Complementary and alternative medicine in developmental disabilities
http://www.100md.com
《美国医学杂志》
Michigan State University College of Human Medicine, Kalamazoo Center for Medical Studies, Kalamazoo, Michigan, USA
Abstract
Developmental disabilities (DD) are defined as a diverse group of severe chronic conditions due to mental and/or physical impairments. Individuals with developmental disabilities have difficulty with major life activities including language, mobility, and learning. Developmental disabilities can begin anytime during development - from prenatal up to 22 years of age, and the disability usually lasts throughout a person's lifetime. Autism spectrum disorders, cerebral palsy, mental retardation, and attention deficit hyperactivity disorder are common conditions falling within the definition of developmental disabilities. Complementary and alternative medicine (CAM) is becoming increasingly utilized in the general population for treatment of everything from the common cold to complex and chronic medical conditions. This article reviews the prevalence of different types of CAM used for various developmental disabilities
Keywords: Alternative medicine; Complementary medicine; Mind-body intervention; Energy therapies
Developmental disabilities (DD) are defined as a diverse group of severe chronic conditions due to mental and/or physical impairments. Individuals with developmental disabilities have difficulty with major life activities including language, mobility, and learning. Developmental disabilities can begin anytime during development, from prenatal upto 22 years of age, and the disability usually lasts throughout a person's lifetime. Autism spectrum disorders, cerebral palsy, mental retardation, and attention deficit hyperactivity disorder are common conditions that can be considered as developmental disabilities.[1]
Complementary and alternative medicine (CAM) is becoming increasingly utilized in the general population for treatment of everything, from the common cold to complex and chronic medical conditions. For many families of children with chronic medical needs and developmental disabilities, CAM offers an additional avenue of treatment other than or in addition to traditional medical care.
Complementary and alternative medicine (CAM), as defined by the National Center for Complementary and Alternative Medicine (NCCAM, USA), is a group of diverse medical and health-care systems, practices, and products not presently considered to be a part of conventional medicine. As therapies proven to be safe and effective come to be adopted in conventional health care, the definition of CAM and therapies included within its definition change continually. The five categories of CAM, as defined by NCCAM, are as follows.[2]
1.Alternative medical systems are those built upon complete systems of theory and practice, such as homeopathic medicine, naturopathic medicine, and traditional Chinese medicine.
2.Mind-body intervention is another subset of therapy that uses techniques such as meditation, prayer, music, art, or dance.
3.Biologically-based therapies use substances such as herbs, foods, and vitamins that have not yet been scientifically studied to treat specific medical conditions.
4.Manipulative and body-based methods, such as chiropractic, osteopathic manipulation, and massage, are commonly used forms of CAM.
5. Energy therapies use unconventional methods such as magnetic fields or alternating current, and include theories on energy fields such as Qi gong in traditional Chinese medicine and the therapeutic touch or application of pressure to the energy field points on the body.[2]
Materials and Methods
The purpose of this review is to identify the current extent of use and specific types of complementary and alternative medicine in treating children with developmental disabilities. A literature search was performed using the PubMed/Medline database. The literature search was limited to articles published in English over the last five years, and on children between 0-18 years of age. Multiple searches, along with a MeSH Complementary Medicine search, were completed using the above limitations. Within the aforementioned search limitations, the following keywords were used to search articles: developmental disabilities, autism, attention deficit hyperactivity disorder, cerebral palsy, and mental retardation. Of the 237 articles produced from the searches, 17 were found to be pertinent to the study. Five additional relevant articles were found in the literature after the formal PubMed/Medline searches were performed. Standard textbooks were also reviewed. Additionally, background information was obtained from review of the information available from websites of Centers for Disease Control and Prevention (USA), National Institutes of Health (USA), and NCCAM, as well as four supplemental reviews.
Results
Results of the literature review are summarized in table1 below.
Discussion
Complementary and alternative medicine therapies are widely utilized among pediatric populations with developmental disabilities. In children with autistic spectrum disorders, the most frequently reported use of CAM was from the realm of biologically-based therapies such as vitamin supplementation, dietary modification and unconventional use of medical therapies. Four articles reported usage of medical therapies such as antifungal, antiviral and antibiotic medications, secretin, Pepcid, oxytocin, intravenous immunoglobulin, heavy-metal chelation, and immunization withholding. Three articles reported various usages of vitamin supplementation and dietary modifications. Finally, one article reported use of music therapy and an additional article discussed the used of behavioral optometry, craniosacral manipulation, and communication therapies, as well as auditory integration training as CAM for treating autistic spectrum disorders.
The greatest amount of information regarding use of CAM in developmental disability was found in literature on treatment of cerebral palsy. These articles focused mainly on mind-body interventions, body-based methods, and energy therapies. Three articles identified massage therapy, chiropractic manipulation, electrical stimulation, conductive education, the Euromed/Adeli suit program, hyperbaric oxygen, and prayer/spiritual blessings as commonly used CAM in children with cerebral palsy. Other therapies identified included acupuncture/acupressure, aquatherapy, osteopathic manipulation, hippotherapy, craniosacral therapy, Feldenkrais method, patterning (Doman Delacato method), Reiki/Ayurveda, homeopathy, light therapy, and virtual reality play. The abundance of therapies focusing on body-based and mind-body intervention for treatment of cerebral palsy is most likely due to the many physical symptoms of the disease such as muscle spasticity or hypotonicity. Additionally, one article was found identifying non-specific dietary modification in the treatment of cerebral palsy.
Two articles were found reviewing the use of CAM in children with Attention Deficit Hyperactive Disorder (ADHD). CAM therapies spanned biologically based therapies, vitamin supplementation, dietary modification, medical treatments, and various physically-based therapies such as biofeedback therapy. Specific CAM therapies for treating ADHD were vitamin A, essential fatty acid, grapine and L-glutamine supplementation, oligoantigenic diet, homeopathy (stramonium cina, hyoscyamus niger), and herbal medications ( Ginko biloba, Melissa officinalis ). Additionally, specific physically-based therapies used to treat ADHD included electroencephalogram (EEG) biofeedback, also known as neurotherapy, yoga, massage therapy, and utilization of school-based environmental green outdoor settings.
Two articles were found discussing the use of CAM in children with mental retardation and Down syndrome. One article reviewed complementary and alternative medical treatments such as Donepezil, Piracetam, vasopressin, pituitary extract, and growth hormone as well as dietary treatments including vitamin, mineral, and nutritional supplementation regimens. Other CAM therapies discussed included cell therapy and plastic surgery. Additionally, a separate article discussed the use of music therapy in the treatment of children with mental retardation and Down syndrome.
Regarding treatment of learning disabilities, one article was found that discussed the use of CAM in treatment. The therapy identified to treat learning disabilities was EEG biofeedback (neurotherapy).
Finally, one article identified and discussed the use of music CAM therapy in treatment of visual impairment as well as autistic spectrum disorders, cerebral palsy and mental retardation/Down syndrome as mentioned above.
Conclusion
CAM use is widespread for treating children with autistic spectrum disorders, cerebral palsy, and ADHD. CAM is less commonly used for treatment of the developmental disorder categories of learning disabilities, mental retardation, and visual impairment. Despite the high level of CAM use for treating children with developmental disabilities, CAM use does not supercede the traditional treatment of such disorders.
Specifically, CAM usage in autistic spectrum disorders is concentrated among biologically-based therapies such as vitamin supplementation, dietary modification, and unconventional use of medical therapies. CAM administration in cerebral palsy most commonly includes mind-body interventions, body-based methods, and energy therapies. CAM treatment for ADHD covers a wide span including biologically based therapies, vitamin supplementation, dietary modification, medical treatments, and biofeedback therapy. Finally, documented CAM usage in visual impairment and mental retardation is limited to music therapy, and CAM treatment of learning disorders is limited to EEG biofeedback.
The widespread and greatly varied spectrum of CAM utilized among families of children with developmental disabilities demonstrates the ongoing search for effective and balanced treatment of these lifelong conditions. Awareness of CAM use is necessary among the pediatric community to allow better education, understanding, and optimal patient-physician relationships.
As the prevalence of CAM usage increases, studying the effectiveness and safety of CAM therapies becomes more important in order to ensure the health and well-being of children with developmental disabilities who are utilizing CAM. After more is known about CAM efficacy and safety, there is great potential for integrating CAM into standard treatment of various developmental disabilities. There is currently a limited body of literature on the effectiveness and safety of CAM in pediatric populations. More studies are needed, particularly in the area of developmental disabilities, since the usage of CAM is widespread[32].
References
1. Accardo PJ, Whitman BY. Dictionary of developmental disabilities terminology. Baltimone; Paul H. Brookes Publishing Co., 1996. 87.
2. National Center for Complimentary and Atteractive Medicine (NCCAM), USA, http://nccam.nih.gov/
3. Page T. Metabolic approaches to the treatment of autism spectrum disorders. Journal of Autism and Developmental Disorders. 2000; 30: 5, 463-469.
4. Levy S, Hyman S. Novel treatments for autistic spectrum disorders. Mental Retardation and Developmental Disabilities Research Reviews 2005; 11: 131-142.
5. Levy S, Hyman S. Use of complementary and alternative treatments for children with autistic spectrum disorders is increasing. Pediatric Annals 2003; 32:10.
6. Chase K. Music therapy assessment for children with developmental disabilities: a survey study. Journal of Music Therapy 2004; XLI: 28-54.
7. Hurvitz E, Leonard C et al. Complementary and alternative medicine use in families of children with cerebral palsy. Developmental Medicine & Child Neurology 2003; 45: 364-370.
8. Sanders H et al. Use of complementary and alternative medical therapies among children with special health care needs in southern Arizona. Pediatrics 2003; 111: 3, 584-587.
9. Liptak G. Complementary and alternative therapies for cerebral palsy. Mental Retardation and Developmental Disabilities Research Reviews 2005; 11:156-163.
10. Rosenbaum P. Controversial treatment of spasticity: exploring alternative therapies for motor function in children with cerebral palsy. Journal of Child Neurology 2003; 18: 1, S89-94.
11. Perry M. Relating improvisational music therapy with severely and multiply disabled children to communication development. J Music Therapy 2003; 3: 227-246.
12. Reid D The influence of virtual reality on playfulness in children with cerebral palsy: A pilot study. Occupational Therapy International 2004; 11: 3, 131-144.
13. Brue A, Oakland T. Alternative treatments of attention deficit/hyperactivity disorder: does evidence support their use. Alternative Therapies 2002; 8:1, 68-74.
14. Rojas N, Chan E. Old and new controversies in the alternative treatment of attention-deficit hyperactivity disorder. Mental Retardation and Developmental Disabilities Research Reviews 2005; 11: 116-130.
15. Roizen N. Complementary and alternative therapies for Down syndrome. Mental Retardation and Developmental Disabilities Research Reviews 2005; 11: 149-155.
16. Thornton K, Carmody D. Electroencephalogram biofeedback for reading disability and traumatic brain injury. Child Adolesc Psychiatric Clin N Am 2005; 14: 137-162.
17. Batshaw M. Children with disabilities, 5th edn, Baltimore, USA; Paul Brookes Publishing, 287-548
18. Behrman RE. Nelson textbook of pediatrics: 17th edn, Philadelphia, USA; W.B. Saunders, 2004.
19. Braunwald E et al. Harrison's essentials of internal medicine, 16th edn, New York; McGraw Hill, 2004.
20. Committee on Children with Disabilities. Counseling families who chose complementary and alternative medicine for their child with chronic illness or disability. Pediatrics 2001; 107:3, 598-601.
21. Cuzzolin L et al. Patterns and perceptions of complementary/alternative medicine among paediatricians and patients' mothers: a review of the literature. Eur J Pediatr 2003; 162:820-827.
22. Hyman S, Levy S. Novel therapies in developmental disabilities - hope, reason, and evidence. Mental Retardation and Developmental Disabilities Research Reviews 2005; 11:107-109.
23. Kemper K, Gardiner P, Conboy L. Herbs and adolescent girls: Avoiding the hazards of self-treatment. Contemporary Pediatrics 2000; 3: 133.
24. Kemper K, Jacobs J. Homeopathy in pediatrics - no harm likely, but how much good. Contemporary Pediatrics 2003; 20: 97.
25. Kemper K, O'Connor K. Pediatricians' recommendations for complementary and alternative medical (CAM) therapies. Ambulatory Pediatrics 2004; 4: 482-487.
26. Kemper K, Cohen M. Ethics meet complementary and alternative medicine: New light on old principles. Contemporary Pediatrics 2004; 21: 61.
27. Nickel R, Desch L. The physicians guide to caring for children with disabilities and chronic conditions. Baltimore; Paul Brookes Publishing, 2000.
28. Prussing E et al. Communicating with pediatricians about complementary/alternative medicine: perspectives from parents of children with down syndrome. Ambulatory Pediatrics 2004; 4: 488-494.
29. Scharff L, Kemper K. For chronic pain, complementary and alternative medical approaches. Contemporary Pediatrics 2003; 20: 117.
30. Swartzman L et al. What accounts for the appeal of complementary/alternative medicine and what makes complementary/alternative medicine "alternative". Medical Decision Making 2002; 22: 431-450.
31. Whelan J, Dvorkin L. HolisticKids.org - Evolution of information resources in pediatric complementary and alternative medicine projects: from monographs to web learning. J Med Lbr Assoc 2003; 91(4): 411-417.
32. Zafiropoulou M, Mati-Zissi H. A cognitive-behavioral intervention program for students with special reading disabilities. Perceptual and Motor Skills 2004; 98: 587-593.(Brown Kelly A, Patel Dili)
Abstract
Developmental disabilities (DD) are defined as a diverse group of severe chronic conditions due to mental and/or physical impairments. Individuals with developmental disabilities have difficulty with major life activities including language, mobility, and learning. Developmental disabilities can begin anytime during development - from prenatal up to 22 years of age, and the disability usually lasts throughout a person's lifetime. Autism spectrum disorders, cerebral palsy, mental retardation, and attention deficit hyperactivity disorder are common conditions falling within the definition of developmental disabilities. Complementary and alternative medicine (CAM) is becoming increasingly utilized in the general population for treatment of everything from the common cold to complex and chronic medical conditions. This article reviews the prevalence of different types of CAM used for various developmental disabilities
Keywords: Alternative medicine; Complementary medicine; Mind-body intervention; Energy therapies
Developmental disabilities (DD) are defined as a diverse group of severe chronic conditions due to mental and/or physical impairments. Individuals with developmental disabilities have difficulty with major life activities including language, mobility, and learning. Developmental disabilities can begin anytime during development, from prenatal upto 22 years of age, and the disability usually lasts throughout a person's lifetime. Autism spectrum disorders, cerebral palsy, mental retardation, and attention deficit hyperactivity disorder are common conditions that can be considered as developmental disabilities.[1]
Complementary and alternative medicine (CAM) is becoming increasingly utilized in the general population for treatment of everything, from the common cold to complex and chronic medical conditions. For many families of children with chronic medical needs and developmental disabilities, CAM offers an additional avenue of treatment other than or in addition to traditional medical care.
Complementary and alternative medicine (CAM), as defined by the National Center for Complementary and Alternative Medicine (NCCAM, USA), is a group of diverse medical and health-care systems, practices, and products not presently considered to be a part of conventional medicine. As therapies proven to be safe and effective come to be adopted in conventional health care, the definition of CAM and therapies included within its definition change continually. The five categories of CAM, as defined by NCCAM, are as follows.[2]
1.Alternative medical systems are those built upon complete systems of theory and practice, such as homeopathic medicine, naturopathic medicine, and traditional Chinese medicine.
2.Mind-body intervention is another subset of therapy that uses techniques such as meditation, prayer, music, art, or dance.
3.Biologically-based therapies use substances such as herbs, foods, and vitamins that have not yet been scientifically studied to treat specific medical conditions.
4.Manipulative and body-based methods, such as chiropractic, osteopathic manipulation, and massage, are commonly used forms of CAM.
5. Energy therapies use unconventional methods such as magnetic fields or alternating current, and include theories on energy fields such as Qi gong in traditional Chinese medicine and the therapeutic touch or application of pressure to the energy field points on the body.[2]
Materials and Methods
The purpose of this review is to identify the current extent of use and specific types of complementary and alternative medicine in treating children with developmental disabilities. A literature search was performed using the PubMed/Medline database. The literature search was limited to articles published in English over the last five years, and on children between 0-18 years of age. Multiple searches, along with a MeSH Complementary Medicine search, were completed using the above limitations. Within the aforementioned search limitations, the following keywords were used to search articles: developmental disabilities, autism, attention deficit hyperactivity disorder, cerebral palsy, and mental retardation. Of the 237 articles produced from the searches, 17 were found to be pertinent to the study. Five additional relevant articles were found in the literature after the formal PubMed/Medline searches were performed. Standard textbooks were also reviewed. Additionally, background information was obtained from review of the information available from websites of Centers for Disease Control and Prevention (USA), National Institutes of Health (USA), and NCCAM, as well as four supplemental reviews.
Results
Results of the literature review are summarized in table1 below.
Discussion
Complementary and alternative medicine therapies are widely utilized among pediatric populations with developmental disabilities. In children with autistic spectrum disorders, the most frequently reported use of CAM was from the realm of biologically-based therapies such as vitamin supplementation, dietary modification and unconventional use of medical therapies. Four articles reported usage of medical therapies such as antifungal, antiviral and antibiotic medications, secretin, Pepcid, oxytocin, intravenous immunoglobulin, heavy-metal chelation, and immunization withholding. Three articles reported various usages of vitamin supplementation and dietary modifications. Finally, one article reported use of music therapy and an additional article discussed the used of behavioral optometry, craniosacral manipulation, and communication therapies, as well as auditory integration training as CAM for treating autistic spectrum disorders.
The greatest amount of information regarding use of CAM in developmental disability was found in literature on treatment of cerebral palsy. These articles focused mainly on mind-body interventions, body-based methods, and energy therapies. Three articles identified massage therapy, chiropractic manipulation, electrical stimulation, conductive education, the Euromed/Adeli suit program, hyperbaric oxygen, and prayer/spiritual blessings as commonly used CAM in children with cerebral palsy. Other therapies identified included acupuncture/acupressure, aquatherapy, osteopathic manipulation, hippotherapy, craniosacral therapy, Feldenkrais method, patterning (Doman Delacato method), Reiki/Ayurveda, homeopathy, light therapy, and virtual reality play. The abundance of therapies focusing on body-based and mind-body intervention for treatment of cerebral palsy is most likely due to the many physical symptoms of the disease such as muscle spasticity or hypotonicity. Additionally, one article was found identifying non-specific dietary modification in the treatment of cerebral palsy.
Two articles were found reviewing the use of CAM in children with Attention Deficit Hyperactive Disorder (ADHD). CAM therapies spanned biologically based therapies, vitamin supplementation, dietary modification, medical treatments, and various physically-based therapies such as biofeedback therapy. Specific CAM therapies for treating ADHD were vitamin A, essential fatty acid, grapine and L-glutamine supplementation, oligoantigenic diet, homeopathy (stramonium cina, hyoscyamus niger), and herbal medications ( Ginko biloba, Melissa officinalis ). Additionally, specific physically-based therapies used to treat ADHD included electroencephalogram (EEG) biofeedback, also known as neurotherapy, yoga, massage therapy, and utilization of school-based environmental green outdoor settings.
Two articles were found discussing the use of CAM in children with mental retardation and Down syndrome. One article reviewed complementary and alternative medical treatments such as Donepezil, Piracetam, vasopressin, pituitary extract, and growth hormone as well as dietary treatments including vitamin, mineral, and nutritional supplementation regimens. Other CAM therapies discussed included cell therapy and plastic surgery. Additionally, a separate article discussed the use of music therapy in the treatment of children with mental retardation and Down syndrome.
Regarding treatment of learning disabilities, one article was found that discussed the use of CAM in treatment. The therapy identified to treat learning disabilities was EEG biofeedback (neurotherapy).
Finally, one article identified and discussed the use of music CAM therapy in treatment of visual impairment as well as autistic spectrum disorders, cerebral palsy and mental retardation/Down syndrome as mentioned above.
Conclusion
CAM use is widespread for treating children with autistic spectrum disorders, cerebral palsy, and ADHD. CAM is less commonly used for treatment of the developmental disorder categories of learning disabilities, mental retardation, and visual impairment. Despite the high level of CAM use for treating children with developmental disabilities, CAM use does not supercede the traditional treatment of such disorders.
Specifically, CAM usage in autistic spectrum disorders is concentrated among biologically-based therapies such as vitamin supplementation, dietary modification, and unconventional use of medical therapies. CAM administration in cerebral palsy most commonly includes mind-body interventions, body-based methods, and energy therapies. CAM treatment for ADHD covers a wide span including biologically based therapies, vitamin supplementation, dietary modification, medical treatments, and biofeedback therapy. Finally, documented CAM usage in visual impairment and mental retardation is limited to music therapy, and CAM treatment of learning disorders is limited to EEG biofeedback.
The widespread and greatly varied spectrum of CAM utilized among families of children with developmental disabilities demonstrates the ongoing search for effective and balanced treatment of these lifelong conditions. Awareness of CAM use is necessary among the pediatric community to allow better education, understanding, and optimal patient-physician relationships.
As the prevalence of CAM usage increases, studying the effectiveness and safety of CAM therapies becomes more important in order to ensure the health and well-being of children with developmental disabilities who are utilizing CAM. After more is known about CAM efficacy and safety, there is great potential for integrating CAM into standard treatment of various developmental disabilities. There is currently a limited body of literature on the effectiveness and safety of CAM in pediatric populations. More studies are needed, particularly in the area of developmental disabilities, since the usage of CAM is widespread[32].
References
1. Accardo PJ, Whitman BY. Dictionary of developmental disabilities terminology. Baltimone; Paul H. Brookes Publishing Co., 1996. 87.
2. National Center for Complimentary and Atteractive Medicine (NCCAM), USA, http://nccam.nih.gov/
3. Page T. Metabolic approaches to the treatment of autism spectrum disorders. Journal of Autism and Developmental Disorders. 2000; 30: 5, 463-469.
4. Levy S, Hyman S. Novel treatments for autistic spectrum disorders. Mental Retardation and Developmental Disabilities Research Reviews 2005; 11: 131-142.
5. Levy S, Hyman S. Use of complementary and alternative treatments for children with autistic spectrum disorders is increasing. Pediatric Annals 2003; 32:10.
6. Chase K. Music therapy assessment for children with developmental disabilities: a survey study. Journal of Music Therapy 2004; XLI: 28-54.
7. Hurvitz E, Leonard C et al. Complementary and alternative medicine use in families of children with cerebral palsy. Developmental Medicine & Child Neurology 2003; 45: 364-370.
8. Sanders H et al. Use of complementary and alternative medical therapies among children with special health care needs in southern Arizona. Pediatrics 2003; 111: 3, 584-587.
9. Liptak G. Complementary and alternative therapies for cerebral palsy. Mental Retardation and Developmental Disabilities Research Reviews 2005; 11:156-163.
10. Rosenbaum P. Controversial treatment of spasticity: exploring alternative therapies for motor function in children with cerebral palsy. Journal of Child Neurology 2003; 18: 1, S89-94.
11. Perry M. Relating improvisational music therapy with severely and multiply disabled children to communication development. J Music Therapy 2003; 3: 227-246.
12. Reid D The influence of virtual reality on playfulness in children with cerebral palsy: A pilot study. Occupational Therapy International 2004; 11: 3, 131-144.
13. Brue A, Oakland T. Alternative treatments of attention deficit/hyperactivity disorder: does evidence support their use. Alternative Therapies 2002; 8:1, 68-74.
14. Rojas N, Chan E. Old and new controversies in the alternative treatment of attention-deficit hyperactivity disorder. Mental Retardation and Developmental Disabilities Research Reviews 2005; 11: 116-130.
15. Roizen N. Complementary and alternative therapies for Down syndrome. Mental Retardation and Developmental Disabilities Research Reviews 2005; 11: 149-155.
16. Thornton K, Carmody D. Electroencephalogram biofeedback for reading disability and traumatic brain injury. Child Adolesc Psychiatric Clin N Am 2005; 14: 137-162.
17. Batshaw M. Children with disabilities, 5th edn, Baltimore, USA; Paul Brookes Publishing, 287-548
18. Behrman RE. Nelson textbook of pediatrics: 17th edn, Philadelphia, USA; W.B. Saunders, 2004.
19. Braunwald E et al. Harrison's essentials of internal medicine, 16th edn, New York; McGraw Hill, 2004.
20. Committee on Children with Disabilities. Counseling families who chose complementary and alternative medicine for their child with chronic illness or disability. Pediatrics 2001; 107:3, 598-601.
21. Cuzzolin L et al. Patterns and perceptions of complementary/alternative medicine among paediatricians and patients' mothers: a review of the literature. Eur J Pediatr 2003; 162:820-827.
22. Hyman S, Levy S. Novel therapies in developmental disabilities - hope, reason, and evidence. Mental Retardation and Developmental Disabilities Research Reviews 2005; 11:107-109.
23. Kemper K, Gardiner P, Conboy L. Herbs and adolescent girls: Avoiding the hazards of self-treatment. Contemporary Pediatrics 2000; 3: 133.
24. Kemper K, Jacobs J. Homeopathy in pediatrics - no harm likely, but how much good. Contemporary Pediatrics 2003; 20: 97.
25. Kemper K, O'Connor K. Pediatricians' recommendations for complementary and alternative medical (CAM) therapies. Ambulatory Pediatrics 2004; 4: 482-487.
26. Kemper K, Cohen M. Ethics meet complementary and alternative medicine: New light on old principles. Contemporary Pediatrics 2004; 21: 61.
27. Nickel R, Desch L. The physicians guide to caring for children with disabilities and chronic conditions. Baltimore; Paul Brookes Publishing, 2000.
28. Prussing E et al. Communicating with pediatricians about complementary/alternative medicine: perspectives from parents of children with down syndrome. Ambulatory Pediatrics 2004; 4: 488-494.
29. Scharff L, Kemper K. For chronic pain, complementary and alternative medical approaches. Contemporary Pediatrics 2003; 20: 117.
30. Swartzman L et al. What accounts for the appeal of complementary/alternative medicine and what makes complementary/alternative medicine "alternative". Medical Decision Making 2002; 22: 431-450.
31. Whelan J, Dvorkin L. HolisticKids.org - Evolution of information resources in pediatric complementary and alternative medicine projects: from monographs to web learning. J Med Lbr Assoc 2003; 91(4): 411-417.
32. Zafiropoulou M, Mati-Zissi H. A cognitive-behavioral intervention program for students with special reading disabilities. Perceptual and Motor Skills 2004; 98: 587-593.(Brown Kelly A, Patel Dili)