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.

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

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.

Macy’s Makes a Special Wish Come True at Thanksgiving for a Special Young Person

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Katie Falwell, CEO, hugs Sam LaManna, 14. She and other Keystone therapists have worked with Sam since he was six years old.

Sam LaManna is 14 years old and a student at Mainspring Academy a school for students with special needs. When he celebrated his birthday this past January, he had just one wish – to get an autograph from Macy’s Thanksgiving Day Parade Executive Producer, Amy Kule. Sam first saw Amy cut the ribbon at the parade a few years ago and she has been his hero ever since!

Sam’s mother had placenta previa, which caused birth trauma and low heart rate and oxygen levels for Sam. Five days after his birth, the doctors discovered that he had two intraventricular brain hemorrhages. Sam survived but now lives with hydrocephalus, the buildup of fluid in the cavities deep within the brain. The excess fluid increases the size of the cavities and puts pressure on the brain, which damages brain tissues and causes a large spectrum of impairments in brain function.

Macy’s has invited Sam and His Family to be Special Guests at the 90th Anniversary of its Thanksgiving Parade

Last year, with the help of his teacher, Sam made a video message asking Amy for her autograph. The video went viral, eventually Amy saw the video, and she was honored to make his wish come true. Not only did Amy send Sam an autograph, she made a video herself inviting his family, Sam and his former teacher to be her special guests at the 90th annual Macy’s Thanksgiving Day Parade! Amy and Al Roker, weather anchor on NBC’s Today and Sam’s other favorite person, have a special Thanksgiving Day planned for Sam.

Sam still attends Mainspring Academy, a private, nonprofit school located in Jacksonville’s Southside. The school opened in 2010 to serve children with a broad range of special needs from elementary through high school.

Sam also receives a number of therapies provided by Keystone Behavioral Pediatrics, which offers integrated healthcare for developmental, behavioral, emotional and learning issues. Using a collaborative team approach, more than 120 therapists are available to help children.

Sam’s lead therapist is Angela Chionchio. Keystone has worked with Sam since he was six years old. When his mother first brought Sam to Keystone in 2008, she described him as happy and affectionate, noting that he loved to read, learned quickly and had excellent memory. Yet, she was concerned that he was stubborn, easily distracted and developmentally delayed. He didn’t sit up until he was 13 months old and didn’t walk until he was 27 months old. Socially, Sam struggled to make friends and seemed disinterested and withdrawn around others.

According to Sam’s lead therapist, Angela Chionchio. “Sam has trouble with ‘first time listening,’ meaning he can be noncompliant when he impulsively sees an object that he wants play with but should not be available at the moment. In the classroom, his teacher and I prompt him to raise his hand to ask permission to do these things and offer him alternatives.”

Sam also has a problem with schedule change. “We help by preparing him for upcoming changes and praising him when he accepts change appropriately,” Angela says.

“Sam is doing great this year,” she says. His new classmates offer him opportunities to grow socially and behaviorally.

“When I asked Sam why he loved the parade so much, he said that it was because he loves when the producer cuts the ribbon at the start of the parade,” she laughs. “He said he also is very excited to see Santa Claus at the grand finale  and meet the host of the Today Show.”

“Sam is a wonderfully unique little guy,” his mom says. “I knew great things were inside him, but I needed Keystone’s help for Sam to bring out all that he has to offer the world.”

Sam’s trip to New York City is made even more special by the fact that his parents and he tried to visit the city last year, but had to cancel at the last minute because Sam needed emergency surgery. The IV shunt that was implanted in Sam’s brain unexpectedly quit working, so Sam had to endure hours of major surgery.

An implanted shunt diverts cerebrospinal fluid from the chambers within the brain to another body region where it will be absorbed. This creates an alternative route for removal of cerebrospinal fluid which is constantly produced within the brain and usually restores physiological balance.

Sam has blossomed under the therapy he receives at Keystone and in his classes at Mainspring Academy. All of us at Keystone and Mainspring are so excited for Sam that he has been able to achieve and even exceed his dream of getting autographs from Amy Kule and Al Roker.

“Sam is a wonderfully unique little guy,” his mom says. “I knew great things were inside him, but I needed Keystone’s help for Sam to bring out all that he has to offer the world.”

Sam’s trip to New York City is made even more special by the fact that his parents and he tried to visit the city last year, but had to cancel at the last minute because Sam needed emergency surgery. The IV shunt that was implanted in Sam’s brain unexpectedly quit working, so Sam had to endure hours of major surgery.

An implanted shunt diverts cerebrospinal fluid from the chambers within the brain to another body region where it will be absorbed. This creates an alternative route for removal of cerebrospinal fluid which is constantly produced within the brain and usually restores physiological balance.

Sam has blossomed under the therapy he receives at Keystone and in his classes at Mainspring Academy. All of us at Keystone and Mainspring are so excited for Sam that he has been able to achieve and even exceed his dream of getting autographs from Amy Kule and Al Roker.