Category: General

Simple Fall Recipes to Make With Your Child

Cooking is fun and enjoyable for children. They get the joy of creating a dish and eating it. Children use all of their senses while cooking; letting them cook helps them to be more comfortable with food and can make them healthier eaters.

Cooking is a great opportunity to introduce some early math concepts in a fun environment. Think about all the mathematical language and equipment used during cooking; adding, reducing, weighing, scales and measuring.

Your kitchen is the perfect place to chat with your child. If your child can read, have your child read out the recipe while you gather the ingredients and materials needed for the dish. In fact, following the steps in a recipe helps children learn about sequencing—essential for good communication skills.

You can show your child that cooking a meal for family and friends is a way of giving and receiving love. Food image created by Pressfoto – Freepik.com
  • Speak to them about what happens first, next, after and last while you are preparing the dish.
  • Ask your child to imagine what the dish will look like once finished. Will it look like the picture?
  • Use lots of ‘describing’ words while you cook.
  • Using words such as ‘crackle’, ‘fizz’,and ‘crunch’ is great for helping your child to practice communication skills.
  • Get your child to use all five senses while cooking. Talk about how things smell, taste, feel, sound and look.
  • Ask your child how the mixture turns out once it’s been cooked.

Preparing and cooking a meal requires patience and care. You can show your child that cooking a meal for family and friends is a way of giving and receiving love. Friends and family appreciate the time and effort it takes to make a meal. They also give lots of praise for the chef! Sharing a special family recipe, cooking for a holiday or making special treats for a friend’s birthday are great ways of creating lasting memories that your child will treasure forever.

In order for cooking to be a fun activity for you and your child, you will need to plan. Try not to plan a cooking activity with your child if you need to eat in a hurry. Remember, your child is in control. Don’t stress out about the mess made in the kitchen – your child can have fun helping you to clear up. Let them pick an ingredient they like and build a dish around that.

Getting your child to help in the kitchen gives a hands-on way for your child to discover new flavors and new foods, boosts your child’s math, language skills and even emotional development.

Here are some simple fall recipes to try:

Fall Colored Leaf Cookies. When thinking of fall, the image of colorful leaves usually pops up in our minds. This cookie recipe take advantage of that and represents the beautiful fall leaves. The only extra materials needed (besides the cookie dough) is leaf cookie cutters and food coloring. This can be a fun time to go out with your child and look at the leaves. Have them observe the colors and then go back in and pick out the needed food coloring. You can buy sugar cookie dough or make your own. Separate the cookie dough into smaller potions in a couple bowls. Your child can help you put drops of food coloring in the selected bowls or supervise to let you know if more is needed to bring out the color. After mixing the food coloring in and combining the dough, your child may be able to help the rolling process. They may not be able to physically use the roller, but they could start the process by smashing the dough down, making it thinner for you to roll. After that, have them help you use the cookie cutters to make the leaves, then bake them.

Candy Cornucopia. Thanksgiving is right around the corner and this can be a fun way to involve your child. It is also super simple. Some waffle cones and little treats such as M&M’s can make a cute holiday desert for the kids. While the parent will have to do the molding with the points of the cones to make the cornucopia shape, the child can help dip the cones and fill them. You can also give them a couple of options they can pick from to fill the cornucopia. Wrap them with clear plastic wrap and it’s a cute cornucopia treat recipe. Turn this into something educational by explaining what a cornucopia is.

Pumpkin Muffins. Pumpkins are a huge part of fall, so why not make some tasty muffins with them. This recipe is basic and only takes 10 minutes to prepare and then 15 minutes to bake. They can help with stirring all the ingredients together and even sifting the flour mixture. Your child may even be able to help pour the mix into the muffin tray. Try giving them a smaller ladle with the amount needed for each muffin cup. This way they won’t overfill. Don’t forget to let your child be in charge of the timer.

Apple Pie Crescents. Apples are another fall related food item. For this recipe, you can use canned apple slices or just cut up apples. Consider going to an apple orchard and letting the children pick out their own apples. That could be a fun family activity. All you need for this recipe is the apples, caramel syrup, cinnamon, and crescent dough. You can lay out the dough pieces and have the child place one apple slice per dough. Either you or the child could sprinkle some cinnamon and then roll it up. The next step is baking. Once again, put your child in charge of the timer and have them check on the progress. After the apple crescents are done, pour some caramel on top and enjoy.

Pumpkin Seed Trail Mix. If your child loves trail mix, try this pumpkin seed version for a fall recipe twist. Have your child help combine all the seeds into a bowl, add some maple syrup, and stir it all together. The next step includes spreading the mix onto a pan for cooking. This could be a fun (and messy) way to get your child more involved. Let your child use his hands (cool sensory) or a large spoon to spread the mix onto the pan. Sprinkle some salt on the mix and pop into the oven for 20 minutes. Let your child be in charge of the timer. After the seeds are done and cool, add the remaining ingredients.

Get a Good Start on the New School Year!

Tips for Making the Beginning of School a Successful Experience for your Child

According to Christy Tirrell-Corbin, Ph.D., in an Aug. 20 article on PBS Parents’ website, “the balance between excitement and anxiety is influenced by a number of factors including:  your family’s schedule, parent-teacher relationships and opportunities for much needed “down-time” from the weekday routine.” Here are some suggestions of ways to make your child’s school experience as successful and positive as possible:  

Make a Transition Book

Take a camera to these meetings and take pictures of everything you can and use them to create a transition book about your child’s new teacher and class. Look at the book regularly to help your child become familiar with the new environment.

Learn the New Routine

Ask the teacher to go over the daily classroom routine so that you can review it with your child. Create social stories and review them often so that your child knows what to expect when school starts.

Develop a Good Relationship with Your Child’s Teacher

Have your younger child make or create something to bring to the new teacher such as cookies, a drawing or some flowers. Try to bring or do something that shows your child’s strengths or skills. Try to keep it short and simple.

Prep Slowly

It’s also important to remember that kids will pick up on your stress, so make sure you have all your necessary supplies early. “I like to have everything ready a full week before school starts — clothes, supplies, meeting the teacher, as well as have the bedtime routine down. It usually makes for smoother adjustment from summer schedule to school schedule again,” says Deborah Arrona, a Pasadena, Texas, mother to Aria, who has cerebral palsy, cortical visual impairment, and other special needs.

Keep Your IEP Available

Keep your child’s IEP or 504 at-a-glance brief, factual and with a bullet list which includes the accommodations—then share your one-page document with the special education teacher or 504 coordinator and ask that they share it with all the teachers (including PE and electives).

Snap Photos for Social Stories

You can have one for your morning routine at home, one about going to school, and one for situations your child may encounter at school, such as eating lunch in the cafeteria. Take pictures with your digital camera or cell phone, develop them directly into a book at a local drugstore, and then narrate them with your child again and again.

Make Digital Copies of Your IEP and Other Paperwork

You’re going to have to send multiple copies of these documents to various professionals throughout the year, and it’s very handy to have them available via email. Stop by an office supply store and have them make you a digital copy as well as an extra hard copy to have on hand.

Schedule Your Well-Child Check up with your Pediatrician and with Keystone

Don’t wait until the school nurse calls to say she doesn’t have your child’s updated records. Schedule your child’s appointment as early as possible – and when you schedule the appointment, let them know you need immunization and other records for school.

At the same time, schedule a free, comprehensive screening beyond what is monitored at a typical one-year pediatrician one-year well check. Keystone knows that getting help early can lead to the best outcomes for kids. Developmental, learning, behavioral and social-emotional issues are estimated to affect one in every six children. Because these issues are often very subtle in young children, only 20-30 percent of children are identified as needing help before kindergarten. If your child is younger than 5-1/2 years old, you may complete an ASQ Developmental Pre-Screening Survey. After we receive the completed and submitted survey, our client care coordinators will call you to sechedule a free, comprehensive screening with our therapists.

Talk to Your Child

So often, adults know what’s going to happen, but they forget to share this critical information with kids. Sit down with your child, and talk about what your child can expect. The first twenty (or two hundred!) times you say, “You’re going to a new school!” you may be greeted with a firm “No!” – but eventually the message will sink in.

Prepare a One-Page Guide to Your Child

Write up a brief, one-page document that covers your child at a glance. Note any food allergies or medical needs the school should know about, things that are likely to set your child off, and things that will calm him down, as well as emergency contact information.

Resource for Parents/Caregivers:

Strategies for Making the New School Year a Success, by Christy Tirrell-Corbin, Ph.D., PBS Parents, Aug. 20, 2017

Keystone Provides Premier ADHD Assessment Services

Dr. Max Horovitz
Dr. Max Horovitz, ADHD Clinic director, and his team of therapists specialize in helping children and adolescents with ADHD.

Our ADHD Clinic is comprised of an interdisciplinary team led by Max Horovitz, Ph.D., clinical child psychologist, as director. The team specializes in the evaluation, treatment and support of children and adolescents with attention deficits, learning problems and related behavioral difficulties.

Evaluation: A comprehensive evaluation will be completed to appropriately diagnose ADHD. This evaluation may include psychological testing evaluating intellectual, academic and executive functioning skills, as well as behavior rating scales, observations and interviews with teachers and the family.

Our therapies focus on reducing inappropriate behavior and improving positive skills.

Therapy: We use evidenced-based therapies with the main goal of reducing the inappropriate behavior (such as hyperactivity and impulsivity) and improving other skills (such as attention, concentration, organization and social skills). Therapy may include school consultation, parent support and individual skills training for children and adolescents. Our team provides treatment recommendations designed specifically to assist children and their families in managing ADHD at home, in school and throughout life. The ADHD Clinic offers a variety of programs to help your child form healthy habits and relationships. From therapy to summer enrichment, our programs provide caregiving and instruction skills for living with ADHD.

One of our Success Stories:

John was brought by his parents to Keystone Behavioral Pediatric’s ADHD Clinic when he was 10 years old, because he was having trouble focusing and concentrating at home and at school. He was struggling with grades at school, and his teacher was sending home frequent reports of behavioral difficulties.  Completing homework was a nightmare; he would only complete it if his mother sat with him throughout and continuously redirected him back to the homework. John’s ability to stay on-task was less than 50% during the afternoon. He also had a lot of problems going to sleep at night. It often took him one to two hours to fall asleep after his mother first sent him to bed, leading to sleepiness in the morning and during the day. John also had daytime toileting accidents, often multiple times per day.

We gave John a comprehensive psychoeducational assessment, which confirmed a diagnosis of Attention-Deficit/Hyperactivity Disorder, Combined Presentation. John and his mother attended weekly individual therapy sessions over the course of six months. Sessions focused on establishing homework routines and bedtime routines, teaching John self-monitoring strategies and his mother strategies for managing off-task behaviors, and developing a toileting protocol for John. The therapist also helped John get academic supports in the form of a 504 Plan at school.

As John began to improve, we set new goals of focusing on broadening improvements to additional areas and increasing John’s independence. As John began to achieve his treatment goals, we reduced the number of sessions to every other week and then once a month.

By the time he was discharged from our services, John’s grades had significantly improved, with no more reports being sent home of behavioral difficulties. Homework was no longer the nightmare it once was; John’s mother could be in the other room cooking dinner and doing other things, only checking in with John periodically. John’s ability to stay on-task was well over 80 percent. John no longer had problems falling asleep, often falling asleep within 15 minutes of being sent to bed. And, only one toileting accident had been reported over the previous three months.

About the Director: 

Max Horovitz, Ph.D.
Clinical Child Psychologist
Director, Attention Deficit Hyperactivity Disorder (ADHD) Clinic

Max Horovitz, Ph.D., Clinical Child Psychologist, Director, Attention Deficit Hyperactivity Disorder (ADHD) Clinic; Co-Director, Educational & Learning Clinic, Horovitz@keystonebehavioral.com

Dr. Max Horovitz has experience working with individuals diagnosed with intellectual and developmental disabilities, particularly autism spectrum disorder (ASD), and children with attention-deficit/hyperactivity disorder in various capacities across development. He additionally has experience working with children with a wider range of emotional and behavioral needs, including oppositional and defiant behaviors, anxiety, depression, toileting issues, and sleep difficulties.  He currently provides a range of services including developmental, psychoeducational, and diagnostic assessments; individual therapy; parent training and school consultation. Dr. Max also has extensive research experience in the areas of ASD and intellectual disability. Dr. Max received a bachelor’s degree in psychology from the University of Florida. He subsequently obtained master’s and doctoral degrees in clinical psychology from Louisiana State University. Dr. Max completed an APA-accredited, predoctoral internship at the Devereux Foundation in Pennsylvania, where he provided clinical services at a residential center for adults with intellectual and developmental disabilities. Following his internship, he completed a postdoctoral fellowship at Keystone Behavioral Pediatrics and then joined the staff at Keystone as a licensed clinical child psychologist. Dr. Max is a qualified supervisor in the state of Florida for mental health counseling interns.

Resources for Parents/Caregivers:

http://www.chadd.org/

www.additudemag.com

www.chop.edu/centers-programs/center-management-adhd/health-resources#.V7MYpJgrLIU

http://www.cdc.gov/ncbddd/adhd/materials.html

https://add.org/

Driven to Distraction (Revised): Recognizing and Coping with Attention Deficit Disorder by Dr. Ratey and Dr. Hallowell

Taking Charge of ADHD, Revised Edition, by Dr. Barkley

 

Horovitz presents Research on Working Memory in ADHD and ASD

Max Horovitz, Ph.D., presented a guided poster tour of his research regarding working memory in children who have been diagnosed with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) or both ADHD and ASD as part of the 6th World Congress on ADHD hosted by the World Federation ADHA, April 20-23, 2017, in Vancouver, Canada.

 Working memory is the thinking skill that focuses on memory-in-action, which is the ability to remember and use relevant information while in the middle of an activity. For example, a child is using working memory as the child recalls the steps of a recipe while cooking a favorite meal.

Children who have trouble with their working memory skills will often have difficulty remembering instructions, recalling rules or completing tasks 

Children who have trouble with their working memory skills will often have difficulty remembering their teachers’ instructions, recalling the rules to a game, or completing other tasks that involve actively calling up important information. There are two types of working memory: auditory memory and visual-spatial memory. Auditory memory records what you’re hearing while visual-spatial memory captures what you’re seeing. Weak working memory skills can affect learning in many different subject areas including reading and math.

 For Keystone, Dr. Max serves as a clinical child psychologist, director of Keystone’s Attention Deficit Hyperactivity Disorder (ADHD) Clinic. Keystone’s Anxiety & Obsessive Compulsive Disorder (OCD) Clinic is a specialty clinic designed to provide evaluation, intervention and medication management for children and adolescents who experience anxiety. The Anxiety & OCD Clinic offers comprehensive assessments to accurately diagnose anxiety disorders. Common diagnoses include separation anxiety, phobias, social anxiety, generalized anxiety disorder, OCD, and selective mutism.

Dr. Max has experience working with individuals diagnosed with intellectual and developmental disabilities, particularly autism spectrum disorder (ASD), and children with attention-deficit/hyperactivity disorder in various capacities across development. He additionally has experience working with children with a wider range of emotional and behavioral needs, including oppositional and defiant behaviors, anxiety, depression, toileting issues, and sleep difficulties.  He currently provides a range of services including developmental, psychoeducational, and diagnostic assessments; individual therapy; parent training and school consultation. Dr. Max also has extensive research experience in the areas of ASD and intellectual disability. Dr. Max received a bachelor’s degree in psychology from the University of Florida. He subsequently obtained master’s and doctoral degrees in clinical psychology from Louisiana State University. Dr. Max completed an APA-accredited, predoctoral internship at the Devereux Foundation in Pennsylvania, where he provided clinical services at a residential center for adults with intellectual and developmental disabilities. Following his internship, he completed a postdoctoral fellowship at Keystone Behavioral Pediatrics and then joined the staff at Keystone as a licensed clinical child psychologist. Dr. Max is a qualified supervisor in the state of Florida for mental health counseling interns.

Keystone Talks about Children’s Mental Health Issues

Dr. Max Horovitz talks about teen suicide.
Keystone clinical child psychologist Max Horovitz, Ph.D., is interviewed by CBS 47 Action News reporter Bridgette Matter about teen suicide.

When local media want to report on news stories about behavioral health issues that children and young adults face and how they affect families and others in our community, they often turn to Keystone Behavioral Pediatrics’ highly educated and experienced therapists for their observations about these issues.

Here are some recent media interviews with Keystone clinical child psychologist, Max Horovitz, Ph.D.:

  • Child misconduct – Dr. Max was interviewed by First Coast News reporter Ken Amaro about a disturbing allegation of misconduct by one child to another child in a local daycare center and why a child might act in such a manner. http://fcnews.tv/2tu15Xn
  • Child abuse – A Nassau County deputy was put on administrative leave while the Florida Department of Children and Families looked into child abuse claims, after a video surfaced of the deputy spanking and yelling expletives at a young girl. Keystone’s Max Horovitz, Ph.D., was interviewed about whether his discipline was appropriate. While spanking is legal if done according to the law, Horovitz said it can do more harm than good, leading to social and legal problems in adulthood. – http://bit.ly/2su3Wvk
  • Teen suicide – When a popular Netflix series, “13 Reasons Why,” began sparking a serious conversation among teens centering on the sensitive topic of suicide, Max Horovitz was interviewed about how parents should handle the topic with their teens. He said suicide is a topic parents should discuss with their kids. http://bit.ly/2qCm4SW
  • Children killing children – Two boys were put behind bars at just 12 years old, accused of killing. When interviewed about the killings, Dr. Max said that there’s no way to predict which children will kill. He noted, however, that children who have been neglected can develop differently and begin to act out and that some killer kids may have turned out differently if reared in a loving environment. http://bit.ly/2spIV9X

Dr. Max is director of Keystone’s ADHD Clinic and co-director of its Educational & Learning Assessment Clinic. Thanks, Dr. Max, for helping Keystone get the word out into the community about how we can help children, their families and the community in which they live!

Keystone Staff Invited to Present Childhood Trauma Study

Brian Ludden, Ed.D., MS, LMHC, NCC, CCMHC Licensed Mental Health Counselor National Certified Counselor Certified Clinical Mental Health Counselor Director, Anxiety & Obsessive Compulsive Disorders (OCD) and Military Transitions Clinic

Children with trauma are often misdiagnosed with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), mood disorder or a combination of these disorders, because diagnosis can be difficult without knowing about any abuse history. This is what Rea Romero, Ph.D., neuropsychologist, and Brian Ludden, Ed.D., M.S., LMHC, NCC, CCMHC, also noted in their work with Jacob, an 8-year-old boy, who was permanently removed from his mother’s care due to abuse and neglect, possibly including sexual abuse.

They submitted a case study about Jacob that was accepted in late 2016 for a poster presentation at the 2017 American Psychological Association (APA) Convention. Dr. Romero will present the poster of their work on Aug. 5, 2017 in Washington, D.C.

Jacob has a history of erratic mood swings, anger outburst, impulse control, fire-setting, stealing, lying and aggression. Before coming to Keystone Behavioral Pediatrics to work with Dr. Brian and Dr. Rea, Jacob had been given Adderall for two years, with minimal benefit. Prior to receiving a neuropsychological assessment at Keystone, Jacob’s treatment had focused on ADHD and disruptive behaviors.

 

Regilda Romero, Ph.D. Neuropsychologist Director, Trauma & Grief Clinic Co-Director, Neuropsychological Clinic and Educational & Learning Clinic

Jacob’s assessment revealed average to superior cognitive functioning, and academic achievement, visual-spatial skills and language skills also ranged from average to superior. Likewise, other neuropsychological assessments results were at the expected level or well above the expected level.

The assessments did reveal that Jacob has problems with adaptive, emotional and behavioral functioning. Research shows that abuse and neglect can affect neurobehavioral development that is necessary for efficient behavioral/emotional control and regulation. This led Dr. Rea and Dr. Brian to believe that Jacob’s difficulties in emotional and behavioral regulation are related to his history of significant traumas associated with abuse and neglect.

Patients will receive a better treatment plan and interventions if complete biopsychosocial history is taken into account

While Jacob denied suffering from increased startled response, flashbacks and psychological symptoms, which are usually an indication of posttraumatic stress disorder (PTSD), his emotional and behavioral problems and patterns are indicative of trauma. Jacob also struggles with handling interpersonal relations and maintaining meaningful relationships, also symptoms of trauma.

Currently, Jacob is receiving a combination of individual mental health sessions and family mental health sessions. Dr. Brian and Dr. Rea have focused on helping Jacob improve his communication with his family and on reducing behavioral concerns, anxiety and the impact of persistent thoughts related to traumatic childhood experiences. He has been taught the use of mindfulness meditation, guided visualizations, compartmentalization, diaphragmatic breathing and other adaptive coping skills for managing and reducing his emotional and behavioral issues.

Over the course of six months of treatment, Jacob’s behavior has improved considerably. As a result of ongoing family mental health sessions, Jacob has come to develop a relationship with his biological mother. Jacob should continue to progress through treatment and master the various mindfulness and self-regulating skills that he has learned in treatment.

As a result of this case study, Dr. Rea and Dr. Brian are presenting to conference attendees that patients will receive a better treatment plan and interventions if complete biopsychosocial history is taken into account. Keystone supports Dr. Brian and Dr. Rea’s research efforts and encourages all therapists to engage in research that continues to improve clinical results for the kids we serve.

For Keystone, Dr. Rea is the director of the Trauma & Grief Clinic and co-director of the Neuropsychological Clinic and Educational & Learning Clinic. Dr. Brian is the director of Keystone’s Anxiety & Obsessive Compulsive Disorders Clinic and the Military Transitions Clinic.

June is Post-Traumatic Stress Disorder Month

By Jessica Hamblen, PhD and Erin Barnett, PhD, for PTSD: National Center for PTSD

Children and Adolescents Experience PTSD, Too

What events cause PTSD in children?

Any life threatening event or event that threatens physical harm can cause PTSD. These events may include:

  • Sexual abuse or violence (does not require threat of harm)
  • Physical abuse
  • Natural or manmade disasters, such as fires, hurricanes, or floods
  • Violent crimes such as kidnapping or school shootings
  • Motor vehicle accidents such as automobile and plane crashes

PTSD can also occur after witnessing violence. These events may include exposure to:

  • Community violence
  • Domestic violence
  • War

Finally, in some cases learning about these events happening to someone close to you can cause PTSD.

What are the risk factors for PTSD?

Both the type of event and the intensity of exposure impact the degree to which an event results in PTSD. For example, in one study of a fatal sniper attack that occurred at an elementary school proximity to the shooting was directly related to the percentage of children who developed PTSD. Of those children who directly witnessed the shooting on the playground, 77% had moderate to severe PTSD symptoms, whereas 67% of those in the school building at the time and only 26% of the children who had gone home for the day had moderate or severe symptoms (6).

In addition to exposure variables, other risk factors include:

  • Female gender
  • Previous trauma exposure
  • Preexisting psychiatric disorders
  • Parental psychopathology
  • Low social support

Parents have been shown to have protective factors (practice parameters). Both parental support and lower levels of parental PTSD have been found to predict lower levels of PTSD in children.

There is less clarity in the findings connecting PTSD with ethnicity and age. While some studies find that minorities report higher levels of PTSD symptoms, researchers have shown that this is due to other factors such as differences in levels of exposure. It is not clear how a child’s age at the time of exposure to a traumatic event affects the occurrence or severity of PTSD. While some studies find a relationship, others do not. Differences that do occur may be due to differences in the way PTSD is expressed in children and adolescents of different ages or developmental levels.

 

Keystone recognizes June as PTSD month in support of the children we serve who work to manage PTSD.

As in adults, PTSD in children and adolescence requires the presence of re-experiencing, avoidance and numbing, and arousal symptoms. However, researchers and clinicians are beginning to recognize that PTSD may not present itself in children the same way it does in adults.

 What does PTSD look like in children?

Criteria for PTSD include age-specific features for some symptoms.

Elementary school-aged children

Clinical reports suggest that elementary school-aged children may not experience visual flashbacks or amnesia for aspects of the trauma. However, they do experience “time skew” and “omen formation,” which are not typically seen in adults.

Time skew refers to a child mis-sequencing trauma-related events when recalling the memory. Omen formation is a belief that there is a belief that there were warning signs that predicted the trauma. As a result, children often believe that if they are alert enough, they will recognize warning signs and avoid future traumas.

School-aged children also reportedly exhibit post-traumatic play or reenactment of the trauma in play, drawings, or verbalizations. Post-traumatic play is different from reenactment in that post-traumatic play is a literal representation of the trauma, involves compulsively repeating some aspect of the trauma, and does not tend to relieve anxiety.

An example of post-traumatic play is an increase in shooting games after exposure to a school shooting. Post-traumatic reenactment, on the other hand, is more flexible and involves behaviorally recreating aspects of the trauma (e.g., carrying a weapon after exposure to violence).

Adolescents and Teens

PTSD in adolescents may begin to more closely resemble PTSD in adults. However, there are a few features that have been shown to differ. As discussed above, children may engage in traumatic play following a trauma. Adolescents are more likely to engage in traumatic reenactment, in which they incorporate aspects of the trauma into their daily lives. In addition, adolescents are more likely than younger children or adults to exhibit impulsive and aggressive behaviors.

Besides PTSD, what are the other effects of trauma on children?

Besides PTSD, children and adolescents who have experienced traumatic events often exhibit other types of problems. Perhaps the best information available on the effects of traumas on children comes from a review of the literature on the effects of child sexual abuse.

In this review, it was shown that sexually abused children often have problems with fear, anxiety, depression, anger and hostility, aggression, sexually inappropriate behavior, self-destructive behavior, feelings of isolation and stigma, poor self-esteem, difficulty in trusting others, substance abuse, and sexual maladjustment.

These problems are often seen in children and adolescents who have experienced other types of traumas as well. Children who have experienced traumas also often have relationship problems with peers and family members, problems with acting out, and problems with school performance.

Along with associated symptoms, there are a number of psychiatric disorders that are commonly found in children and adolescents who have been traumatized. One commonly co-occurring disorder is major depression. Other disorders include substance abuse; anxiety disorders such as separation anxiety, panic disorder, and generalized anxiety disorder; and externalizing disorders such as attention-deficit/hyperactivitiy disorder, oppositional defiant disorder, and conduct disorder.

How is PTSD treated in children and adolescents?

Although some children show a natural remission in PTSD symptoms over a period of a few months, a significant number of children continue to exhibit symptoms for years if untreated. Trauma Focused psychotherapies have the most empirical support for children and adolescents.

Cognitive-Behavioral Therapy (CBT)

Research studies show that CBT is the most effective approach for treating children. The treatment with the best empirical evidence is Trauma-Focused CBT (TF-CBT). TF-CBT generally includes the child directly discussing the traumatic event (exposure), anxiety management techniques such as relaxation and assertiveness training, and correction of inaccurate or distorted trauma related thoughts.

Although there is some controversy regarding exposing children to the events that scare them, exposure-based treatments seem to be most relevant when memories or reminders of the trauma distress the child. Children can be exposed gradually and taught relaxation so that they can learn to relax while recalling their experiences. Through this procedure, they learn that they do not have to be afraid of their memories.

CBT also involves challenging children’s false beliefs such as, “the world is totally unsafe.” The majority of studies have found that it is safe and effective to use CBT for children with PTSD.

CBT is often accompanied by psycho-education and parental involvement. Psycho-education is education about PTSD symptoms and their effects. It is as important for parents and caregivers to understand the effects of PTSD as it is for children. Research shows that the better parents cope with the trauma, and the more they support their children, the better their children will function. Therefore, it is important for parents to seek treatment for themselves in order to develop the necessary coping skills that will help their children.

Parent Resource: U.S. Department of Veterans Affairs PTSD: National Center for PTSD

Keystone Supports May National Mental Health Month

As the largest provider of integrated, collaborative healthcare in northeast Florida for children who have behavioral, developmental, mental, emotional and learning issues, Keystone Behavioral Pediatrics recognizes May as National Mental Health Month.

One of Keystone’s child psychologists, Max Horovitz, Ph.D., was interviewed by Action News CBS 47 Fox 30, about the connection between mental health issues and suicide by teenagers. Specifically, the news station was reporting on increasing concern by educators, schools and parents about the Netflix show, “13 Reasons Why,” which tells the story of the main character, Hannah Baker, who took her own life, leaving behind 13 tapes for the 13 people she said were responsible. Schools are beginning to send letters home to parents warning them about the show’s potentially dangerous message.

During the interview, Dr. Horovitz noted that some children are more easily influenced than others and parents might consider talking with their child about the show’s message. “We want kids to know there are a lot of ways they can be helped that don’t have to be suicide,” Horovitz said.

Several other occasions spotlight mental health issues throughout the month:

May 4 – Children’s Mental Health Awareness Day

May 7-13 – National Anxiety and Depression Awareness Week

May 13-17 – Children’s Mental Health Awareness Week

Keystone advocates every day for the importance of integrating behavioral health and primary care for children, youth and young adults is mental and/or substance use disorders by working with children in its Southside clinic, in their homes, at their schools and in the community. This year’s national theme, “Partnering for Help and Hope.” is especially meaningful, in light of the number of news stories recently that report instances of police having negative interactions with children and young adults who have special needs.

Keystone would welcome the opportunity to help local media discuss children’s mental health issues in a variety of subject areas to bring attention to National Mental Health Month. Its team of child psychologists and therapists can make themselves available for interviews as needed.

Keystone’s team also provides in-service training to educators in schools and other community organizations, police officers and emergency medical service providers. Keystone can share information and techniques to help them understand why children with special needs may act and/or react the ways that they do in stressful situations and what methods can be used to deescalate a potentially unpleasant or potentially dangerous situation.

To schedule an interview or an in-service training, contact Karen Rieley, director of marketing and communications, 904.333.1151, rieley@keystonebehavioral.com.

Keystone Launches Two New Schools

Since its opening in 2013, Keystone Child Development Center has grown rapidly. The school was founded based on the inclusion model that provides opportunities for students with disabilities to learn alongside their non-disabled peers. The center’s leaders have spent the past four years developing and perfecting an educational approach that is thoughtful and balanced. They have successfully prepared hundreds of preschool children for success in primary school and beyond.

“Our goal was to produce an educational program that is developmentally appropriate for all young children and based on the best practices in the education field,” Katie Falwell, CEO and founder, said. “We are inspired by a variety of philosophies and approaches, which we have blended together into a program that reflects our commitment to helping children lay the best possible social, emotional, physical and cognitive foundations.”

As a result of rapid growth and what has been learned from the success of Keystone Child Development Center, Dr. Falwell is retiring KCDC and launching two new schools. Collage Day School and Mosaic Day School will open with the 2017-18 school year.

Collage Day School opens in Palm Valley with the first day of school on Aug. 10.

Collage Day School

Collage Day School, an academically challenging, independent day school that will open in Palm Valley this coming August, is currently accepting applications for students from 3 months old through 5th grade. The school focuses on providing a rich, integrative curriculum that encourages creative thinking and that is personalized for each student.

Students will start classes on Thursday, Aug. 10, and the school will follow the St. Johns County Public School Calendar. Collage Day School is located at 171 Canal Boulevard, Ponte Vedra Beach, FL 32082. The 8-acre campus is nestled between the Intracoastal Waterway and Atlantic Ocean in the heart of the Ponte Vedra Beach area of St. Johns County, which offers students hands-on experiences with nature and outdoor learning and additional layers of education, history and ecology.

The faculty of the School is made up of a combination of certified lead teachers and assistant teachers. Each teacher is tasked with bringing subject matter to each student in a way that is engaging and appropriate for the developmental stage of the student, rather than following a scripted lesson plan developed by someone else.

Our approach is thoughtful and balanced. It is also developmentally appropriate and based on the best practices in the education field. We are inspired by a variety of philosophies and approaches, which we blend together into a program that reflects our commitment to helping children lay the best possible social, emotional, physical and cognitive foundations.

Collage staff is challenged with uncovering the unique learning profile of each individual student and matching that knowledge with instruction to help their students develop the tools to be problem solvers, innovators, creators and change makers.

The grounds around Collage Day School will be put to good use as a “living classroom” where children can develop cognitive, social and emotional skills. The school is dedicated to promoting students’ health. Students do not spend their day sitting in front of computers under artificial lights, but have the opportunities to move and use their bodies in healthy ways and to spend time outdoors with a myriad of natural features such as woods and pathways, garden, play equipment and an inner courtyard that provides a common area for the Collage family to gather and socialize.

Collage is completing the process for full membership and accreditation by the Florida Council of Independent Schools (FCIS), Florida Kindergarten Council (FKC) and the National Association for the Education of Young Children (NAEYC). The school’s VPK program is endorsed by the Florida Department of Children & Families.

How important is preschool?

As reported in Parents.com, “There’s increasing evidence that children gain a lot from going to preschool,” says Parents advisor Kathleen McCartney, PhD, dean of Harvard Graduate School of Education, in Cambridge, Massachusetts. “At preschool, they become exposed to numbers, letters, and shapes. And, more important, they learn how to socialize — get along with other children, share, contribute to circle time.”

Mosaic Day School

 Mosaic Day School offers education for children with special needs, ages 1-7. Mosaic has classes designated for early intervention for students who are not appropriate for Collage Day School. Students attending Mosaic will receive services from Keystone Behavioral Pediatrics, as needed, and attend either a half-day program (morning or afternoon) or a school day program (8:30 a.m. – 2:30 p.m.). Before- and after-care will also be available. Mosaic also offers a day treatment program for older students that are not able to successfully participate in a classroom setting.

The school primarily serves children with behavioral/developmental issues who have experienced failure in the continuum of available public or private special education environments and require a high degree of individualized attention and intervention. The program includes intensive one-to-one sessions and small group sessions, when appropriate, which teach students to relate to their peers and participate cooperatively in group activities. The goal is for each student to reintegrate or matriculate to a less restrictive academic setting with traditional classrooms.

Mosaic Day School is located at 6867 Southpoint Rd. N, Jacksonville, FL 32216.

To learn more about Collage Day School, visit @Collage Day School on Facebook and contact Rebecca Bowersox, director of admissions, rbowersox@keystonebehavioral.com, 904.900.1439.

To learn more about Mosaic Day School, contact info@keystonebehavioral.com, 904.619.6071.

Psychiatrist Joins Keystone to Provide Medication Management

Beginning April 4, psychiatrist Chadd K. Eaglin, M.D., joins Keystone Behavioral Pediatrics as our new medical director in charge of medication management. He will work with our team of providers to develop a comprehensive plan for your child to assist your family and primary care physicians.

Chadd Eaglin, M.D., psychiatrist, becomes Keystone’s medical director, with appointments beginning on April 4.

Depending on the specific concerns and/or diagnoses that a child may have, such as ADHD, autism, anxiety, depression or other behavioral issues, a course of medication in combination with other therapy techniques may be helpful. Keystone’s team works collaboratively in diagnosing, monitoring and treating any issues or concerns that parents may have about their child, consulting to determine whether medication may be helpful. If medication is determined to be helpful, Dr. Eaglin will prescribe and closely monitor the effects.

It is important for a child to have regular medical checkups to monitor how well the medication is working and check for possible side effects. Most side effects can be relieved by changing the medication dosage, adjusting the schedule of medication or using a different stimulant or trying a non-stimulant.

Staying in close contact with Dr. Eaglin will ensure that Keystone therapists and parents find the best medication and dose for their children. After that, periodic monitoring by Dr. Eaglin is important to maintain the best effects.

Dr. Eaglin comes to Keystone with 11 years of education and experience in medicine and psychiatry. He received an M.D. from the University of Missouri at Kansas City School of Medicine and completed his psychiatry residency training program at the University of Hawaii. He is certified by the American Board of Psychiatry and Neurology with specialty training in NeuroStar Transcranial Magnetic Stimulation (TMS) therapy. He focuses on diagnosis, treatment and management of patients from school-aged children to geriatrics who have mood disorders, anxiety disorders, impulse control orders, autism and complex behavioral challenges.

For now, Dr. Eaglin will be available by appointment each Tuesday morning, 9 a.m. – 12 p.m. The goal is to build his caseload to a full time practice with Keystone. To set an appointment, call 904.619.6071 or fill out the online Appointments form.