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.

Keystone Clinic helps Children deal with Trauma and Grief

Prince Harry brought an important pediatric mental health issue to light recently when he revealed to the BBC (British Broadcasting Corporation) that he regrets not talking about how the death of his mother, Princess Diana, affected him. The now 31-year-old was only 12 when Diana was killed in a car crash.

Prince Harry knows, as do the therapists at Keystone Behavioral Pediatrics, that all of us need an outlet for expressing feelings of grief. For children, it is likely the first time that they have had some kind of loss, and they have no experience in the course that grief may take and the impact it may have on their lives.

To help children cope with grief and other types of trauma, Keystone Behavioral Pediatrics offers Trauma and Grief Clinic in Jacksonville, Fla., to evaluate and treat children and adolescents dealing with these issues. Exposure to traumatic events can affect children’s cognitive, social, emotional, and behavioral functioning. Early therapeutic intervention can minimize the harmful effects of experiencing psychological trauma.

The most common diagnoses associated with trauma and grief are PTSD (Post-Traumatic Stress Disorder) or Acute Stress Disorder. Kids with this disorder may avoid things associated with the event and may have difficulties remembering parts of the event. Parents, caregivers and others, such as teachers and coaches, may notice changes in their mood, thoughts or behavior.

If you suspect that you child is suffering from trauma or grief, you may bring your child to Keystone for an initial evaluation. One of our therapists or child psychologists will interview you and, when appropriate, your child. The therapist may use rating scales and screening forms as well.

The Trauma and Grief Clinic offers evidenced-based trauma-focused cognitive child behavior therapy (TF-CBT). TF-CBT has been shown to help children, adolescents and their families overcome trauma-related difficulties. It is designed to reduce negative emotional and behavioral responses after witnessing domestic violence, experiencing traumatic loss, or experiencing abuse.

The first step to get help for your child is to complete Keystone’s online appointment form. Once we receive the completed application, a client care coordinator will call you to set up an appointment for the initial evaluation.

Keystone’s Trauma and Grief Clinic is one of 15 clinics that together offer comprehensive, collaborative and integrated healthcare for all children, from infancy to 22 years old, to deal with all mental health issues and child behavior and developmental disorders. In addition to the Trauma and Grief Clinic, Keystone clinics include Right from the Start, Health & Wellness, ADHD, Anxiety and OCD, Autism & Developmental, Disruptive Behavior, Educational & Learning Assessment, Feeding, Mood, Neuropsychological Assessment, Occupational Therapy, Speech/Language, Early Intervention and Day Treatment clinics.