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.

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.

Light It Up Blue on April 2!

The ninth annual World Autism Awareness Day is April 2, 2017. Every year, Keystone Behavioral Pediatrics joins other autism organizations around the world in helping to increase awareness of autism and of how we can help children achieve success through change provided by our highly educated and experienced therapists.

Celebrate autism awareness by wearing blue on April 2

In some of the latest news from AutismSpeaks.org, its newest study out of the Autism Speaks MSSNG project – the world’s largest autism genome sequencing program – identified an additional 18 gene variations that appear to increase the risk of autism. The new report appears this week in the journal Nature Neuroscience. It involved the analysis of 5,205 whole genomes from families affected by autism – making it the largest whole genome study of autism to date.

The omitted letters in MSSNG (pronounced “missing”) represent the missing information about autism that the research program seeks to deliver.

“It’s noteworthy that we’re still finding new autism genes, let alone 18 of them, after a decade of intense focus,” says study co-author Mathew Pletcher, Ph.D., Autism Speaks’ vice president for genomic discovery. “With each new gene discovery, we’re able to explain more cases of autism, each with its own set of behavioral effects and many with associated medical concerns.”

Identifying subtypes to advance personalized treatment

To date, research using the MSSNG genomic database has identified 61 genetic variations that affect autism risk. The research has associated several of these with additional medical conditions that often accompany autism. The goal, Dr. Pletcher says, “is to advance personalized treatments for autism by deepening our understanding of the condition’s many subtypes.”

The findings also illustrate how whole genome sequencing can guide medical care today. For example, at least two of the autism-associated gene changes described in the new paper are also associated with seizures. Another has been linked to increased risk for cardiac defects, and yet another with adult diabetes. These findings illustrate how whole genome sequencing for autism can provide additional medical guidance to individuals, families and their physicians, the investigators say.

Many genes; a few key pathways

The researchers also determined that many of the 18 newly identified autism genes affect the operation of a small subset of biological pathways in the brain. All of these pathways affect how brain cells develop and communicate with each other. “In all, 80 percent of the 61 gene variations discovered through MSSNG affect biochemical pathways that have clear potential as targets for future medicines, Dr. Pletcher adds.

Increasingly, autism researchers are predicting that more-effective, personalized treatments will come from understanding these common brain pathways – and how different gene variations alter them.

Lead study author Ryan Yuen, left, and senior author Stephen Scherer, both of The Centre for Applied Genomics at the Hospital for Sick Children (SickKids), in Toronto.

Not one autism, but many

“The unprecedented MSSNG database is enabling research into the many ‘autisms’ that make up the autism spectrum,” says the study’s senior investigator, Stephen Scherer, Ph.D.

For instance, some of the genetic alterations found in the study occurred in families with one person severely affected by autism and others on the milder end of the spectrum, Dr. Scherer notes. “This reinforces the significant neurodiversity involved in this complex condition,” he explains. “In addition, the depth of the MSSNG database allowed us to identify resilient individuals who carry autism-associated gene variations without developing autism. We believe that this, too, is an important part of the neurodiversity story.”

Dr. Scherer is the research director for the MSSNG project and directs The Centre for Applied Genomics at the Hospital for Sick Children (SickKids), in Toronto. MSSNG is a collaboration between the hospital, Autism Speaks and Verily (formerly Google Life Sciences), which hosts the MSSNG database on its cloud platform.

Beyond traditional genetics

Traditional genetic analysis looks for mutations, or “spelling changes,” in the 1 percent of our DNA that spells out our genes. By contrast, the MSSNG database allows researchers to analyze the entire 3 billion DNA base pairs that make up each person’s genome.

In their new study, the investigators went even further – looking beyond DNA “spelling” variations to find other types of genetic changes associated with autism. These included copy number variations (repeated or deleted stretches of DNA) and chromosomal abnormalities. Chromosomes are the threadlike cell structures that package and organize our genes.

The researchers found copy number variations and chromosomal abnormalities to be particularly common in the genomes of people affected by autism.

In addition, many of the copy number variations turned up in areas of the genome once considered “junk DNA.” Though this genetic “dark matter” exists outside of our genes, scientists now appreciate that it helps control when and where our genes switch on and off. The precise coordination of genetic activity appears to be particularly crucial to brain development and function.

An unprecedented resource

Through its research platform on the Google Cloud, Autism Speaks is making all of MSSNG’s fully sequenced genomes directly available to researchers free of charge, along with a toolbox of analytic tools. In the coming weeks, the MSSNG team will be uploading an additional 2,000 fully sequenced autism genomes, bringing the total to over 7,000.

Currently, more than 90 investigators at 40 academic and medical institutions are using the MSSNG database to advance autism research around the world.

Autism Speaks is also funding the creation of a community portal that will allow study participants to explore their genomic information and share experiences with others who have similar genetic profiles.

For more about the MSSNG, visit www.mss.ng. For more about Autism Speaks, visit www.autismspeaks.org.

November is National Epilepsy Awareness Month

national-epilepsy-monthKeystone Behavioral Pediatrics’ Neuropsychological Assessment Clinic, led by co-directors Rea Anne A. Romero, Ph.D., licensed psychologist, and Rebecca J. Penna, Ph.D., NCSP, neuropsychologist and clinical psychologist, provides comprehensive evaluation of brain functions and processes. The neuropsychological approach is particularly useful for individuals who have experienced a brain injury or other medical conditions that impact the central nervous system, such as epilepsy, as well as other complex clinical conditions that impact the way a person thinks and learns. Following the assessment, a profile of the individual’s processing strengths and needs is developed, which guides treatment, rehabilitation and educational planning.

Parents of children with seizures have a special role.

The national Epilepsy Foundation acknowledges the following critical roles that parents of children with seizures play in their children’s lives:

  1. You are parents and the primary caregivers of your young children. You are the one giving information to the health care team and the primary one working with schools, camps, or other community groups. You are staying up at night worrying, or caring for your child during and after seizures. You want them to stay safe, but may have to balance this with how to let them be kids, and develop independence.
  2. You are a manager. You need to manage your young child’s epilepsy. As your child grows, you need to teach him or her how to manage his epilepsy. If your adult child can’t manage their epilepsy on their own, you may need to continue in the manager role or find someone else or an agency (for example a group home or agency overseeing your child’s care) to manage their care.
  3. You are an advocate. You may have to advocate for your child to get the care they need, to get an appropriate education and any necessary accommodations, and to have their rights respected.
  4. You are an educator. You have to educate so many people (as well as yourself) about epilepsy and how to treat and respond to your child. You want your child to be treated just like anyone else, but this may take work over the years.
  5. You are also a “patient.” Epilepsy affects the whole family – the person with seizures, parents, siblings, grandparents, and more. How it affects you will be different than how it affects the child, other children in the family, or your parents. But it will affect you. As a patient, you’ll have needs too and would benefit from information and support to help you.

Epilepsy and seizures are tough for children and families to bear. It might feel like more than you can handle on your own. Luckily, you don’t have to. Keystone can assess and evaluate your child to provide an individualized treatment and education planning.

Cognitive behavioral therapy has become a successful way to help people through a variety of problems. It has been shown to reduce depression, anxiety, or anger (or more than one of these) in some people with epilepsy. Cognitive behavioral therapy is grounded in the belief that your thoughts guide your feelings and actions. To help your child manage feelings and change actions, we help your child first focus on changing thinking patterns. When your child learns how to focus on her own thoughts instead of outside events or other people, she can have more control over her progress and a greater chance of improving her life.

In many cases, epilepsy co-occurs with other developmental and behavioral issues, for example, autism. We can also provide specific recommendations that relate to educational placement and instructional strategies that can be shared with your child or adolescent’s school. This can include recommendations for testing accommodations (e.g., SAT) if indicated.

“Monkey See, Monkey Do”: Protecting Kids from Negative Social Influence in the Media

By Andrew Scherbarth, Ph.D., BCBA-D, Clinical Child Psychologist

What exactly is social influence? Social influence is the effect of modeling – not runway models with their fancy clothes but the effects that happen when kids see how others behave. Social influence can be a good thing, such as when kids see good role models who make them want to work hard or be kind. However, social influence can be negative if kids see someone act out inappropriately, rudely or aggressively, followed by that person coming out ahead. This article will describe how social learning works, social rewards shown as a result of negative behavior in the media, the effects that happen when kids or teens observe negative social influences, as well as what can be done by parents to reduce the influence of negative social role models on our kids and teens.

Social influence can positively or negatively affect children, depending on the behavior being modeled.

Does social learning change behavior? It absolutely does.

In a classic experiment in 1960 by social learning theory theorist Albert Bandura et al, two groups of kids were separately shown a video. One group saw a child treating an inflatable child-sized clown blow-up doll with respect. The other group saw a child punching, kicking and knocking over the doll while laughing. After seeing the video, each group was put into a room with the exact replica of the doll in the video. In both groups, the kids treated the doll the way they saw the kids in the video treat the doll—either with respect or with aggression.

Negative social learning can happen as a result of a child viewing any type of media source—video games, television, movies, social media or even the news. What kind of incentives for negative social behavior does a child observe in the media?

Video gamesvideo-games-fan-893839-m like Grand Theft Auto show prostitution as being paid off with health and aggression/robbery with more items, cars and cash. Other video games give more money or more experience points for increased killing. TV shows or movies may depict criminal life and drug use with the characters receiving higher amounts of money, fame, respect, attention from romantic partners, the thrill of defeating those who are trying to bring them to justice, laughs and/or popularity.

In various countries, dictators or other leaders who are socially aggressive can be revered and described as being “great,” “powerful,” or “strong leaders.” Violent protesters can be seen as being “heroes” fighting for a just cause—even when they are actually causing people to get hurt or property to be destroyed. Ironically, even if these acts shown in the media ultimately push many people away from the behavior, the short-term positive results they portray can still influence kids or teens to do these behaviors. Social media, such as YouTube and Facebook, may show stories about aggressive, crude or reckless people which receive a high positive view rating.

Do kids and teens who view negative media engage in negative behaviors as a result? Yes

The effect is shown to be greater when someone develops a preference to choose violent/aggressive media, leading to further exposure to negative role models (Boxer et al, 2008). The effects were measured to determine both the impact on boys (direct physical aggression after playing violent video games for children with less empathy and social understanding, but even those with higher levels of social understanding demonstrated more social aggression—Wallenius, 2007) and also girls (aggressive television viewing leading to more bullying among girls in school settings—Martins, 2008). Even children on the spectrum appear to be impacted by the types of games they play, and it is associated with oppositional behavior (Mazurek, 2013). Clearly, kids are influenced by violent or aggressive media and engage in lower intensity aggressive acts (pushing, name calling, verbal disrespect), even if they never engage in some of the exact acts that were shown on social media (shooting guns, fist fighting, etc.).

What can parents do to prevent negative social influence from the media? Some suggestions are:

  1. Choose holiday gifts wisely. Consider video games with sports and/or that require strategy, such as dialog, social decision making and problem solving—but not graphic violence. Video games have ratings, just like movies do—M for Mature is a clue that it may be unwise to buy it.
  2. Choose carefully the movies and television shows that your child is allowed to watch. Limit exposure to those with negative or “adult” themes and encourage pro-social themes like achievement, respect or kindness.
  3. Consider internet and/or cable box filters for various sites and/or monitor online behavior.
  4. Limit exposure to graphic or extensive news about negative events or role models. As a parent, you want to stay informed, but consider whether your kids need to see or hear the news about terrorists and terror attacks or watch dictators or other leaders act aggressively. It might impact their sense of safety.
  5. For kids who are mature enough, describe in age-appropriate ways what is happening in relation to something that you both just viewed on TV. Explain the choices that were made and the negative result of those choices—even if the show only demonstrated the positive short-term result.
  6. Related to news, young adolescents often talk about current events in their classrooms or view news stories online and have a reaction. You may even want to talk with a younger child if they bring up something that another kids told them in school. While we cannot keep kids in a bubble and we know that they will encounter some of these things, we can limit exposure to negative influences and help them process what they’ve seen or heard about.
  7. Parents can also talk to their children about ways to behave that allow them to be positive role models for others, as well as how to deal with negative influences in real life. Further, by demonstrating at home how to put these positive strategies to work, parents can be a positive role model for their children.

Therapists at Keystone Behavioral Pediatrics, in Jacksonville, Fla., can help children learn positive behaviors and guide parents in how to avoid negative influences. Keystone works with all child behavior disorders and provides behavior therapy for autism and all other types of pediatric behavior, developmental, emotional and learning issues.

Parent Resources:

Simply Psychology: Bobo Doll Experiment

Rutgers Today: Rutgers Researcher’s Study Cites Media Violence as ‘Critical Risk Factor’ for Aggression

Disability Scoop: Autism Behavior Problems Linked To Video Game Play

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

483a6457-edit-1-cropped
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.

Keystone’s Rehabilitative Medicine Director named Fieldwork Educator of the Year

robert-navarro
RJ Navarro, OT/L, cNDT, has been named Fieldwork Educator of the Year.

Keystone’s director of rehabilitative medicine, RJ Navarro, who is a licensed occupational therapist and certificated in neuro-developmental treatment, has once again been named Fieldwork Educator of the Year by the Florida Occupational Therapy Educational Consortium.

The award includes a year-long membership in the Florida Occupational Therapy Association. RJ will be recognized at the FOTA Conference in Orlando on Sat., Nov. 5.

RJ graduated with a degree in occupational therapy from the University of Southern California (USC) in Los Angeles. He has spent his entire career in settings specializing in neurological rehabilitation for both adult and pediatric populations.

Within the pediatric population, RJ has focused on helping children diagnosed with autism spectrum disorders, cerebral palsy, spinal cord injuries, Down syndrome and sensory integration disorder. He is a state-recognized Early Steps Intervention provider and certificated in neuro-developmental treatment with practical knowledge of all modalities.

As director of rehabilitative medicine, RJ supervises occupational therapy, feeding therapy, speech and language services and nursing, within a multidisciplinary team approach. RJ is currently pursuing his doctorate in physical therapy.

 

Neuropsychological Clinic Assesses Brain Injuries

doc3
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.

Behavior Therapy Education for Police Reduces Misunderstandings

By Matthew J. Delaney, MSW, BCBA

Director of Applied Behavior Analysis

If you have tuned into the news recently, you are well aware of the behavior therapist in Miami who was shot by law enforcement as he was trying to bring his client who has autism back to the group home from which he had wandered. The video footage going viral on social media shows a behavior therapist with his hands up pleading with the man with autism to remain still and to lie down on the ground for fear that the police will shoot if he does not comply. The 23 year-old man with autism holding a toy truck continues to rock back and forth not adhering to the therapist’s request.

The fact that the individual did not comply with the demands of his therapist, and likely the demands of law enforcement, placed him at significant risk for harm. While many details will come out in the next few days regarding this unfortunate event, I think it is a great opportunity to spark discussion about the need for greater collaboration’ between behavior analysts and our law enforcement community in an effort to prevent events like this from reoccurring.

The Substance Abuse and Mental Health Services Administration funded a global initiative called Mental Health First Aid. The premise behind this initiative is that if an individual had a heart attack in a public venue, it is likely a witness in the community could come and provide CPR. However, if an individual was contemplating suicide or having a panic attack, the odds are less likely that a bystander would know how to adequately respond. These trainings are open to anyone, but are particularly marketed toward law enforcement and our first responders.

While this initiative is meeting a huge need within the mental health community, it does not address information and techniques specific to individuals with autism and related disorders. Similar to this initiative, there is an urgent need for behavior analysts to partner with first responders to provide training on the many presentations of autism symptoms and train law enforcement agencies on ways to interact with individuals who may have autism or related disorders that protects them from further escalation or harm.

Keystone Behavioral Pediatrics is eager to partner with law enforcement and other first responders in the Jacksonville community. We will provide educational training sessions as a community service to help empower these professionals with the tools and knowledge necessary to work with individuals with autism and related disorders.

We take seriously our role as advocates for the children and young adults we serve, and, in that role, we hope to build lasting partnerships with Jacksonville’s first responders and be a community resource for education and training on working with individuals with autism and related disorders.

You may contact Matt Delaney, 904.619.6071, delaney@keystonebehavioral.com, to discuss a potential educational training session or other ways that we may be helpful.

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.

483A2863-1-copy
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.