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.

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.

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

Neuropsychological Clinic Assesses Brain Injuries

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

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

Kids’ Concussions Cause for Concern

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

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

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

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

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

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

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

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

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

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