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.

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

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.

Second Keystone OT Therapist Named 2016 Fieldwork Educator

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Samantha Bean West helps develop skills that will lead to success in everyday life including: motor, social, personal, academic and vocational pursuits.

Samantha Bean West, pediatric occupational therapist, assistant director of occupational therapy, CMS Early Steps Provider, Handwriting Without Tears® Level 1 Certified Handwriting Specialist, joined RJ Navarro, director of rehabilitative medicine, in being recognized as 2016 Fieldwork Educator of the Year by Florida State College at Jacksonville and Florida Occupational Therapy Educational Consortium on Nov. 5, in Orlando, Fla., during the opening ceremony of the annual FOTA Conference.

Every year FLOTEC selects fieldwork educators from across the state and honors them with the Award of Excellence. Award recipients have been nominated and selected by an academic program or students as a fieldwork educator who exhibits superior communication, interpersonal behaviors, professional and teaching behaviors.

FLOTEC honors fieldwork educators with the Award of Excellence for exhibiting superior communication, interpersonal behaviors, professional and teaching behaviors.

The award recognizes Samantha and RJ as educators who are able to:

  • Clarify expectation of supervision at outset
  • Establish and maintain boundaries
  • Teach practical skills
  • Maintain membership in his/her state and national association.
  • Be assessable and available to the student
  • Encourage students to explore new ideas and techniques (think outside the box)
  • Use and promote reflective practice
  • Show enthusiasm for Occupational Therapy
  • Foster autonomy and independence
  • Model professional and ethical behavior
  • Assess student’s learning needs
  • Accept values and celebrate diversity
  • Be aware of our own limitations and strengths
  • Work collaboratively with students – listen more than talk to students
  • Maintain open and honest relationships with student
  • Convey a supportive and caring attitude

Keystone is proud of and congratulates both Samantha and RJ!

Keystone CEO Recognized for Integrated Healthcare

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

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

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

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

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

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

Research also confirms that getting help early can lead to the best outcomes for kids. Developmental, learning, behavioral and social-emotional issues are estimated to affect one in every six children. Because these issues are often very subtle in young children, only 20 to 30 percent are identified as needing help before kindergarten.

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

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

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

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

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

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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.

 

Right from the Start Clinic Identifies Challenges Early for Best Outcomes

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Keystone Behavioral Pediatrics’ Right from the Start Clinic helps you know whether your child would benefit from early intervention to solve or alleviate any issues before they become problematic.

All children learn and grow at different rates. We know that getting help early can lead to the best outcomes for kids. Because these issues are often very subtle in young children, only 20-30 percent are identified as needing help before kindergarten. Keystone Behavioral Pediatrics’ Right from the Start Clinic helps you know whether your young child would benefit from early intervention to solve or alleviate any issues before they become problematic.

Developmental, learning, behavioral and socio-emotional issues are estimated to affect one in every six children

The Right from the Start clinic is a free screening clinic for children between the ages of 1 month and 5½ years old. We provide a multidisciplinary screening evaluation to assess your child’s developmental progress. You will meet with clinicians from our psychology, occupational therapy, and speech language departments, as well as our pediatrician. At the end of the visit, you will receive information on how your child is doing developmentally, with suggestions to target any areas of need that have been identified.

Common concerns that might indicate your child could benefit from a screening include delayed speech, not making eye contact, not smiling in response to you smiling, poor coordination, toileting delays, motor delays, prematurity, concerns about emotional or behavioral development, or other developmental delays.

The Ages and Stages Questionnaire (ASQ) is a developmental screening test that assesses communication, fine motor, gross motor, problem solving and person-social skills. Complete the ASQ online before your appointment, and the results will be reviewed with you during your visit.

At the conclusion of the Right from the Start screening appointment, you will meet with a psychologist to review the findings and recommendations. We will help you create an action plan of next steps to take, based upon what concerns were identified, if any. We provide local resources to assist your family, and our Client Care Coordinators are available to provide further guidance in accessing those resources.

Contact info@keystonebehavioral.com, 904.619-6071, to talk to a Client Care Coordinator.

By Rebecca J. Penna, Ph.D., NCSP, Neuropsychologist and Clinical Psychologist, Director of Right from the Start Clinic

Keystone Therapist Earns Handwriting Without Tears Certification

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Samantha West, MOTR/L, occupational therapist, assistant director of occupational therapy, CMS Early Steps Provider, recently earned Handwriting Without Tears (HWT) certification.

Samantha Bean West, assistant director of Keystone’s Occupational Therapy Clinic, has added to her education, including a master’s in occupational therapy and recognition by the Florida Health Department as a Children’s Medical Services provider, by earning Handwriting Without Tears (HWT) Level 1 Certification.

Level 1 Certified handwriting specialists must complete an extensive process successfully to achieve certification. These individuals are recognized for their expertise in using the Handwriting Without Tears® program and The Print Tool® assessment.

Handwriting is one of the fastest growing areas of referral to occupational therapy. Because handwriting is such a complex skill, there are many children who have difficulty mastering it. This may cause frustration and distress and affect a child’s desire to write. It may also cause anxiety for the parents and teachers who watch the child struggle to put his or her ideas on paper. Not all difficulties are the same or caused by the same factors, and any assessment of the problem must take into account the age and experience of the child.

As a result, more and more educators are sharing what they have learned from the Handwriting Without Tears® program. The only such program in the country—Level 1 Certification provides exceptional training.

Samantha is now available to provide handwriting assessments and individual or group treatment sessions. She provides parent-friendly reports, sets goals, determines remediation activities and documents progress for evidence-based practice to help children from Pre-K through Grade 5.

Should you as a parent be concerned about your child’s handwriting? Some initial questions to ask are:

  • Has your child received any direct teaching of handwriting?
  • What is the policy for handwriting in the school?
  • Are the concerns about the handwriting shared by the teacher, the parents and the child?
  • What are the main areas of concern?
  • Legibility? (All or most of the words written can’t be read out of context.)
  • Neatness? (The handwriting is messy or poorly controlled.)
  • Comfort? (The child is experiencing pain, strain or discomfort when writing.)
  • Pressure? (S/he is pressing too hard or not hard enough, or pressure within one piece of writing is variable.)
  • Speed? (S/he writes very slowly, producing too little writing, or too fast, becoming inaccurate.)
  • Motivation/enjoyment? (S/he is reluctant to write or gives up too easily.)

If you are concerned, contact us to schedule an appointment or ask questions.

Resources:

National Handwriting Association

Handwriting Without Tears Certification

HWT Certification Specialist – Samantha (Bean) West

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.