Dr. Victoria Maizes: Hi Andy.

Dr. Andrew Weil: Hi Victoria.

Dr. Victoria Maizes: Today on Body of Wonder, we are going to interview one of our first fellows, Dr. Sandy Newmark.

Dr. Andrew Weil: Sandy is a long time, very long-time friend and colleague, and I'm delighted to have him as a guest on our podcast.

Dr. Victoria Maizes: Me too. He’s been a leader developing strategies for taking care of kids with ADHD, autism, and also tackling some of the tough subjects like vaccines.

Dr. Andrew Weil: Great. Let's hear what he has to say.

Introduction Music

Dr. Victoria Maizes: Dr. Sanford Newmark is a clinical professor in the department of pediatrics at the University of California and the head of the pediatric integrative neuro developmental program at the OSHA Center for Integrative Medicine. He specializes in the treatment of autism, ADHD, and other chronic childhood conditions.

Dr. Newmark has lectured widely on autism and ADHD. He is the author of the book, ADHD Without Drugs; A Guide to the Natural Care of Children with ADHD. And we are proud that he is one of the first pediatric graduates of the integrative medicine fellowship at the University of Arizona Andrew Weil Center for Integrative Medicine.

Welcome Sandy.

Sanford Newman: Thank you for having me, I’m honored.

Dr. Victoria Maizes: It's great to have you, Sandy. And I would love to begin by asking about the major differences between the conventional and integrative approaches to the care of children.

Sanford Newman: Yeah I would say that before we answer that question, we should answer do children in our country really need a lot more help than they're getting.

And by just about any measure, they are if we really look carefully, physically and psychologically. And of course we know mind and body are inseparable anyway, our children are less healthy than most of the developed world. Just to share a few sobering statistics. The UNICEF publishes a big survey of overall child health and the developed countries.

And we were 36 of 38 on a wide variety of measures. Infant mortality, we’re 33 of  36. And we have the second highest rate of obesity in developed nations, aside from a very small Asian islands. So 30% of our children are overweight or obese, and this is risen dramatically. Just since 1970, the rate of obesity in children has gone from 5 to 7 to 20%.

And mental health issues are just as concerning. It's a little harder to be concrete about because with mental health, a lot depends on what your definition of things are and how hard you're looking as opposed to something measurable more easily like obesity. But in one JAMA study there a 27% increase in anxiety and a 24% increase in depression.

Just between 2016 and 2019, that was before the COVID epidemic.

Dr. Andrew Weil: So let me ask you what can integrative medicine offer that conventional medicine? Can't the deal with these you know, very concerning from.

Sanford Newman: I think that we need to really look at every level of how we take care of kids in our society.

And it has to come right from preconception. We know that there are many mental and physical health problems that arise out of nutritional and toxic issues that happened before conception. Things like levels of pesticides and lead levels. And these cause real problems, both on child's mental and physical health, so we have to start paying attention to women even before pregnancy and especially during pregnancy. And unfortunately we do very little of that really compared to other countries. Just as an example, low prenatal vitamin D levels can be tribute to autism and ADHD and [00:04:00]abnormalities of the maternal microbiome and toxic exposures and obesity.

All these things are things that integrative doctors look at and try and change even before a child develops a problem.

Dr. Victoria Maizes: So these are really so sobering to hear the challenges we face. And I have to say in, in my years of practicing medicine, I have just experienced that more and more kids carry one chronic disease or another, and, and clearly we're going the wrong way. They’re becoming less healthy. So. It seems like there's multiple levels we have to work at. You know, one is the the social level. You talked about some of the environmental toxins. It's really hard for an individual to fix all of that, but the other is on the individual level and the things that you can do as a parent or a soon to be parent.

Sanford Newman: Right, right. The things that you can do, if you have care, and if you have an integrative doctor, who's aware of all of this can be very important. If you're a parent, you can make sure you feed your children correctly and right. Starting from infancy breastfeed and make sure your own microbiome is in as good a shape as you can get it.

And your own vitamin and mineral levels are as good as you can get them and you can keep your house free of pesticides and toxins, even, even having flea collars in a house increases the risk of autism and probably other developmental issues. So those are all things that we can do. And of course, diet. Diet is tremendously important in all of these things.

But I will say when you look at whatever levels you're looking at, the role of the tremendous inequity in our society is a really big, we have the highest level of inequity and economic inequity and childcare equity of any developed nation. And, and this really this goes right down to the individual level where people aren't able, they're looking if they have a primary care doctor, much less an integrative doctor.

And they're lucky if they can forward any kind of decent. So we need to really kind of look at every level from government and politics to community and education, and then to the individual family.

Dr. Victoria Maizes: Yeah you have set out a very big frame for what we need to do to correct the mess that we're in. Andy food and healthy nutrition have been core to how you have defined integrative medicine. Can you expand a little bit on what should we be feeding our child?

Dr. Andrew Weil: Well, I've, you know, argued that the anti-inflammatory diet should be started as early as possible in life.

And then to think about the dietary supplementation that's desirable. Sandy mentioned vitamin D is one example. I would say omega three fatty acids are another. And then what we should not be feeding. You know what I would say if there's one step that we could take to get out of the nutritional mess it would be to try to get people not to drink sweetened liquids. And that's especially important for kids, not just sodas, but also fruit juice, energy drinks, adding sugar to drinks that that one step would go a long way toward moving things in a better direct.

Sanford Newman: I have to tell you that coincidentally I heard today on a podcast that Tropicana has come up with a new breakfast cereal, sugar cereal meant to have orange juice poured on it. Seriously. [00:08:00]

The guy said it comes, it comes with a little prize in the carton of the syringe of insulin. No, but seriously, the breakfast that some of our kids eat are terrible… things like pop tarts, and even a very popular breakfast of waffles with syrup, you really might as well take a funnel and pour about 15 teaspoons of sugar into your child's mouth and send them off as to give them that kind of reference.

But it's really very common. And as we all know them, because of the glycemic index, the sugar goes up and then it goes down. Yeah, unhealthy kids who act like they have ADHD.

Dr. Andrew Weil: You know aside from the environmental issues and lifestyle issues that Sandy mentions integrative lead trained physicians and other healthcare professionals are aware of other kinds of interventions and treatments that are not really known in conventional medicine and not used. And I would just like to say that I've known Sandy for a very long time. I knew him when he was an anthropology graduate student before he went to medical school. And during that time he introduced me to Robert Fulford an elderly osteopathic physician who had come to Tucson to retire.

And I've written about him, talked about them extensively. He was a master of cranial therapy, and I think the most effective healer I've ever met. And one of the areas of his great success was ending recurrent cycles of otitis media, ear infections in kids. And. Which conventional doctors treat with rounds of antibiotics and that, you know, many, many problems associated with that kind of treatment.

And he would do simple manipulation to change breathing patterns. And that was the end of the year infections. I mean, this, I had never seen any kind of medicine like that, and it really shaped my thinking and was one of the foundations of philosophy that led to integrative medicine.

Dr. Victoria Maizes: So I've heard you talk extensively over the years about Dr. Fulford, but I did not know that it was Sandy who made the introduction, Sandy, how did you come across him? And what did you learn from him?

Sanford Newman: Because my own daughter had developmental problems. I was looking for some help and I got his name and I went to him and he was very helpful and he didn't fix everything, but he really, he really seemed to be helpful.

And then went and actually. I followed him for a summer, twice a week. And it was really remarkable seeing the kinds of things people would report to me. You know, the interesting thing is he came to Tucson to retire from Cincinnati. First was working out of his house and then the demand got so great.

He had to get to have an office and.

Dr. Victoria Maizes: Yeah. I don't know whether you would be willing to tell us a little bit about how Dr. Fulford helped your daughter or perhaps one of the other children that you saw.

Sanford Newman: Yeah, he did help my daughter. And he did a luck, a lot of work to kind of open up her whole cranial area.

And it seems like she just sort of brightened up after that. And you could, you could just see it move more, you know? Cause she was, I think she was probably, 3 months old when we brought her there. So the sutures hadn't closed And then I, you know, I saw other people who had had longstanding pain, syndromes, you know, abdominal pain or back pain or something like that just went away and one or two treatments, it was quite remarkable.

Dr. Victoria Maizes: One of the patients that I remember you taking care of when you were a fellow at the center was a teenager who had a chronic pain syndrome. I'm wondering whether you could describe how he got help, because that was a somewhat different approach.

Sanford Newman: Yes, that was amazing. I was just thinking of Harmon.

He said that, so this was a boy who at age 15, I was an entirely normal child and he got sinusitis, which was then accompanied by a headache. I'm going to miss a few details because this is now like 20 years ago, but basically he got a sinusitis and then a headache, and the headache wouldn't go away. And he got treated with various things for it.

And then, because the headache didn't go away and he was out of school, they decided he was depressed and they treated him with all sorts of psychiatric medications, none of which worked. So he just gave up and went back to it and had a headache for about six months. And finally got better. Three years later, he developed this horrible neck pain with a neck tick and he was literally ticking away this really fast, painful snack all day long. And once again, you know, he went to the orthopedist and neurologist, they couldn't find anything. So they decided that he was depressed or that he had, you know, a functional pain and he went down this whole array of psychiatric medications, none of which you did anything.

And he actually used one which caused the tardive dyskinesia, which luckily went away. And finally, at the end of all this he's he's homebound. He can't do anything. He's in pain. He's having all these ticks and we brought him to see Harmon Myers and I was the fellow then. Who did strain counter-strain you know, an osteopathic manipulative technique.

And after the first session, which was like half an hour, he said he felt significantly better. And Harmon just told them to go home and take it easy and not do anything different. And come back in two weeks, it came back in two weeks. He was back on the baseball team. He stopped to all his medications.

And after the second treatment, it was better. I never saw him again. And I called him and it was like, well, I'm better. Back to his normal life. And it was just really remarkable. And [00:14:00] one of the lessons from that is, of course, you'd have to look at alternative modalities. And especially if you have a musculoskeletal abnormality, you'd go with a muscular treatment musculoskeletal treatment.

But the other one was. This was a normal kid. He never had a psychiatric or psychological problem in his life. Why at the age of 15, do you decide that you decide that he's has such terrible depression that is causing all of this? Well, yeah, he did have depression, but it was because his neck hurt and he couldn't go to school mean he lost all his friends and he couldn't play on the baseball team.

Dr. Andrew Weil: So, Sandy, I know what you'll say in answer to this, but how do you feel about the current fad of putting so many kids on psychiatric drugs and multiple psychiatric drugs, it seems to be completely out of hand.

Sanford Newman: It is completely out of hand. It's really terrible. There, are a small percentage of kids who really do need them, but I think we're vastly over-treating even with one psychiatric drug.

And then the, the number of kids who have multiple psychiatric drugs is just amazing. It's awful. And I think most of our psychiatrists have become medication dispensers. They, you know, they see kids, not only, it's not just their fault because they're only paid for insurance. Only wants to pay for 15 or 20 minutes every month or two or whatever, but they simply see the kid as couple of questions in there.

If the medicine isn't going a lot of times, it just add one.

Dr. Andrew Weil: How much progress are we making with integrative psychiatry training?

Sanford Newman: I think we're making really good progress at OSHA. We have two, three now wonderful integrative psychiatrists who are using all kinds of. Other methods to help two kids, including doing real therapy, including mindfulness space, stress reduction, and including even expressive arts therapy.

And I think we're making good progress at least where I am, you know, San Francisco what what's happening [00:16:00] across the rest of the country. Maybe a little more limited. You know, the other interesting thing, you know, that take care of a lot of ADHD and sometimes I do need to use medication, but do you know, we have, the, most of the medications are used for ADHD are now 60 years old. Ritalin and Adderall there hasn't been a new one in 30 years.

I mean, that's really awfully remarkable, terrible way. I mean, think of all the other good medications we've had…

Dr. Victoria Maizes: You mentioned that sometimes you need to use medication when you're treating ADHD, but I know that most parents, well, most parents who come to integrated medicine would rather not use the medication.

So what are the other strategies that you turn to?

Sanford Newman: Yes. I think this is where a whole child integrated approach can really be so helpful. It's not one strategy, but I use nutrition and of course, sometimes I'll use elimination diets because there's food sensitivities involved. Definitely the anti-inflammatory load, the diet, or maybe three fatty acids supplementation for everyone. Cause that's where the biggest research on ADHD is, is when I look at iron as measured by ferritin, because low ferritin is associated with ADHD and a remarkable number of kids have a low ferritin ADHD look at vitamin D levels. And then the lifestyle things are really important.

Sleep. Exercise. Screen time management, screen time is just unbelievable problem with the kids I take care of now that the schools are often having kids use computers in the classroom [00:18:00] all day and for their homework, there are kids who are literally on screens almost every minute of their waking life.

Dr. Victoria Maizes: Wow. Wow. I know that you get asked this question despite being a pediatrician, but does adult ADHD really exists? And how do you diagnose.

Sanford Newman: Yes, it does really exist. Then you can see that because kids who have relatively severe or even moderate ADHD do grow up to be adults with ADHD. And in fact, most of the time when I see a kid with ADHD, one of their parents goes “Oh, he just like me.” So I think it really exists. It shouldn't be dying. By a full, a full history and physical and good testing by a doctor with experience. But it's not, it's just diagnosed. There is there's companies now that actually put out advertisements that say, get your AD diagnosis, get your Adderall And they give this little list of, of symptoms. All of which anybody could convince themselves they have, and then you can go get your Adderall without ever being seen by anybody. And these companies are all competing with each other for a, for a market space. It's really awful. So ADHD for an adults is the most quickly increasing sector of treatment.

And it's it's even more, I think it's going to end up being even more over diagnosed than in kids.

Dr. Andrew Weil: It seems to me in the, in recent months I've seen more and more articles speculating on the cause of autism and saying that we're getting close to finding how it originates. What are your, what's your thinking about that?

Sanford Newman: Well, I think it's. It's definitely a multifactorial. And we do, we do need to realize, I mean, the, the, the incidents and prevalence of autism has gone up very dramatically in the [00:20:00] last 20 years or so. Some of that is just diagnostic opening of the diagnosis. And some of it is looking harder, but some of it is very real.

And I think it has to do with a combination of nutrition and toxic factors. I just want to share with you one really amazing study. I’ll read you this little part, cause it's just so.. “we report the DNA methylation profile of a child's and neonatal whole blood can be significantly influenced by his or her mother's neonatal blood levels.

We found that mothers with high neonatal blood level. Carla with altered DNA methylation at 564 low side and their children's blood to put this another way is for a girl or boy born today…if their grandmother had high blood lead levels, which they passed on to their mother, this would affect their DNA methylation.

And if that's true, just think about the amount of lead, for instance, that was in mine and your what, when we were having our children, when I was a medical school, the acceptable blood level is, was less than 20. Now it's less than five and we know that it should be, you know, for every number, it goes up between one and five there's a correlating decrease in IQ. So this to me is under a tremendous example of a toxins maybe it causes and methylation is a big problem in autism. So this is a tremendous example of how toxins can be really affecting our children's still even the ones that are going down and many others.

Dr. Andrew Weil: Any treatment options for autism? And is integrative medicine is aware of.

Sanford Newman: Yes definitely. So there's a word called biomedical treatment for autism, and that's really kind of a nutritional deep based integrative approach. And this is what I do. Half of my practice is autism and this has to do with cleaning the diet

Often a gluten-free casein-free diet and some of the same things as autism fish oil and various things, but other things are even a little more out there… My most successful treatment right now for autism is methyl B12, methylated vitamin B12, because as, as hinted at, by that, a lot of kids with autism don't methylate well, and when you give them this methylated B12, they can dramatically positive reactions.

And another thing is folinic acid which is just basically an activated fully because they also often don't absorb folate very well. And some of them, even some of the kids with autism, even antibodies. And so folinic acid can be absorbed and there's studies showing that Foley can actually folinic acid can actually improve autism symptoms.

So those are the kinds of things we're doing. We're doing it on. Just a little basic research because it's really hard to get that research done, but there is research and it is safe.

Dr. Victoria Maizes: So one of the things that we have learned from epigenetics is that if you can fully methalate genes, which you do with methyl donors, which come from B vitamins and late then that genetic predisposition may not get expressed.

And you also do it with a really healthy diet that includes leafy green vegetables. That may be harder with some kids with autism. But, but how early do you have to start to have enough?

Sanford Newman: Yeah that's a really good question because one of my pet peeves is how late kids are diagnosed with autism.

So many of my parents tell me, they told their family doctor pediatrician, and there was something wrong as early as 6 months, 9 months, 12 months. And they just sort of got put off for another year, year and a half. And those are [00:24:00] crucial times. The earlier you start. You know, the better your chances.

I don't think there's hardly any age before adulthood I wouldn't try it, but the kids who I see you have the most dramatic improvements are 3, 4, 5, not even eight, nine and 10. So it's so important to get that in early.

Dr. Victoria Maizes: Three four or five years old, you're saying. How about the integrative medicine approach or ideas from integrative medicine to prevent autism?

Sanford Newman: So there's a good story I know about that. I know two people who are, who are primary care pediatricians, but also take care of a lot of autism. In their practice they have not had in the last 10 years, a sibling born to a child with autism who had autism when the risk is 10 times as high. Wow. Wow.

If you have one child and this is the simple things avoid during pregnancy avoiding pesticides, avoiding other toxins, taking their prenatal vitamins, making omega 3 levels are okay. And trying to work on your on your biome. We know the biome is abnormal in autism. So all those things can really make a difference.

There's one study that showed if, if women were taking their, just the amount of folate and their prenatal vitamins there, the, the risk of pesticides causing autism and their kids was dropped significant. So it's really this whole bunch of simple nutritional and toxic and avoiding things. And then of course, once the kids are born, you do the same things.

Just like Andy was saying the good probiotics and the fermented foods. So I think that's the way we do it.

Dr. Andrew Weil: Sandy, how do you deal with the rising incidents of anti-vaccine sentiment and tough question, but what do you think about that?

Sanford Newman: I mean, it's really hard and because of the nature of my practice, I probably even got a little more of that than anybody else? I just tried to be really rational about it and point out that the benefits are so much greater than the possible side effects. One of the stories I tell people, which is the truth from my internship is when I was an intern in 1985, practically every week, you'd have some infant come in with Haemophilus B meningitis.

And, you know, they either died or had brain damage or they became deaf. And cause we didn't have a vaccine until the children were two. And then they developed a vaccine that we gave it to four and six months. And now living pediatrician, I mean, anybody is a younger pediatrician never seen that disease.

So, you know, I kind of try and tell them that story. But I mean, I don't try and kick them out of my practice and we fear occasionally. I don't think vaccines cause autism, for instance, most of the time, but something triggers regressive autism in some kids, you know, there's autism, which is there all the time and other kids never developed, well, then you have these kids, which is even sadder where they're 18 months, two years, two and a half, and they're just normal and they just start to lose their abilities.

And anything can trigger that I've seen gastroenteritis triggered or nothing triggered, but occasionally I'll get the story. They got their MMR, they got a fever to 104 for a week. And after that they stopped talking. I'm not going to tell them that wasn’t caused by a vaccine. And nor am I going to tell that parent to get more vaccines, I just won't. But that is such a minority.

Dr. Andrew Weil: Yeah. Do you think there's any reason to modify [00:28:00] our vaccine schedules or to delay giving some of them?

Sanford Newman: I Yes, do. When I was in primary care, pre integrative medicine, I, most of my patients who came to the integrative practice wanted a modified vaccine schedule. And I didn't mind at all.

So two major modifications. And one, I don't think there's a reason you have to have Hep B at birth. You know, you know, somebody has been well-tested now that may not be true for certain parts of the population who don't have good prenatal care or have higher risk. But for most of the people I was seeing, it wasn't necessary.

And second I would give like instead of five vaccines at two months, four months and six months, I would give them a half, a two months, then a couple of three months, then four and five, just spread them out a little. So it's not such a shock to the nervous system. Seems to me that just makes sense. But yet everybody would get all their vaccines on time.

As our friend Randy Harwood says, I mean, vaccines may be the most brilliant public health measure ever invented. I hate to see us kind of turning away from them and especially because of the politics of it. Now, this stream combination of Trumpism and anti-vaccine ism is really strange.

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Sanford Newman: I wanted to talk a little about something else that I think really affects our kids' mental and physical health.

And that is the change in our, in the structure of our communities, you know? We used to grow up in my generation has kids. And then a little less than an that one in a neighborhood where usually our grandmother lived in the house or next door and our cousins and the aunts and [00:30:00] everybody was around. And we often grew up, at least I did, and many people in a neighborhood where everybody was sort of stable. We knew everybody who lived near us. And they all watched out for us. And now that is so not true. People who live thousands of miles from, from their grandparents. They live in neighborhoods where nobody knows them and it causes tremendous stress.

So now instead of you know, you come home from school and one parent or other is home. And I won't say it should be the motherhood who should be it could be the dad for sure, but now, you know, your parents are both parents are working and they're sending their kids to the preschool program that preschool, and then they go to school and then they go to aftercare and then their parents pick them up and a rush home and try and get something decent on the table before they're exhausted.

And everybody is completely stressed. And not only that kids can't go out and play so much, you know, it used to be kids went out and played. And that's, that's how people develop their ability to interact socially, not when some soccer coaches managing them on the field, but when they're running around by themselves, forming groups and figuring out how to play.

And I think this whole change of society has really had a very negative effects on our children. And that's a hard one to fix right.

Dr. Victoria Maizes: That is a hard one to fix. And yeah, I was hoping you were going to say something about time outdoors. Cause I think that the other side of screen time is people are staring at their screens as opposed to wandering around the trees and playing in the grass and, and being outdoors.

And, and that too seems to have a really negative effect on kids.

Sanford Newman: Yeah. The research on screen time and things like ADHD and autism stuff is still not there yet, but the early research indicated, it's really bad for us. And children, a little preschoolers are exposed to more TV ended [00:32:00] up at screens now.

I mean, how often do you see two-year-olds staring at a tablet? Frightening

Dr. Andrew Weil: When I was growing up in Philadelphia from a very early age, I was traveling around the city by myself. You know, I go to connect with my parents and downtown taking public transportation. It felt safe. I mean, I think that's one way that I develop my independence and, and self-confidence, and you know, it doesn't feel that way anymore.

Sanford Newman: Well, it doesn't matter what sort of hard to figure out is how much is real danger to kids or how much is just paranoia, because our news just abuse the system. I'm sure back when I was a kid, there were kids who are. You know, got into trouble in some way or other, but, but you know, they weren't so over protective, I did the same thing, Andy I lived in Queens.

And I would my friends and I would take a bus into different parts or take a train and go into the city. And nobody thought anything much of it. And you don't have to live in the country to play outside. By the way, I believed in the schoolyard football, baseball, whatever, you know, all the time there was, it was cool being outside.

So I think that's really important. You know, the, the other thing is getting back to the government level when they expanded the child tax credit in early 2000-2021, they, it they've figured it reduce child poverty by 30% and food insufficiency by 25%. And then a year later it was gone. So talking about a simple thing you could do that hardly had any impact on the budget.

Cause, you know, everything we said that kid kids are popping out with these days is worse for boardroom. You know, they got less medical care, they got less good food. They have more stress they're exposed to more toxins, you know? So at that level, there's so much we could do

Dr. Victoria Maizes: Sandy, give us a few good next steps for people who want to raise healthy kids.

Sanford Newman: Yes. So first step if you're a woman of childbearing age or know child bearing age, have them get preconception counseling because those, those people should be actually taking their folate and their fish oil before they even get pregnant and then find it integrative OB GYN, which is not very easy to find, but we had a family practice doctor and, and talk about the things you can do to ensure health during pregnancy and have good birth.

Cause you know increased level of C-sections increase risk of autism for example. And good diet you know, and all the things we were talking about just, just starting early and then try and keep your kid off of screens, trying to make sure they get enough sleep. Some of my parents have to literally round up every electronic thing in the house and lock them up at night,

Dr. Andrew Weil: Sandy with regard to C-sections.

Do you remember, remember that was one of the things that Dr. Fulford talked about, and this was long before C-sections had become as popular as they are now. But he said that the pressure on the cranium of vaginal birth established the cranial rhythm you know, which she directed this treatment to, and that didn't happen with a C-section and he thought that any baby born by C-section should go as soon as possible to a cranial therapist, you know, a DA who could do very simple manipulation to help restore that movement.

Sanford Newman: Yeah. That's a really a good idea. And we actually, I actually have a couple of very good cranial sacral therapists in the bay area. I don’t know how common; they are in some of the areas of the country. But yeah, and, and you don't use, I use I use traditional Chinese medicine for some of my children too. I think that can be really helpful, especially for sort of nervous system issues.

You know, it's sympathetic fight and flight that so many kids. Cause anxiety and depression are also increasing in our kids, especially anxiety with COVID and everything. It's just the, so using traditional Chinese medicine methods can be helpful as well.

Dr. Victoria Maizes: We so appreciate all the work that you've done to bring a different thought process, to both preventing health problems in kids and treating them when they do occur and that your leadership in autism and in ADHD. Thank you. Thank you for all the work that you've been doing.

Sanford Newman: Oh your welcome and thank you for getting me started on this.