Santa, The Tooth Fairy and Psychology

When families come to a psychologist seeking services, they
are worried about their children, they feel stressed, and they are often
concerned about the investment of time and finances required to achieve their
goals. They are experiencing ambivalent and contradictory feelings. They want help restoring peace in their families, yet wish they could do it without professional intervention. They want to hear the results of an assessment yet are afraid it may be bad news. Parents may have different points of view about the problem and are unsure about whether the psychologist will ‘agree’ with them or their spouse.

For some people, these feelings are amplified by their concerns about stigma or their misunderstanding of the mental health field. They find it easier to dismiss mental health as voodoo, make-believe or sentimental nonsense than it is to tolerate the possibility that thoughts and emotions can have a significant impact on our functioning. Parents have very sincerely told me that they “don’t believe in psychology.” I suppose that makes me something like the Tooth Fairy. Sometimes I wonder if they ever told their college professors, “I don’t believe in history” or their doctors “I don’t believe in dermatology.” It’s odd for someone who studied the science for years that it can be dismissed as fantasy.

However, ongoing work with these families has shown me that their initial hesitance to acknowledge that psychology is ‘real’ is due to our natural inclination to distance ourselves from the unknown. Many people maintain the cartoon stereotype of psychologists as bearded men who nod while someone lays on the couch and talks about their potty-training. They worry that a psychologist’s job is to look into them and reveal problems. They wonder if their children, the family, or their parenting will be judged or criticized. So, they belittle or minimize the expertise of the field that they view as a threat to the family they want to protect.

Families often feel better once they educate themselves about the current state of psychology. Evaluations and diagnoses are now based on standardized measures. This means that scores are based on a statistical comparison of their symptoms to a large sample from the population. With the use of the DSM-IV-TR, diagnostic criteria have been standardized to help ensure that the language we use to describe mental health is specific. It helps to prevent people from being needlessly diagnosed when symptoms do not cause difficulties in their lives.

Our understanding of mental health conditions has been deepened by years of scientific research about the biological, social and cognitive factors that contribute to learning, attention, or emotional symptoms. In addition, treatments that we currently use have been studied extensively to determine if they harm or benefit people. Psychologists spend years in training to learn these techniques and are required to take ongoing training to ensure their skills are up-to-date. Though managed care has caused many frequently discussed problems, one benefit is the push for treatments that have been proven to be effective through controlled studies. Obviously, insurance companies will not spend their money on therapies that are based on make-believe. Thus, families can rest assured that, even if they are nervous about mental health services, their experiences will be based on real science, significant training, and a careful evaluation of their family rather than ‘make-believe.’

Dr. Madison 1/12

Red Flags for a Reading Disorder

Parents are often told that you cannot diagnose a reading disability or dyslexia until the third grade. This is actually not the case, and the earlier you are able to detect a reading problem, the quicker you will be able to put intervention strategies into place. Here are some red flags to watch out for in the early years of reading acquisition:

1)When writing, they insert or delete letters. For example, when asked to write “born,” he or she may write, “boirn.”

2)They are not recognizing sight words that are common in their environment, such as the word STOP, and are rather trying to sound it out.

3)You notice that once you have taught them a word on one page of a book, they have “forgotten” it by the next page.

4)When reading aloud, they pronounce the first segment of the word and then make up a new word. For example, with the word, “fire,” they may say “find.”

5)Naming the letters of the alphabet has not yet become automatic, and is labored or slow.

6)Your child has difficulty hearing the different segments of a word to help them spell it out. For example, when asked to spell “tiger,” they may write “tire.”

Early detection of a reading disability is crucial. There are many types of dyslexia including phonological dyslexia, orthographic dyslexia, difficulty with heard sounds or auditory processing that impacts reading, or challenges with the written word and visual motor integration. By determining what type of reading challenges your child has, the appropriate intervention can be put into place.

Rachna Varia, PhD
Licensed Clinical Psychologist
Director, Testing and Diagnostics
MindWell Psychology

Blog for Mental Health Day! May 18, 2011

Click this link to see the American Psychological Association's Blog for Mental Health Day! Lots of great information about the power of psychology to change lives.

New Screening Measure for Doctors Detects Signs of Autism at 12 Month Well Baby Visit--Good News!

New Screening Measure for Doctors Detects Signs of Autism at 12 Month Well Baby Visit--Good News!

There is some wonderful news for all of us parents of young children! The Journal of Pediatrics has published a new tool for screening one-year-olds designed to detect early signs of developmental delays--including symptoms and behaviors consistent with Autism. Autism is a developmental delay that impacts children's language, social functioning, play, learning, and behaviors. Since Autism varies so much in severity, clinicians refer to it as a 'spectrum disorder' (you may hear the term Autism and Autistic Spectrum Disorder used interchangeably in news stories). This is excellent news for parents and children, because early identification is crucial.

The Communication and Symbolic Behavior Scales Developmental Profile for Infants and Toddlers
The new screening questionnaire called the Communication and Symbolic Behavior Scales Developmental Profile for Infants and Toddlers (abbreviated CSBS DP IT) is specifically designed to be used by pediatricians during the 12 month well baby visit. So why is this such a big deal? Most children who have Autism and other developmental delays do not get referred for a proper diagnosis until around 5 and a half years of age. This means that most families lose two or three years that would be the very best time to get their child early intervention services. Research has shown that early intervention services (including speech language therapy, special education, applied behavior analysis and psychotherapy) are the gold standard of care in treating children with Autism. Not only is this the time when the child's brain is the most adaptable, but professionals can intervene early to prevent undesirable behaviors from taking root. Young children with Autism desperately need to learn skills that unfold naturally for most children, and there is no time to be lost in getting them the help they need.

The CSBS can be downloaded for free from this website:
http://www.brookespublishing.com/store/books/wetherby-csbsdp/checklist.htm.

Aiden's Story
Lets consider a fairly typical course for a child with Autism. I'll ask you to imagine the case of a child named Aiden Doe (not his real name). Aiden was an incredibly easy baby. He was beautiful and healthy. He did not cry much, but liked to be left in his crib to stare at his mobile. Since he was their first baby, his parents did not notice that he babbled and smiled less than most babies. During his doctor's visits, he was growing and gaining weight. The physician did not note anything amiss. Aiden did begin speaking at 18 months, so that was a relief. What his mom did not realize for a while was that he was not speaking like most children, but repeating things other people or TV characters said. Over time, Aiden became more and more different from his peers. He developed sensory hypersensitivities to noise and textures. Brushing his teeth and getting his haircut were exhausting battles. He started having temper tantrums. His mother took him to the doctor, but during his visit he played happily with the otoscope and sang songs, so the physician did not get to see anything unusual. The next couple of visits he had ear infections and strep throat, so he just clung to his mother like all children do when they are sick. So again,the pediatrician could not see anything of concern.

“He's just a boy,” or “He'll grow out of it” said Aiden's relatives. Aiden's parents tried him in the best preschool they could afford. Preschool was a nightmare for Aiden. He became so stressed he withdrew to the 'train corner' and screamed when anyone touched him. He was soon expelled for hitting other children who tried to touch 'his' trains. Mrs. Doe quit her job to stay home with Aiden. Mr. and Mrs. Doe were facing increasing behavior problems at home. Aiden began banging his head on the wall when they tried to stop him from playing with his trains or watching his favorite video. He would spend hours pacing and talking to himself. When he was upset, he rubbed the skin on his lips until it was raw. Mr. and Mrs. Doe could no longer go out to eat or to visit friends without fearing Aiden's meltdowns. Nobody would babysit for them. “How on earth is he going to be ready for Kindergarten next year?” they began to ask. “Are we just bad parents?” they worried.

A Different Outcome for Aiden
Now lets imagine that Dr. Jones the pediatrician gave Mrs. Doe the CSBS to complete before Aiden's 12 month visit. It would have taken Mrs. Doe about 5 minutes to complete the 24 item questionnaire. The CSBS could have picked up on early signs such as less eye contact, delayed communication skills (both language use and gestures), and unusual motor and social behaviors. All of us parents know that a well baby visit lasts about 15 minutes. This is barely enough time for the physician to conduct a physical exam, never mind learn much about the child's development (and lets face it, doctor's visits are hardly the time when your child presents his best self). Unless your child is demonstrating obvious differences during those precious 15 minutes, even a terrific physician can miss important signs of developmental delays.

In this new scenario, Dr. Jones would have had data to indicate that there was something unusual about Aiden's development. Dr. Jones could then have referred the Does to a psychologist, speech language pathologist, developmental pediatrician or the public school system's Infants and Toddler's Program. Any of these professionals could have given Aiden a thorough evaluation to determine if he had a significant developmental delay. Each of those professionals would have been able to create an individualized treatment plan just for Aiden. The Does' could have accessed the services they needed to help their son. Aiden could have spent the next four years learning the skills he would need to cope with the world. His parents could have learned how to manage his behavior and soothe him. When it was time for Kindergarten, the family would have had a team of professionals in the public school system (or private, as appropriate) who were designated to meet Aiden's needs so that he could make progress. Best of all, the Does could have escaped the misery of not knowing how to help their little one.

Data Collection: The New Standard of Care
Since 2007, the American Academy of Pediatrics has recommended that physicians screen for Autism and other developmental delays at 18 and 24 months. With this new tool, physicians can gather information that may identify up to 75% of children with developmental delays at 12 months. It is not the standard of care anymore for a pediatrician to simply 'eye-ball' a child and ask a few questions--particularly when there are such high quality, easy to use, screening tools. I encourage all of the parents who read this to ask your pediatrician to use objective screening devices. Children with disabilities need to be identified as early as possible! Again, the CSBS can be downloaded for free from this website:
http://www.brookespublishing.com/store/books/wetherby-csbsdp/checklist.htm. If your doctor does not already use it, you can bring it in yourself.

Spread the Word!
All of us who are parents need to advocate for our kids--we all know that. In this case, we need to encourage our pediatricians to start adding data collection measures into how they care for our children. If you are like me, you just adore your kid's pediatrician, but feel rushed at well-child visits. These sorts of measures can help make sure our kid's development gets as carefully evaluated as their physical health. So get out there and tell your sister, the play group moms, your colleagues and most of all, your pediatrician!

Psychological Testing for Accommodations: What Parents and Student Need to Know to get Ready for the SAT and other Standardized Tests

There is such confusion and stress about applying for accommodations during “high stakes” tests such as the SAT, ACT, GRE, LSAT, and MCAT. For some students, accommodations such as extended time or frequent breaks during testing gives them a better chance of showing their true potential. As a clinical psychologist, I frequently receive calls from parents or young adults asking what they need to do to arrange for accommodations when they take standardized tests. Unfortunately, most parents, students, and even some psychologists, are not familiar with the process. Common mistakes can jeopardize the student's chances of being granted accommodations. It is critical to do your research well in advance. This blog was written to help you plan ahead to document a disability and request accommodations.

Background: The Americans with Disabilities Act and the Right to Accommodations
The right to reasonable accommodations is granted to people who have disabilities that interfere with performing a major life task (such as learning, reading, speaking, working). The law that guides who gets accommodations under what circumstances is the Americans with Disabilities Act (ADA), Section 504. This section of the law protects individuals with disabilities from discrimination.

Students with disabilities may receive special education services during the K-12 years as delineated in a “504 Plan” of "Individualized Education Plan." A student with a documented disability has the right to reasonable accommodations under the ADA. The key word here is 'reasonable.' The word 'reasonable' does not mean that the testing situation has to be perfect, only that testing companies take reasonable steps to 'level the playing field' so that students with disabilities can compete with their peers. Accommodations may include special privileges to help minimize the impact of a person's disability. For example, a person with diabetes may take breaks to check blood sugar or eat. A person who can not write well with a pencil may dictate responses or use an alternative interface. A person with dyslexia may take his test untimed or with 50% extra time.

There have been recent changes to ADA that will make it easier to document a disability. The changes also broaden how many people may qualify for accommodations. Under the revised ADA, people may have accommodations even when their disability is managed with a “mitigating measure”. A “mitigating measure” refers to medication or other helpful device that the person uses to cope with his disability (hearing aid, dictation software etc). For example, a student with diabetes can still have accommodations, even though insulin regulates her blood sugar. It can also mean that a student with ADHD is still entitled to accommodations when taking their stimulant medication. The new changes in the law also protect people with disabilities that only create problems every now and then. For example, a person with epilepsy could be entitled to accommodations even if he is not actually have a seizure during the testing.

Finally, the law has been changed to recognize people's difficulties across a broader range of 'life activities.' These activities may include learning, self-care, writing, or working. The student's performance can now to be compared to that of their peers, not only the general population. This means that the student's need for accommodations can be compared to the other people in their same situation, such as other students applying to graduate school or other college students. All of these changes mean that more people with disabilities could be eligible for accommodations. Companies who produce and administer standardized tests must comply with the provisions of ADA.

How Do I Qualify for Accommodations?
Though the changes in the ADA law are good news for people with disabilities, it is very important to understand the process to avoid being denied. There is a natural tension between students and the publishers of standardized tests. Parents and students want to get the best scores possible. Testing companies want to make sure the scores they produce continue to be useful predictors of how a student will perform in the higher education setting. Testing companies naturally want to maintain standard procedures as much as possible. Standard procedures ensure fairness as well as the validity of the scores they produce. As a result, they carefully study all applications for accommodations. Its not that testing companies are 'bad guys' who want to deny students at all costs; they provide a service and must protect their ability to do so as well as they can.

Plan Ahead!
Make sure that the student has a DOCUMENTED record of receiving, using, and benefiting from accommodations in the educational setting well before the test. Any accommodations that the student will request from the testing service should already be a documented aspect of that student's educational program (e.g. 504 plan or IEP).

Avoid the Pitfall of 'No Documentation'
Many parents make the mistake of letting their high school students 'get by' with informal accommodations granted by helpful teachers. For example, Ms. Smith may let Jay turn in his work late, and finish tests during lunch because she knows he will do well if given more time. Some students beg their parents to let them avoid a 504 plan or IEP so they will not have to feel different from their peers. Of course, many parents give in and do things like spend hours helping with homework or hiring tutors to help the student along. This will hurt the student when she then applies for accommodations from a testing company, because there is no documentation of what the student had to do differently from her peers in order to succeed. Without a formal 504 plan, IEP, Disability Support Services record from a college, or private school education plan, there is no documented history of a need for accommodations. If the student has been successful without accommodations for all of his educational, why should the testing company believe that he suddenly needs them a month or two prior to a 'high stakes' test?

Schedule your Testing Well Before the Deadline
Parents and students also make the mistake of calling to schedule a psychological evaluation a few weeks before the test date. Waiting until the last minute can be a disaster. Companies like the Educational Testing Service review thousands of applications for disability accommodations. They specify on their websites how much time they need in advance to review each student's case. Do not miss their deadlines. Also consider that during peak times of year, particularly January through April, a psychologist may be booked out for months. After the testing, some psychologists and doctors may take at least four weeks or more to produce your report (though I am proud to say that here at Mindwell we get you a report two weeks after we collect all the data). Families must make their testing appointment months in advance of the application deadline to ensure having results on time. Remember too that you may end up going through an appeals process or having to get extra documentation if you are denied, so allow extra time for that as well.

Choose an Expert Psychologist
Parents and students also make the mistake of selecting the wrong person to do the testing. Some clinicians who do psychological testing are not familiar with the law or with the guidelines of the testing companies. As an active member of my state psychological association, I often see listserv questions come up between psychologists who are confused about how to test to document disabilities for high stakes testing. Additionally, not all professionals who conduct evaluations know much about the provisions of ADA and IDEA (the laws that protect students with disabilities). They may have excellent clinical skills, but little training in how to advocate for a student's rights in a letter or report. Last but not least, before you schedule your testing, make sure that the psychologist or educational diagnostician has the credentials the testing company requires.This information is on the testing services websites.

Aside from credentials, it is critical to ask if the evaluator has the experience, the very latest versions of all tests, and up-to-date training to make sure the testing is done properly. The last thing anyone wants is to pay for an expensive psychological evaluation only to learn that the evaluator was not well prepared to document a disability for 'high stakes testing.' Before calling the psychologist, parents and students must visit the websites of each testing company to learn exactly what to ask for in an evaluation. For example, each test publisher has specific requirements about what tests they accept as documentation and whether they require the student to take his medication as usual ( some testing companies require testing be done with the student taking his medication as he does on school day, even though doing so may make it harder for the psychologist to understand the nature of the student's impairments).

Don't Try to Fake It!
Finally, there are research data to indicate that quite a few students who request testing for accommodations exaggerate or even fake problems. So aside from giving a sermon about why this is wrong (if you can read this, you already know), its a mistake to try it. If a student tries to exaggerate a disability, he may end up skewing the results to look like he is of low intelligence or severely impaired. Not a great idea if the student plans to use the report to advocate for herself in college or graduate school! The student may also happen to be tested by a psychologist who uses tools designed to detect malingering or detect unusual response patterns. Remember, psychologists are behavior specialists, and will be very skeptical if a very smart, successful student comes in and earns unexpectedly low scores (most would probably refer that student for a serious neurological work-up to rule out a tumor or stroke). I certainly don't claim that we can't be fooled, but if a student corrupts the data of a psychological evaluation, then that very expensive document becomes pretty worthless.

To learn more about ADA and IDEA, please check these websites:
The National Dissemination Center for Children with Disabilities www.nichy.org
The Council for Exceptional Children www.cec.sped.org
and of course, check the website of the publisher of any standardized test you plan to take

I am greatful to JoAnn Simon Esq and Robert Mapou PhD, as well as Jim Hardcastle Esq for their excellent training in understanding the changes to ADA

Good luck on your tests!
Dr. Rebecca Resnik
Licensed Clinical Psychologist

But the Checklists Say It's ADHD

The first step in determining whether your child has attention problems is when you or the teachers notice high activity level, off-task behavior, difficulty sustaining attention or limited effort on low-interest tasks. The next step is often a discussion with the pediatrician or school personnel. At this point, parents are often given checklists which are meant to compare their children’s behavior to that of other children in their age range.

But what do these checklists really tell you? Are you willing to consider medication based on these alone? The answer depends on your child.

Difficulty with attention and executive functioning (which are the skills that help people organize and plan behavior and thinking) are caused by many different mental health and learning problems. Symptoms that seem like ADHD are common among children with autistic spectrum disorders, anxiety, depression or learning disorders. In addition, medical difficulties such as sleep apnea, narcolepsy and other disorders cause difficulty with attention.

Therefore, scoring high on a checklist may not tell you much about what is causing difficulty staying on task. A comprehensive evaluation of your child’s learning, attention and emotional functioning is preferable as it provides a roadmap for intervention and helps you rule-out other causes for the attention problems.

You should never accept a diagnosis based on checklists alone if your child has certain characteristics. Testing should be conducted for all children with a history of anxiety or mood problems. Emotional stress can reduce a child’s energy level, disrupt their sleep, and cause distracting negative thoughts. In addition, children who engage in repetitive behaviors, become excessively focus on certain topics, have difficulty reading social cues or experienced early language delays should participate in a thorough evaluation to determine whether the executive functioning difficulties are related to a Pervasive Developmental Disorder.

The evaluation is necessary not only to determine an accurate diagnosis but also to ensure that interventions are planned appropriately. Children with emotional issues or PDD can react differently to stimulant medication than children without those factors. In addition, behavioral plans and reminders may not be as effective as they are for children with ADHD alone because they fail to address the underlying cause of the difficulties.

The process of testing may seem daunting and time consuming, but the information you gain will help you feel confident in the diagnoses and avoid ineffective treatments.

Erika Madison Ph.D.
Licensed Clinical Psychologist
Mindwell Psychology

Kindergarten with Fewer Fears and Tears

Many children are eager to be Big Girls and Big Boys and eagerly head to
Kindergarten . However, others are uncertain of the big transition and their
ability to handle the changes. Children who tend to be sensitive, anxious or
rigid have a harder time with change and may need more support as the ease
into the idea of a new school, new teachers and new friends.

While many parents look forward to watching their children grow and learn in
a new school environment, others share their children's worries that
elementary school will be overwhelming for their children and their family.

A successful transition to Kindergarten requires that parents can convey a
sense of excitement and certainty to their children so they view the change
as an adventure. To do this parents must be honest with themselves about the
ambivalence that often accompanies their children's developmental advances.
We're thrilled to see the new things they can do, yet worried about what the
Big Bad World may show them and sad that they need us a little less each
day. Some parents are unsure of the school's ability to provide the support
and education their child needs. These little doubts can easily be reflected
to children in our tone as we speak to them or our actions as we prepare
them to start school. If children sense uncertainty in the adults - who they
believe can handle anything! - their own doubts grow. Conveying a sense that
you are confident in their ability to make new friends, learn well and
tolerate the change is imperative in boosting their spirits.

There are several ways you can increase their confidence and limit the
uncertainty of the experience. Attend the school orientation, play on the
playground if possible, visit a friend at the school for lunch, read
books/watch movies about new schools, discuss the New School Jitters to
normalize the feeling, visit the school website and discuss in as much
detail as possible the school day (i.e. check the menu if it is posted, look
for pictures of the gym or common areas). Most importantly, let your child
know that you will be supporting them during the transition and together you
can handle anything.

Mindwell is offering Kindergarten Readiness groups to help make the
transition an exciting adventure. Contact us if you are interested.
Erika Madison, Ph.D.