatment too) is best and holistically done by medical Doctors…
What an expert has gone through decades of experience, no single book / page or line can give it. Ask an expert for an
individualized action plan. Every kid is different.
Read books once your kid’s needs have met, read books mainly to help others. Read books so That u write books
which doctors can read during their medical curriculum, but save time by asking for expert help.. Save Time Save
Brain, Think Brain! Please pass on message to needy parents. When thirsty – and u go digging a well, you may end up
in a grave than accidental chest. #DrSK
Prime aim of this post is to make parents understand that Time with The Child is Key. Don’t lose the time running after
books when you may learn one tip after reading hundred pages. It’s better to get tips from experts who seen
hundreds of cases, getting hundreds of queries solved in single consultation, that looking for chance clue in some
book whose story may b different from your kid.

Enemies of RECOVERY:
Milk-Casein-dry fruits - indigestion-Constipation – frequent respiratory complaints – all have a definite and reliable
solution and should not be reason to stop medicines and therapy.
Mobile – TV – Screen
When we want child to talk from mouth listening from Ear, a screen in front makes the child appear deaf and delays
speech initiation and development.

Mobile -Screen – Read – copy- write… will delay talking / Speech, introduce mobile only after fluent speech
established.

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What are sensory issues in Autism?

visit www.facebook.com/cdcmumbai www.neuropediatrician.com
SENSORY CHECK LIST FOR SENSITIVE KIDS: Sensory assessment: CHART AS 3,2,1,0, AVOIDS/SEEKS/MIXED/NEUTRAL
Vestibular: 1. Being moved passively by another person
vestibular 2: riding equipment that moves through space like swing, escalator
Vestibular 3: spinning activities, carousels, spinning around in circles
Vestibular 4:activities that need change in headposition, bending over sink, somersault etc
Vestibular 5: chalanges to balance like skating, bicycle,skiing, balance beams,
Vestibular 6: Climbing descending stairs, slides, ladders
Vestibular 7: being up high; top of slide or mountain
Vestibular 8: less stable ground surfaces deep pile, grass,sand, snow
Vestibular 9: riding in a car or other transportation
Auditory Listening:1. hearing loud sounds car, horns,sirens, loud music, TV
Auditory Listening:2. being in noisy settings like crowded restaurants, party or busy
Auditory Listening:3. watching TV or listening to music at very high or low volumes
Auditory Listening:4. Speaking or being spoke amidst other sounds, voices
Auditory Listening:5. background noise while concentrating on a task responses
Auditory Listening:6. Games with rapid verbal instructions
Auditory Listening:7. back and forth interactive conversations
Auditory Listening:8.unfamiliar sounds, silly voices, familiar language
Auditory Listening:9. singing alone or with others
vision :1. learning to read or reading for more than few minutes
vision :2. looking at shiny spinning or moving objects
vision :3. activities requiring hand eye cordination, ball catch, stringing beads, writing, tracing
vision :4. activities that require descrimination between colours shapes sizes
vision :6 visually busy places like store or playground
vision :7. finding objects such as socks in drawer, book on a shelf
vision :8.very bright light or sunshine or being photographed with flash
vision :9. dim lighting shade or dark
vision :10. action packe colour TV movies video games
vision :11. new visual exepriences such as looking through a glass or kaleido scope
Taste and smell:1.smelling unfamiliar scents
Taste and smell:2. Strong odors such perfume, gasolene, ether etc
Taste and smell:3. smelling objects, non edibles , plastic items, garbage
Taste and smell:4 eating new food
Taste and smell:5.eating familiar food
Taste and smell:6.eating strongly flavoured food like v spicy, salty, bitter,sweet
Touch 1: being touched on some body parts hugs cuddles
Touch 2: certain clothing, fabric, tags, waistband, cut offs
Touch 3:clothing, shoes, accessories v tight or loose
Touch: 4. getting hands face body parts messy with ;paint glue sand food or lotion
Touch: 5. grooming activities such as face or hair wash, brushing, cutting, nail trimming
Touch 6: taking a bath, shower, swimming
Touch 7:getting towelled dry
Touch 8: trying new foods
Touch 9: feeling particular food textures and temperature inside the mouth mushy smooth
Touch 10. standing close to other people
Touch 11: walking barefoot
Proprioception 1:activities such as rough housing, jumping, banging, pushing, bouncing
Proprioception 2: high risk play jumps from extreme heights, climbs high trees,rides cycle over gravel
Proprioception 3: fine motor tasks writing drawing closing buttons and snaps, attaching pop beads, and snap together building
toys
Proprioception 4: activities requiring physical strength and force
Proprioception 5: eating crunchy foods, dry cereals, or chewy foods like meat caramel
Proprioception 6: smooth creamy foods yogurts cream cheeze pudding
Proprioception 7: having eyes closed or covered.
www.facebook.com/cdcmumbai www.neuropediatrician.com
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