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.

Military Transitions Clinic Helps Children Cope

brian-ludden
Brian Ludden, director of the Military Transitions Clinic, is a licensed mental health counselor, national certified counselor and certified clinical mental health counselor.

Under the direction of Brian Ludden, MS, LMHC, NCC, CCMHC, Keystone’s Military Transitions Clinic focuses on those issues that are unique to service members and their families. Our experience with military families allows us to provide the support these families need through a variety of military-life transitions; for example, preparations for permanent changes of station, deployment readiness, deployment separation, reintegration, separation from the Armed Forces, and even death and loss.

Keystone’s proximity to Mayport Naval Station and Naval Air Station Jax (NAS Jax), as well as NAS Jax’s designation as an EFMP (Exceptional Family Member Program) provider makes us ideally situated to meet the mental health and behavioral health needs of Northeast Florida’s very mobile military service members and their families. The clinic uses evidence-based therapeutic practices to treat military-transition related concerns. Some of these therapies include Cognitive-Behavior Therapy, Rogerian Therapy, Family-Systems Therapy, and more. Keystone’s compassionate and caring clinicians acknowledge and va

Our highly trained, experienced and compassionate staff is eager to support and assist families through any and all transitions, struggles and successes they may experience, military related or not.

Common diagnoses include:

  • Separation Anxiety: The experience of inappropriately extreme or excessive fear or distress when separating from parents/caregivers or other major attachment figures or items in the child’s life. It can cause a reluctance to leave home or significant individuals, as well as causing nightmare, sleep disturbances and physical symptoms including headaches and stomachaches.
  • Generalized Anxiety Disorder: Uncontrollable worry about multiple situations, performance, social, academic and health; “what if” concerns that span far into the future, physical symptoms including headaches and stomachaches, inability to unwind, low risk-taking and needing constant reassurance
  • Major Depressive Disorder: A significant depressed mood, loss of interest in pleasure and activities, or both, nearly every day. It can impact appetite, sleep, concentration and cognitive function, and reflexes.
  • Adjustment Disorder: Emotional or behavioral issues in relation to an identifiable stressor. Stressors can include changing schools, moving, parental separation, loss of friendships, and more and can be accompanied by depression, anxiety and conduct issues.
  • Posttraumatic Stress Disorder (PTSD): For children of military service members, learning that their parent/sibling/loved-one has been involved in a traumatic event can be enough for them to experience PTSD symptoms. It is characterized by intrusive thoughts of the event; hypervigilance; extreme avoidance of distressing thoughts, memories, or feelings about the event; frightening dreams; problems with concentration; sleep disturbances; irritability, and more.

Before joining Keystone, Brian spent three years working as a mental health counselor in Clay County School in northeast Florida as the county’s Military Connected Student Support Specialist, where he provided counseling support for military families and children coping with transitions, deployments, separations and grief.  Brian’s primary experience has been in supporting and assisting children with anxiety disorders through art therapy and guided visualization, as well as intensive cognitive behavior therapy and exposure and response prevention. 

Brian is a licensed mental health counselor, national certified counselor and certified clinical mental health counselor with a Master of Science degree in clinical mental health counseling from the University of North Florida.  He is currently a doctoral candidate in educational leadership at UNF and will be defending his dissertation later this year, with a focus on the availability of adolescent mental health services in urban public school settings. 

In addition to serving as director of Keystone’s Military Transitions Clinic, Brian serves as the director of the Anxiety and OCD Clinic and provides mental health counseling and support to children and their families.  Additionally, he provides supervision to master’s level mental health interns seeking to gain experience in the field of counseling.

Resources for Parents/Caregivers:

Military Child Education Coalition (MCEC)

Tutor.com for U.S. Military Families – Free Academic Tutoring for Dependents of Active Duty Service Members

Military Connect – “Connect with Kids Like You”

Keystone Clinic helps Children deal with Trauma and Grief

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

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

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

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

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

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

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

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