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.

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.

Keystone offers ABA services on Florida’s Emerald Coast

Keystone recently announced that ABA services are available to the Emerald Coast. The mission of Keystone Behavioral Pediatrics – Emerald Coast is to provide Okaloosa and neighboring counties with the same standard of excellence which has been established by KPB in the Jacksonville area. 

Presently, behavior therapists are offering ABA services in Emerald Coast homes, with the eventual goal of offering therapy in a variety of settings including a clinic, community settings and schools, in addition to in-home. Therapy is individualized to each child based on an initial assessment (ABLLS-R, VB-MAPP, AFLS, essentials for living, functional assessments of problem behaviors, etc.) and continually modified based on the child’s progress.

Laura Mathisen, M.S., BCBA, leads the team of ABA therapists for Keystone Behavioral Pediatrics – Emerald Coast.

Applied Behavior Analysis (ABA) therapy is a systematic teaching approach based on B.F. Skinner’s analysis of behavior and the subsequent contributions of other behavior analysts. ABA focuses on changing behavior in socially significant ways to improve the lives of the children and families who seek ABA services.

Keystone’s Emerald Coast team is led by Laura Mathisen, M.S., BCBA, who serves as senior clinical supervisor. She has experience providing behavior analytic services for children and adults with developmental disabilities, genetic disorders and traumatic brain injuries. Mathisen specializes in early intervention services, problem behavior reduction and supervision of BCBA candidates. She worked at Keystone Behavioral Pediatrics for three years and eventually served as director of behavior analysis. After her military husband was transferred to Destin in 2013, she continued to work for Keystone as a senior clinical supervisor and board certified behavior analyst (BCBA), while also working as a BCBA clinical supervisor for a private ABA clinic in the Florida Panhandle, where her caseload primarily focused on problem behavior reduction and early intervention cases.

For questions and to make an appointment with the team at Keystone Behavioral Pediatrics – Emerald Coast, complete the Appointments or Contact form at www.keystonebehavioral.com or call 904.619.6071.

Keystone Behavioral Pediatrics, based in Jacksonville, Fla., offers consultation and integrated healthcare to children who may have one or more behavioral, developmental, socio-emotional or learning issues, for example, autism spectrum disorders (ASD), attention deficit hyperactivity disorder (ADHD), intellectual delays, aggression, self-injury, tantrums, anxiety, compliance, self-help skills, toileting, speech/language or cognitive, physical, sensory, and motor skills. Keystone’s comprehensive and highly skilled team of providers – child psychologists, board certified behavior analysts, licensed mental health counselor, occupational therapists, speech/language pathologists, feeding therapists, registered behavioral technicians and clinical assistants – work together to develop a plan of action to provide success for each child through change. Medication management is also available, if medication is recommended as part of a child’s plan.

Aggression, Tantrums and Refusal—Annoying and Frustrating but Treatable

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Dr. Scherbarth works with a child and his parent to help them understand and relate to each other better by building reasonable and enforceable limits.

The trifecta of terrible problem behavior in children is physical or verbal aggression, with tantrums and refusal to follow instructions. These symptoms are often consistent with the diagnosis of Oppositional Defiant Disorder (ODD). It is very annoying and frustrating for parents and peers—to say the least. Parents often try their best to manage it—including seeking out anger management for their child—but nothing they try seems to work. That said, ODD is entirely treatable by a clinician skilled in one of several Behavioral Parent Training programs.

ODD is a pattern of behavior for over six months that has three parts: a child or teen being argumentative in general or defiant when given instructions; the child being very angry and irritable most of the time; and at times the child may be vindictive and deliberately trying to make others angry. It can seem from the outside that the child is totally fine one minute and blows up the next minute. This appearance has led many people down the wrong path to think it’s bipolar disorder—especially when the tantrums last 45-90 minutes or when they are very destructive at home or school. However, bipolar disorder is a very different diagnosis.

ODD not only causes frustration in the moment for the parent and child, it also spreads throughout the family’s entire social life at all levels.

Parents of kids with ODD often do not want to go to stores or restaurants anymore for fear that something will set their child off. Parents may hear that other parents don’t want to set up play dates anymore. Schools may send these children home early because of the disruption they cause, or they may totally refuse to enroll these kids altogether. Kids with ODD often have little or no friends, and the friendships they do develop may be very conflicted. Clearly, it takes a serious toll on everyone and this toll creates resentment in the family towards the child and from the child back towards the family.

ODD typically emerges in younger childhood (before age 5). Without treatment, up to 2
5 percent of kids may lose ODD traits on their own; however it persists for many years in half of all kids, whereas the other 25 percent have behavior that starts to become downright cruel or even criminal in nature. With a total of 75 percent of kids with ODD having years of difficult or even criminal behavior ahead of them, it’s clearly to everyone’s advantage to seek treatment by a qualified therapist who goes beyond individual anger management counseling to also include some form of behavioral parent training.

There are a number of risk factors related to development of ODD (Barkley, 2013). Individual factors from the child include having ADHD, a mood/anxiety disorder or just an irritable temperament from birth. Parent factors include if they have ADHD themselves, irritable temperament, high stress due to a number of reasons and/or being young parents. Family social environmental factors include living in an area with a high crime rate, being influenced by delinquent peers, or having conflicted marriages or a conflictual extended family. How parents raise their children is one of the most important factors. Inconsistent parenting, highly negative parenting (or by contrast, low negative but also low discipline parenting), inappropriate expectations, as well as lack of monitoring of the child, and/or low positivity in parenting are all  risk factors.

At least one parent and the child engage in the Coercive Family Cycle (Patterson, 1982). A parent gives an instruction (possibly a harsh instruction or nearly impossible instruction), then the child reacts with negativity and both continue with negativity (yelling, harsh tone, possibly escalation to destruction) until one or the other gives up. It’s not healthy for the child, even if it “works” in the moment. Worst case scenario, the child gets away without having to do what they’re told and the negative behavior reinforced. In the “best case scenario,” the adult is able to force compliance BUT then the child learns the social lesson that to be respected in the family and society, that is that a child has to be big, loud, angry and bad. That’s not a very good outcome.

By contrast, Behavioral Parent Training (BPT) aims to make an impact by changing the parenting factors. It’s NOT about finding better ways to punish children more harshly. Rather, it has two aims—to improve warmth between parents and kids, as well as to build reasonable and enforceable limits. Warmth can be provided by making sure that there’s always positive interaction time and that when the child follows the instructions, good things happen—like acknowledgement and normal daily privileges. Limits include expectations that school work must be completed school work, children are expected to clean up after themselves to whatever extent that they can in relation to their age, destructiveness leads to consequences and rude or obnoxious behavior doesn’t pay off. The consequences for destruction shouldn’t be harsh, just consistent and providing for everyone’s safety.

Of course, BPT has limits. It only addresses the parenting factors. At times, the child’s individual factors (irritability, impulsivity) have to be addressed as well, possibly in conjunction with Cognitive Behavioral Therapy or anger management. However, anger management alone is insufficient. A course of treatment may take 3-6 months or even longer, depending on how longstanding the issues are and other factors. Therapy may require a lot of effort and be difficult at times, but it can’t be any more difficult than having these behaviors affecting the family for years or decades.

Behavioral Parent Training can allow the parents to enjoy their kids again, and kids to enjoy their parents. Contact Keystone Behavioral Pediatrics to learn more about how BPT can help.

Resources for Parents/Caregivers:

Centers for Disease Control

Mayo Institute

Child Development Institute

National Institute of Mental Health—DMDD

National Institute of Mental Health—Treatment of children with mental health issues in general

 

Keystone Provides Medication Management

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Keystone medical director Dr. Tammy Tran monitors heart rate and blood pressure of one of children to determine the effectiveness and the medication he is taking.

When needed, we can prescribe and monitor the medications recommended for your child, while also making sure that they are effective and interacting with other medications safely. Tammy Tran, M.D., Keystone’s medical director, works as part of our team of providers to develop a group plan for each child to assist families and primary care physicians. The team works collaboratively in diagnosing, monitoring and treating any issues or concerns that you may have about your child, consulting with Dr. Tran to determine whether medication may be helpful for your child. If appropriate, Dr. Tran will prescribe and closely monitor the effects.

It may take some time to find the best medication, dosage, and schedule for your child. Your child may need to try different types of stimulants or other medication. Some children respond to one type of stimulant but not another. The amount of medication (dosage) that your child needs also may need to be adjusted. The dosage is not based solely on your child’s weight. Dr. Tran will vary the dosage over time to get the best results and control possible side effects. The medication schedule also may be adjusted depending on the target outcome. For example, if the goal is to get relief from symptoms mostly at school, your child may take the medication only on school days.

It is important for your child to have regular medical checkups to monitor how well the medication is working and check for possible side effects.

What Side Effects Can Stimulants Cause?

Side effects occur sometimes. These tend to happen early in treatment and are usually mild and short-lived, but in rare cases they can be prolonged or more severe. The most common side effects include:

  • Decreased appetite/weight loss
  • Sleep problems
  • Social withdrawal

Some less common side effects include:

  • Rebound effect (increased activity or a bad mood as the medication wears off)
  • Transient muscle movements or sounds called tics
  • Minor growth delay

Very rare side effects include:

  • Significant increase in blood pressure or heart rate
  • Bizarre behaviors

Most side effects can be relieved by:

  • Changing the medication dosage
  • Adjusting the schedule of medication
  • Using a different stimulant or trying a non-stimulant

Staying in close contact with Dr. Tran will ensure that Keystone therapists and you find the best medication and dose for your child. After that, periodic monitoring by Dr. Tran is important to maintain the best effects. To monitor the effects of the medication, Dr. Tran will probably have you and your child’s teacher(s) fill out behavior rating scales; observe changes in your child’s target goals; notice any side effects; and monitor your child’s height, weight, pulse, and blood pressure.

Common diagnoses that typically benefit from medication:

  • ADHD
  • Tic disorder, such as Tourette syndrome
  • Anxiety disorders

Resources for Parents/Caregivers:

NIH National Institute of Mental Health: Treatment of Children with Mental Illness

ADHD Parents Medication Guide prepared by American Academy of Child & Adolescent Psychiatry and American Psychiatric Association

ADAA Anxiety and Depression Association of America

Keystone CEO Recognized for Integrated Healthcare

Keystone CEO Katherine Falwell, Ph.D. and clinical psychologist, was recognized in a recent issue of the Ponte Vedra Recorder for her efforts to help children with integrated healthcare that focuses on all areas of behavioral, developmental, socio-emotional and learning services provided by Keystone Behavioral Pediatrics, which Dr. Falwell founded in 2008.

The article chronicled the path that led Dr. Falwell to open Keystone, starting with her postdoctoral residency at the University of Florida, where Dr. Falwell became part of the faculty at University of Florida in the Department of Behavior Analysis. She became aware that Northeast Florida needed more comprehensive pediatric services than it had available at the time to meet the growing numbers of children with unique needs and took the opportunity to open Keystone Behavioral Pediatrics in 2008 to further her idea of collaborative, integrated healthcare.

Keystone provides Integrated Healthcare that Focuses on All Areas of Behavioral, Developmental, Socio-Emotional and Learning Services

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Katie Falwell (far right), in addition to her passion for helping children become successful, is also devoted to her family and northeast Florida beaches community.

Next, Dr. Falwell opened Keystone Child Development Center in 2013, because she believes passionately in research that supports the importance of providing individualized instruction and support as early as possible in a young child’s life. She designed KCDC to focus on all aspects of a child – mind, body and soul – to offer children the best opportunity for success in elementary school and throughout life.

In response to the paper’s question about her focus on early intervention, Dr. Falwell notes, “All children learn and grow at different rates. These first five years of a child’s life are filled with major developmental milestones that prepare them for lifelong learning.” She refers to research which shows that 90 percent of a child’s brain is developed by age 5.

Research also confirms 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 to 30 percent are identified as needing help before kindergarten.

The article described Keystone’s new Right from the Start Clinic designed to help parents know whether their baby would benefit from early intervention to solve or alleviate any issues before they become problematic. The Right from the Start clinic is a free screening clinic for children between the ages of one month and 5-1/2 years old. Parents can complete a free questionnaire online by clicking on the ASQ logo on our website. The questionnaire gives Keystone therapists an idea of areas of a child’s development that are of concern to the child’s parents. A client care coordinator contacts the parents after the clinic receives their completed survey and invites them to visit Keystone for a free multidisciplinary screening evaluation to assess their child’s developmental progress. Parents will meet with clinicians from Keystone’s psychology, occupational therapy and speech language departments, as well as a pediatrician. At the end of the visit, they will receive information on how their child is doing developmentally, with suggestions to target any areas of need that have been identified.

Keystone Behavioral Pediatrics, located in Jacksonville, Duval County, northeast Florida, offers integrated healthcare by a collaborative, interdisciplinary team of 130 child psychologists, mental health counselors, social workers, behavior analysts and technicians, speech and language pathologists, occupational therapists, teachers, and pediatrician working in 17 specialized clinics. The focus is on early intervention regarding health and wellness, the whole child and all issues that affect a child’s potential for success including physical, developmental, learning, behavioral and social-emotional issues.

Keystone works with children from one month old to 22 years old on all types of behavioral, developmental, socio-emotional, physical and learning issues in four types of clinics: assessment clinics (Neuropsychological, Attention Deficit Hyperactivity Disorder (ADHD), Health and Wellness and Educational and Learning), developmental clinics (Autism and Developmental, Right from the Start, Early Intervention and Day Treatment); Rehabilitative Clinics (Feeding, Occupational Therapy and Speech and Language); and Treatment Clinics (Parent-Child Interaction Therapy, Anxiety and Obsessive Compulsive Disorders (OCD), Disruptive Behavior and Mood).

Keystone Child Development Center offers safe, nurturing and stimulating preschool and early intervention services from infancy through kindergarten. We have a minimum of two teachers in each classroom and a child development team that works with the teachers to focus on intellectual, social and behavioral success for each child. With maximum class sizes of 12, KCDC is able to create individualized learning plans.

Neuropsychological Clinic Assesses Brain Injuries

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Keystone’s Neuropsychological Assessment Clinic is co-directed by Regilda (Rea) Anne A. Romero, Ph.D., licensed psychologist, and Rebecca J. Penna, Ph.D., NCSP, neuropsychologist and clinical psychologist.

Keystone Behavioral Pediatrics’ Neuropsychological Assessment Clinic can provide a comprehensive evaluation of brain functions and processes that is particularly useful for children who have experienced a brain injury. The assessment includes a profile of a child’s processing strengths and needs so that treatment, rehabilitation and educational plans can be developed. Clinic Co-Directors Regilda (Rea) Anne A. Romero, Ph.D., licensed psychologist, and Rebecca J. Penna, Ph.D., NCSP, neuropsychologist and clinical psychologist, can help with making “return to play” decisions.

Kids’ Concussions Cause for Concern

ABC News reported in September on an alarming new statistic: Kids only report one out of every 10 concussions. The danger in not reporting concussions is the possibility of post-concussion syndrome, a complex disorder that, according to Mayo Clinic’s website, can last for weeks and sometimes months after the injury that caused the concussion.

What makes the disorder even harder to diagnose is that a child who has suffered a blow to the head doesn’t necessarily lose consciousness. In fact, the injury may not even have seemed that severe.

The ABC News story reported on 15-year-old Willie Baun who was hit on the field during a game. His father, Whitey Baun, said, “It was absolutely a normal hit, nothing that made me go, ‘Oh! That was a real hit!”

But, in fact, they learned later that it was his second concussion in just six weeks. And, it resulted in Willie losing his memory. It took eight months and help from doctors for Willie’s memory to return.

According to Mayo Clinic, post-concussion symptoms include headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of concentration and memory and noise and light sensitivity. Parents should seek help if their child experiences a head injury severe enough to cause confusion or amnesia, even if their child hasn’t lost consciousness.

Coaches play an important role in preventing post-concussion syndrome as well. They should not allow a player who has suffered a head injury to return to the game. ABC News refers to the HeadMinder test as one way to test cognitive ability. After a hit, the player is asked a series of questions by the coach or parents. The score is tested against a baseline number to see whether there’s been an injury and whether the play is ready to go back on the field.

However, none of the diagnostic studies are completely objective and should never be used as the sole means of assessment or in deciding when to return an athlete to play.

The November/December 2011 issue of Practical Neurology reports that “the best way to assess an athlete or any individual who has sustained a concussion is still a comprehensive neurological history and detailed neurological examination performed by a properly trained physician.”

Keystone’s Neuropsychological Assessment Clinic also diagnoses other medical conditions that impact the central nervous system and complex clinical conditions that impact the way a child thinks and learns, for example, epilepsy/seizure disorders; neurodevelopmental disorders such as ADHD, learning disabilities, autism spectrum disorder and/or language delays; and various medical issues and illnesses that can impact the integrity of the brain, such as cancer and cancer treatment late-effects, viruses and infections, congenital or genetic disorders and stroke or Sickle-cell “silent strokes.”

Keystone child psychologists are eager to share information on neurological assessment with urgent care centers, school counselors, coaches, community and faith groups, pediatricians and other health care providers, as appropriate. To arrange an in-service training or presentation, contact Karen Rieley, director of marketing and communications for Keystone, 904.333.1151. If you are a parent who is concerned that your child may have suffered a brain injury or other medical condition that is having an impact on your child’s ability to think clearly and learn, contact Keystone, 904.619.6071, to set up an appointment with the Neuropsychological Assessment Clinic.

Children benefit from predictable and balanced summer schedule

Yay, it’s summertime! No school and time for fun things. It’s great for kids to have a change from the norm; however, a fairly predictable schedule and activities are great too. Although some kids and teens are fine without any kind of schedule being given to them, children with developmental delays, behavioral challenges and special needs such as ADHD and autism spectrum disorder require support and behavior management that provides them a predictable set of things to do without having to stir up their own excitement. The following is a list of ways to do that.

First, keep consistent morning and evening routines. Parents can decide on their own if they want to have a later bedtime overall and what they want to include in the routine (brushing teeth, showers, etc.) That said, toddlers and young children will have better rest and go along better with wake-up/go-to-bed routines if they are consistent, such as regular wake and sleep times, regular hygiene schedules and a regular set of things to do as they are going to bed and waking up.

Consistent feeding schedules often keep kids’ moods more balanced. With all of the busy activities in which people get involved, it can be hard at times to keep feeding and/or snack times within 30-45 minutes of their normal routine. This doesn’t have to be overly restrictive though; it just takes planning. For example, parents and caregivers don’t have to totally abandon a trip to the zoo if they are going to be away from home during a meal or snack time. However, the zoo trip may go a lot better if parents pack a snack or box lunch and then take a quick break at the zoo during their child’s regular feeding time.

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Practicing mastered skills during the summer, such as reading, helps your child transition more smoothly back to school.

Summertime may include academic time. Most children lose some skills over the summer if they don’t practice, which means more frustration for everyone in August. Parents don’t have to go above and beyond to teach new skills, but even practicing mastered skills that are relevant to their child’s academic and developmental level will contribute to a smoother transition back to school.

If you haven’t already received a packet of summer academics from your child’s teacher, it’s still possible to practice. Parents can choose as few as one to three activities or worksheets a day in the areas of reading, writing and math. Appropriate grade level workbooks are available at bookstores or online with suggested materials, although there are also websites with readily available—and free—online resources. Academics are often best done in the morning, when children have better attention.

Active kids are going to need an outlet for their energy. Since parents often have to provide supervision, it can be a challenge to be on the go all the time. One simple formula is to alternate active times (even as little as 15-30 minutes) with times spent indoors or concentrating. That way, kids get to expend energy, and parents don’t have to deal with extra mischief that comes from kids trying to find a thrill if they’re kept indoors all morning or all afternoon. Active time can be in a park, in an indoor playground or other appropriate places.

Finally, predictability does not have to be boring. Parents can plan for variety within a routine. For instance, there can be some kind of museum trip every Tuesday afternoon that changes each week or some kind of different cooking activity on Wednesdays. Alternatively, there could be a daily academic time at 10 or 10:30 a.m. and recess planned at 11 a.m. each day in a variety of places.

Some local offerings this summer are:

  • Cinemark Tinseltown’s Summer Movie Clubhouse with 10 films for kids at $1 per show or $5 for all 10 movies
  • AMC Regency 24’s Sensory Friendly Movies four times a month with more light and lower volume, and with kids able to get up and move about
  • The Museum of Science and History’s Little Learners preschool group the second Wednesday of the month at 9:30 a.m. (visitors can see exhibits any time)
  • The Cummer Museum of Art & Gardens’ Florida Blue Free Tuesdays and Art for Two classes for you and your child each month on the second and third Saturday (first come, first in—sign-up starts at 4 p.m.; classes start at 5 p.m.) (and, The Cummer is fun any time plus it has a large garden outside)
  • Your neighborhood public library’s Epic Summer Program full of activities for children of all ages through July (and parents can take a trip with their children anytime they like to get books to read there or to take home).

By Andrew Scherbarth, Ph.D., BCBA-D, licensed child psychologist

Published on page 8, June/July issue, Jax4Kids.com

Keystone Behavioral Pediatrics offers integrated healthcare by a team of highly educated child psychologists, behavior therapists, occupational therapists, speech/language therapists, feeding therapists and a medical director who lead the 120-person staff in collaborating to bring the best resources for addressing behavioral, developmental and physical issues in children. It offers one stop services to parents plus collaboration is the most effective way to address interactive issues that children often have. In addition to pediatric occupational therapy, child behavior therapy including applied behavior analysis, pediatric speech therapy, Keystone Child Development Center, located in Southpoint Office Park is the area’s premier early learning and child development center, providing day care and education to all children, 3 months through kindergarten, in four levels – Infants and Walkers, Preschool, Pre-K/VPK (state-endorsed free VPK for 4- and 5-year-olds) and Kindergarten.