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.

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.

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.

Keystone Psychologist Focuses on Diversity in Integrated Healthcare

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Dr. Romero (left) meets with a parent to discuss developmental issues.

Regilda (Rea) Romero, Ph.D., a licensed psychologist for Keystone, has focused her research work on issues related to diversity in the United States and its effect on clinicians’ ability to successfully help the children they serve. She has collected data via a survey regarding Filipino/Filipino-American acculturation and mental health on which she has presented preliminary analysis at local and national conferences.

She co-wrote a research abstract that was presented during the 2016 Asian American Psychological Association (AAPA) Annual Convention, at the University of Colorado this past August. The abstract was entitled, “Experiences of Distress for 1.5th and 2nd Generation Asian Americans.”

Her paper was in keeping with the convention theme, “Beyond ‘Yellow’ Borders: Revealing Our Diverse Community, Expanding Our Coalition Horizon.” The conference spotlighted Asian Americans and their role in our country, noting that over the 50 years since the passage of the Immigration and Nationality Act of 1965, a sociopolitical community of culturally diverse Asian Americans has taken shape. While they originated from diverse countries, Asian Americans were lumped into one racial category within the United States – which eventually developed into many stereotypes and even hierarchies between different ethnic groups. The conference’s goal was to create the opportunity for dialogue about the attendees’ overlapping roles as AAPI psychologists, students, community activists, consumers, scientists, educators, caretakers and allies.

In mid-October, Dr. Romero co-presented “Biopsychosocial Approach to Integrative Care: Pediatric Neuropsychologists as Diversity and Inclusion Advocates,” in Seattle at the National Academy of Neuropsychology. Their workshop highlighted biopsychosocial issue/bias factors such as rural/urban settings, private practice vs. medical settings, parental factors such as age and marital status, use of technology and disease states to determine how these factors have an impact on assessment, interpretation and treatment of pediatric integrative care.

In late October, she presented a paper of “Bicultural and Bilingual Assessment” to the Florida Psychological Association: North Central Chapter,” noting that as the demographics in the United States have rapidly shifted, the need for culturally-competent clinicians has also increased.

Dr. Romero focuses on pediatric neuropsychology, neurodevelopmental disorders, multicultural psychology, special education and transition-to-adulthood services. In addition to English, she is fluent in Tagalong (the standardized form is named Filipino), a language spoken as a first language/dialect by a quarter of the population of the Philippines and as a second language/dialect by the majority.

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.