Speaking The Mind

Santa, The Tooth Fairy and Psychology

2012-01-25T21:08:00.002-05:00

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

2011-09-18T22:02:00.000-04:00

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

2011-05-18T12:04:00.001-04:00

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!

2011-05-18T11:11:00.002-04:00

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

2011-05-18T10:45:00.002-04:00

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

2011-05-17T16:09:00.002-04:00

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

2010-06-01T12:26:00.002-04:00

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.

How to Ensure You are Getting a GOOD Psychological Evaluation

2010-03-07T22:01:00.002-05:00

Many times people wonder why psychological testing requires such a commitment of time and financial resources. In order to ensure appropriate diagnosis and generate a useful treatment plan several steps are required. Many of these steps are minimized or skipped when clinicians are forced to work under the constraints of managed care. Though doing so saves money for the company and family initially, it often results in inadequate treatment. Thus, problems continue for longer and, eventually, more time and money are wasted on extended treatment. The family also experiences greater stress as the result of failed interventions. A thorough evaluation documents the diagnoses and provides a roadmap for treatment.

Here’s what to look for to ensure you are getting top quality care:
• Training: Licensed Clinical Psychologists are doctoral level mental health personnel who have studied the full range of normal human development (cognitive, personality, family functioning), the causes/symptoms/treatment of mental health disorders, and the biological bases of certain disorders. They have also completed their supervision years, passed national and state examinations, and have been granted a licensed by the state. Other psychologists who do testing have focused their training on educational testing or counseling.

• Tailored Battery: Ask whether the doctor gives a “standard” battery or changes the battery to meet each child’s needs. There is no point in having a child do tests that are not relevant to their particular difficulties. Testing should focus on defining their strengths and weaknesses, and the battery should be modified as needed to follow up on any issues that become apparent during the initial tests. Tests that often should be included are: IQ testing (provides an understanding of children’s ability, which helps us accurately interpret the other tests), achievement (if it’s a learning issue), and parent checklists (provide a quick way to screen for an array of learning and mental health problems).

• Standardized Tests: Although some very useful psychological tests are quite open-ended, requiring clinical experience to interpret, most tests used should provide a standardized score to allow meaningful comparison to other children. Test developers use large norm samples to determine how most people perform on a test, allowing us to understand how common or unusual the child’s ability or symptom level is.

• Clinical interview, Collateral Data and Multiple Tests: In order to obtain a full sample of the child’s functioning, the psychologist should interview the family, gather background history, and collect observations from an outside source (teachers, daycare providers) by phone interview or checklist data. Conclusions should not be drawn based on one test or by a brief observation in the office.

• Access to a Wide Range of Tests: In order to ensure that all aspects of the referral question (i.e. reason for coming in) are covered, the clinician should be capable of administering a wide range of tests and have those tests available to give. If the evaluation is a re-test, many previous tests cannot be given within a one year period. Therefore alternate ways of measuring those traits must be available. Also, some children have difficulty with certain types of tests, so it is helpful to have other options available.

• Time Commitment: A thorough evaluation typically requires several hours of face-to-face contact. Clinicians then spend many hours reviewing data, scoring the tests, interpreting the tests and integrating the tests into a report. The work that the family observes is often the ‘tip of the iceberg.’ The cost of the evaluation takes into account these hours as well as the face to face time.

• A Report and Feedback Session: The results of the evaluation should be provided in a report so that you can refer to it later, share it with the school, pediatrician or other professionals, and have a documented diagnosis. The psychologist should meet with you to discuss the results and allow you to ask questions. The face to face feedback session is crucial to your understanding of the testing and your child. Because many insurance companies will not cover it, some psychologists do not arrange for the meeting. Discuss ahead of time whether or not they do a feedback session and seek a professional who will.

• Recommendations and Referrals: The main goal of any evaluation is to provide a clear plan of how to help your child be successful. The evaluation should provide treatment recommendations, which may include therapeutic recommendations, educational modifications, or suggestions to seek other services (i.e. occupational therapy, speech therapy). The psychologist should also be able to refer you to professionals that can conduct these services or recommend ways to locate them.

Erika Madison, PhD
Licensed Clinical Psychologist
MindWell Psychology

Trusting Your Gut

2010-02-02T19:30:00.003-05:00

I was interviewed for an article in the Northern Virginia Parent Magazine. Here is an excerpt:

Just Not the Right Fit
One warning sign that a child’s care situation is not working out is when his or her teacher is constantly frustrated and exasperated, and only has negative things to report, says Rachna Varia, co-founder of MindWell Psychology, a practice of child psychologists located in Chantilly. Preschool teachers should be able to balance out their reports with at least one positive thing to say about a student, she adds.

For infants and toddlers, who are at an age when they can’t yet express their feelings, Varia says parents will be warned in several ways if their child’s center is not working out. “Young children often cannot be consoled, they show regressed behavior, or there is a dramatic change in their sleep routine,” says Varia.

In order to prepare infants and toddlers for entering preschool, Varia suggests parents read back-to-school books like “The Kissing Hand” by Audrey Penn, or “DJ Goes to Preschool” from the Arthur series by Marc Brown. Varia also says parents should “prepare children through play dates or by leaving them with a babysitter so they know the parents will come back.” She suggests parents tell their young children about a special event they plan to do with them after their first big day at school.

When it is taking a month or more for a child of any age to adapt to their new preschool—meaning they go to school crying or are still upset at the end of the day—the facility may not be a good fit, Varia says.

When a child doesn’t adapt to one particular program, it doesn’t mean they’ll never adapt to another, says Varia. “Montessori school might be better for more independent kids, while other children need more group structure. Some children might do better going to preschool three hours a day, three days a week, rather than a full-time program.”

For more information and the complete article, go to www.northervirginiamag.com/dacares-trusting-their-gut/

Rachna Varia, PhD

Two Offices - One Philosophy

2010-01-24T16:23:00.002-05:00

The MindWell Bethesda office is now up and running! We are excited to have this new office because it provides excellent and convenient services for our Bethesda and surrounding area clients. Being from NoVa, I had no idea how difficult parking can be! The Bethesda office is conveniently located in a family friendly office park off Old Georgetown Road with free above ground parking. Of course, beyond the convenience is the speciality of child and adolescent services we provide.

Dr. Sanchez is one of the few psychologists who will come to your residence to provide home-based services. This is particularly useful to help with behavioral modification in REAL LIFE and not just in the office setting. Dr. Baumgartner has a speciality in working with adolescents and her rapport-building is incredible. Of course, Dr. Resnik continues her superb work with developmental, educational, and emotional assessments. Please contact us! - Rachna Varia, PhD

Neuropsychological Evaluation vs. School Evaluation

2009-10-14T19:06:00.001-04:00

The primary job of a child is to “learn.” When a child fails to acquire academic skills, this failure may mean the presence of subtle brain dysfunction of a developmental nature. Additionally, a child who has medically-complex conditions (e.g., epilepsy, traumatic brain injury) is at risk for experiencing learning disorders. The goal of a neuropsychological evaluation is to identify brain-related dysfunction so that academic and behavioral interventions can be implemented in order to maximize a child’s benefit from school.

School-based evaluations are typically limited in scope, focusing only on academic skills, due to organizational constraints. Additionally, school psychologists do not generally give diagnoses because their role is to determine educational needs. For some children with learning problems, the typical school-based evaluation is sufficient to identify learning problems and make appropriate treatment recommendations. However, some children do not benefit significantly from common educational strategies. In these instances, a more detailed neuropsychological evaluation is warranted to help better understand the child’s learning disorder. Additionally, if a child’s learning problem is the consequence of a documented neurological disease or condition, then teachers need to know how to modify and adapt the child’s instructional program with special educational strategies and methods. Neuropsychological assessments offer extensive, comprehensive analysis of brain functioning which can provide useful information to determine a child’s cognitive strengths and weaknesses, provide diagnoses, and develop appropriate treatment/ intervention plans.

Jillian C. Schneider, Ph.D.
Licensed Pediatric Neuropsychologist

Recognizing Concussions

2009-10-14T18:59:00.001-04:00

According to recent estimates by the Center for Disease Control, up to 3.8 million children and adults sustain concussions each year. Even more alarming is that evidence suggests that this figure may be an underestimate as a large number of concussions in youth go unrecognized.

A concussion is a brain injury that results from a bump, blow, or jolt to the head or body that causes the brain to move rapidly inside the skull. Injuries to the developing brain of the student-athlete can have serious and long-term health effects, and even seemingly minor “dings” to the head need to be taken seriously.

What are the symptoms of concussion? If an athlete has a concussion, parents, coaches and teammates may observe the following:
-appears dazed or stunned
-confused about assignments/plays
-forgets plays
-moves in a clumsy way
-is unsure of score, opponent, play
-shows behavior or personality change
-can’t recall events or plays
-loss of consciousness
-answers questions slowly
-repeats questions

The individual himself/herself may also experience the following:
-headache
-visual problems
-balance problems
-sensitivity to noise and/or light
-fatigue
-nausea or vomiting
-dizziness
-moving and/or thinking slowly
-irritability
-sadness
-anxiety
-sleeping more than usual
-trouble falling asleep
-problems remembering things
-trouble concentrating
-feeling mentally “foggy”

It is important to remember that concussions can:
-occur in any sport;
-occur, even if the individual does not lose consciousness;
-result in symptoms that emerge during the days following the injury;
-cause brain swelling, permanent brain damage, or even death, if an athlete has a second concussion before recovering from a first one.

What should you do if you suspect than an individual has sustained a concussion?
1. Seek medical attention immediately. It is important to contact your child’s pediatrician, and in some cases a neurologist specializing in concussion. Neuropsychological testing is also essential to concussion management, as a way of measuring changes in important cognitive abilities during recovery.
2. Rest is key. Individuals with concussion should not return to any high risk activities (e.g., sports, physical education, high-speed activities) while they are experiencing any of the symptoms listed above. It is also important to manage the amount of cognitive activity during recovery. Too much activity can make worsen symptoms.
3. Inform coaches and teachers about any recent concussions. It is important to monitor individuals with concussion for any of the symptoms listed above, especially in the context of increased physical and cognitive exertion.

How can I prevent concussions from occurring? Unfortunately, concussions are an inherent risk in any physical activity. Nevertheless, wearing the correct protective equipment for the sport or activity (e.g., helmets) and ensuring that the equipment is properly fitted and maintained, and worn correctly and consistently; following rules and safety guidelines for sports activities; and, maintaining good sportsmanship in athletic activities, can reduce the risk of injury.

The Centers for Disease Control and Prevention has additional information for athletes, parents and coaches on concussion. Please visit them at:
http://www.cdc.gov/ConcussionInYouthSports/ or
http://www.cdc.gov/TraumaticBrainInjury/coachestoolkit.html

Dr. Schneider has expertise in working with children and adolescents with concussions. She completes brief neuropsychological testing to monitor recovery from injury. Please contact Dr. Schneider should you have any questions.

Jillian C. Schneider, Ph.D.
Licensed Pediatric Neuropsychologist

Back to School Crush

2009-10-08T12:54:00.003-04:00

Recently, I recalled a conversation with my sister when I learned she was travelling 2 hours every weekend for travel soccer. "I will never do that, I'm not joining that club", I said smuggly. "Yes you will", she warned. I watched my friends with school age kids running from one activity to the next, often exhausted, late and irritable.

My sister was right, on September 8th I joined the club. It all started at my daughter's back to school night, which was like a carnival. There were balloons, colorful poster presentations and candy. I was so eager to explore my choices. First Grade was a whole new world -- Daisy's, Chess, Dance...was I hyperventilating?

The following evening my husband and I sat at the kitchen table with my daughter. My husband had a strong opinion about the Northern Virginia Activity Machine. "We need to choose one activity. We can't do everything", I told her, and my husband nodded. But she wanted to do everything. How could I say no to my 6 year-old doe eyed daughter? She wanted to be a Daisy, she wanted to learn to play chess. My husband warned of mommy burnout but gave us his vote.

A week later the madness ensued with an activty everyday. Suddenly, I was the activity maven...I was also exhausted, irritable and always late. We were not engaging as a family, instead we were fried. Something had to change. Then it hit me.....special play time. This is a play therapy technique that I recommend to parents when there is a behavior problem with a child or the family is not engaging. It is actually easy to do. Carve out 15 to 20 minutes to play with your child one-on-one everyday. They choose the activity and they can't lose the time as a punishment.

The theory here is simple:
It is a time to build attachment, positive interaction and playfulness into your relationship.

The following week we began and quickly everything seemed to magically shift.
As a result of beginning this new ritual, our actvites have taken on a new kind of playfulness. There is less stress in traffic to and from activities. Instead of watching swimming, I am in the water. If we eat at 8 PM, I remind myself of how happy Italian kids are who eat later in the evening. I am on a mission to be sure my family is happy and connected. I want to remind every family out there that you can do both. If you have and use 15 minutes everyday to spend together, it will change the entire mood in your house.

A funny thing happened yesterday - my daughter said that she was tired of chess and didn't want to be in the club anymore..................my husband, a chess lover said, "honey, are you sure?".....ha!

Kristi Guadagnoli, PsyD
Licensed Clinical Psychologist
Director, Therapy Services
MindWell Psychology

Your Child’s IQ Score: How to Prepare for Your Child’s Intelligence Test

2009-09-22T14:27:00.002-04:00

Your Child’s IQ Score: How to Prepare for Your Child’s Intelligence Test

There are many reasons parents seek an evaluation of their child’s intellectual functioning, which we commonly call ‘IQ’ testing. Aside from an evaluation to diagnose learning problems, parents seek IQ testing for school admission or entry into a ‘gifted and talented’ program. No matter what the reason, having an IQ test done can be anxiety provoking for both parent and child. It is easy to lose perspective on what the IQ test actually does, and what the scores actually mean.

Across the world, people have broad interpretations of what it means to be intelligent. Many people interpret having a higher IQ with all sorts of positive outcomes, such as high achievement in school, prestigious careers, or upward mobility in society. Psychologists use IQ tests as tools to measure an abstract concept known as ‘G’, which may be broadly defined as the ability to solve problems. IQ tests typically assess abilities including: abstract reasoning, language functioning, processing speed, visual-spatial reasoning and a person’s knowledge base. How well a child does on various types of tasks shows a pattern of strengths and weaknesses that can be extremely useful in helping him succeed. It is important to note that an IQ test does not measure qualities such as talent, determination, or creativity. These latter characteristics tend to be every bit as important in determining a person’s quality of life as his intelligence. Keep in mind that getting a number score from an IQ test does not change who he is or what he can do well.

There has been a recent surge in companies who sell IQ test ‘preparation’ to anxious parents. People sell materials taken from IQ tests, or sell ‘tutoring’ that they promise will raise children’s scores. These individuals exploit parent’s natural desire to do what is best for their children. What many parents do not know is that individuals are providing and illegal and unethical services. They are teaching children to cheat. IQ tests are kept highly confidential because they are critical tools in making diagnoses. Psychologists and Neuropsychologists need them to make important diagnoses such as learning disabilities, traumatic brain injury, or to measure the impact of degenerative illnesses. That is why all IQ tests are copyrighted, making it illegal to expose the content. Licensed psychologists are bound by an ethical code, as well as copyright laws, to protect the content of the tests. A psychologist who offers to ‘help’ your child score higher or share test materials should be reported to the state licensing board. Anyone who would act unethically or illegally is not someone you want interacting with your child. Unfortunately, there are unlicensed people who have access to IQ tests, so it is important to check credentials. Aside from the fact that people who expose test content are acting illegally, the services they provide are not likely to raise scores as their advertisements claim.

It may seem strange that IQ preparation would not be a good thing, since we encourage our children to study for tests all the time. IQ tests are different from tests that measure how well a person has mastered a content area or specific skill. They are designed to present people with unfamiliar types of problems to see how well they adapt. Consequently, even if a child has been exposed to the test materials or taught to practice similar types of problems, there is usually not a significant increase in the child’s scores. Even if a test preparations program did raise the scores a bit, the resulting IQ test data would be contaminated and useless.

Some parents may feel it is worth 'bending the rules' to get a child into a special school or program. They may believe that this will give their child the best opportunity. However, there are negative consequences of inflating a child’s scores. Placing a child in an academic program that is not a good match for him is not kindness. It makes no more sense than putting him in a super competitive soccer team if he did not have the ability to make the team on his own. If there is not a good match between the child and the program, the child is likely to be overwhelmed, and to feel bad about himself because he can to keep up with his friends.

So how should you help your child get ready for an IQ test? You should start during infancy by talking to him and playing with him. As he grows, consider each day a chance to learn something new. The sorts of activities that will truly prepare a child for IQ testing include: puzzles, reading, building blocks, solving riddles, going to museums, and enrichment classes (anything from art and computer classes to music lessons). Most products that promise to improve your child’s IQ are only entertainment. This includes baby videos that promise to make your little one smarter, ‘learning’ toys, television programs, and computer software. Research has shown that these are no substitute for the kinds of real-life activities that will foster your child’s problem solving abilities.

Finally, when you are ready to schedule the testing, prepare your child by lowering his stress level. Find a licensed psychologist who has a good reputation for ethical practice. Find someone who specializes in children, who can help your child feel comfortable during testing. Have the child tested on a weekday morning, when he is at his most alert. Do not be tempted to make an appointment in the afternoon, evening, or on the weekend. These are times when your child has less energy. Avoid offering your child a reward or prize for earning a certain score. If a child is worrying about not getting a prize or disappointing you, he can not concentrate on the test. A good night sleep and a healthy breakfast have a big impact on test performance. Finally, relax. If you are worried about the test, you will only make your child nervous. Praise his effort (IQ tests are tiring!) and take him out to lunch afterward for a job well done.

Red Flags for a Reading Disorder

2009-08-27T17:14:00.001-04:00

Unhappy at School

2009-08-19T22:45:00.004-04:00

Every fall, parents all across the country drop their children off at a new school. If you were like me, the drop off was a time of great excitement, lots of anxiety, and a few tears. As parents, we have so many bright dreams for our child’s school experience. Unfortunately, the happy dream sometimes dissolves quickly in the face of emerging problems. It can be heartbreaking to watch your child experiencing mounting frustration, anxiety, social difficulties, or behavior problems at school. The stress of a poor match can have long-term consequences for the child’s mental heath and academic success. As a psychologist, I receive many calls from parents who are struggling to understand why their child is unhappy and unsuccessful at school. In the worst case scenario, parents call because their child is about to be expelled. Many parents are shocked to learn that even a pre-schooler could be expelled, however, this is actually quite common, and happens most to boys.

While some parents discover problems abruptly, more go through periods of increasing uneasiness about their child’s adjustment. Children give us clues about how well they are tolerating school. Younger children tell us they are unhappy at school through their behavior. Parents of young children may observe excessive crying, withdrawal, or trouble eating and toileting at school. Teachers may report aggressive behaviors such as biting or hitting other children. Children of all ages may show their unhappiness in their bodies. They may complain of stomach pain, headache, or have trouble sleeping on school nights. Frequent visits to the school nurse can also be a ‘red flag’.

Older children are sometimes able to tell us when something is wrong. Typically, children say vague things such as “Its boring,” “The teachers are mean,” or “Its stupid.” Though older children can voice their opinions, it still requires detective work to determine why they are unhappy. For example, parents can not assume that just because a child says the school is boring that the work is too easy. Vague comments often mean that the situation is too complex for the child to make sense of himself, and should cue parents that its time to seek help.
One major source of potential ‘match problems’ is related to the child’s unique needs. Unhappiness at school is often a ‘red-flag’ for an emerging disability. The first signs of a learning disability, speech language delay, or Attention Deficit Disorder are often behavior problems or school refusal. Parents may recognize years later that the telltale signs emerged a few months after the child began formal schooling. Many parents are told to wait until the child ‘grows out of it’ or to hold their child back a year. Both of which can be very bad advice that squander valuable time to intervene.

Boys with learning problems or delays are often identified earlier because they tend to act-out when frustrated. Girls with disabilities may be overlooked for years because their behavior is less likely to be disruptive. While some private schools are ready and willing to make accommodations, many parents are dismayed to find their school does not offer any assistance to children with disabilities. It can be quite hurtful to learn that your child has to leave his school because of learning differences. Though public schools are mandated by law to provide an appropriate education to all children, this does not guarantee a good match. In our area we are fortunate to have many private schools with special needs programs or learning support centers within the school. If you suspect that your child has learning problems, it is wise to consult a psychologist to determine if your child has a disability. Finding out sooner rather than later can save years of expensive trial-and-error approaches to solving the problem. Parents who wait until the situation becomes a crisis are more likely to spend significant amounts of money on things that do not work. Getting an assessment takes the guessingwork out of helping your child.

Another source of mis-match could be the school culture. In this category are characteristics of a school such as level of structure, competitiveness, and style of instruction (Montessori, Waldorf etc.). The key to a good child-school match is understanding your child’s temperament and the school culture. An independent learner may enjoy Montessori, while a child who relishes working in groups may prefer a more traditional classroom. Another example is how much emphasis is placed on seatwork. If your little one is full of energy and must able to move his body, then a school that emphasizes long periods of seatwork would be a recipe for disaster.

There are schools that are nurturing, and schools that have more of a ‘sink or swim’ mentality. Some schools are competitive environments, where children have to fight for positions in the band or athletic teams. If your child becomes anxious about competing or just likes to do things for fun, then clearly this would not be a good match. A psychological assessment can help you determine if your child is experiencing an unhealthy level of anxiety at school.

You may also find that the social environment is wrong for your child. Some schools do an excellent job of promoting peer acceptance and positive interactions; others do not. A socially nurturing school is ideal for a more sensitive child who may be vulnerable to bullying. It can be worth changing schools to escape peer harassment. Bullying or social rejection places a child at higher risk for depression and even suicide, so it is not to be taken lightly. If your child is bullied or ostracized at school, he should be seen by a psychologist. If you are not sure about the match between the child’s temperament and school culture, ask the director to refer you to a psychologist who is familiar with the school’s culture.

Another source of ‘match problems’ is related to school expectations—how challenging is this school? As parents, we all hope our children will be eligible for accelerated schools or ‘gifted and talented’ programs. Gifted children may be bored and frustrated without sufficient challenge. For some children, acceleration and enrichment are the catalyst for excellence. However, there are many talented, intelligent children who do not thrive in accelerated settings. Not all children are happy under pressure to meet academic milestones ahead of schedule. Some schools push children towards activities that are not developmentally appropriate, such as forgoing play time for seatwork in early childhood. When evaluating an accelerated program, consider – does the program focus on what will excite your child and foster a love of learning, or does it focus on what looks prestigious to adults? Many children prefer to work at their own pace, or to select activities that capture their passions. These children may love a magnet program or Montessori school. If you are unsure that your child is suitably challenged, talk to the child’s teacher. If the teacher has doubts about the ‘goodness of fit,’ you may want to consult with an psychologist, independent school consultant, or individualized tutoring company.

Finally, if you are unsure that the school is a good match, get help. Ask to meet with the teacher and director. Be ready to listen as objectively as you can, because you may hear unwelcome news (I always recommend that both fathers and mothers attend these meetings whenever possible). Hearing that your child should leave his school can be a blessing in disguise. While it is tempting to assume that the problem lies with the school, be prepared to consider that your child may have different needs than most of his peers. If the plan you make with school staff does not lead to improvement in a couple of weeks, seek professional help from an outside source. Psychologists can draw up behavior plans that can make the difference for your child’s success in the classroom. Psychologists can also provide direct support to teachers unfamiliar with the child’s disability. If a child is not happy at school, the worst thing a parent can do is nothing.

Adult ADHD: A Common Source of Treatable Problems

2009-07-20T11:43:00.000-04:00

Attention Deficit Hyperactivity Disorder has generally been considered largely a disability of childhood, one that many people expect to resolve as they grow to adulthood. Most of us think of ADHD as primarily a child’s problem that interferes with progress at school. We often picture hyperactive little boys with behavior problems. However, when an adult has trouble doing all the things he or she needs to get done at home, work, and in educational settings, doctors do not always consider that the culprit could be ADHD. Recent research suggests that as many as 5% of adults have ADHD. That could mean that 5 out of every hundred adults are struggling with underachievement and frustration due to a very treatable disorder. This is a significant number of people, particularly when you consider that ADHD runs in families. This rate would mean that ADHD among the most common mental health disorders in adults. The research suggests that more adults have ADHD than have schizophrenia, bipolar disorder, and many other well known mental health problems (though depression still remains more common).

As Dr. Larry Silver so eloquently described it, ADHD is not just a learning disability; it is a ‘life disability.’ The problems associated with ADHD do not just occur in the classroom or during childhood. In a recent online panel discussion lead by Dr. David Goodman, researchers emphasized that the same symptoms we recognize in childhood ADHD also occur in adults. These same childhood symptoms take on different forms in adults. For example, most adults with ADHD are not floridly hyperactive. Instead, an adult is more likely to report ‘inner restlessness’ or problems with impulsivity. Symptoms of ADHD impact important adult tasks such as remembering to pay the mortgage, paying attention while driving, or managing your children’s schedules. Studies have shown that people with ADHD have higher rates of underachievement, car accidents, career setbacks, and substance use. Adults with ADHD have significant problems functioning in their daily lives. These problems can ‘snowball’ as individuals take on increasing responsibility throughout adulthood, such as raising a family or being promoted at work.

Dr. Russell Barkley has written about the ‘core deficits’ of ADHD. The deficits most likely to be seen in adults include: problems with working memory, impulsivity, distractibility, trouble persisting through challenges, and trouble organization and planning. While these deficits may not sound serious on paper, they are a very big deal to those with the disability and their families. Because ADHD can be successfully treated, it is important to obtain an accurate diagnosis.

The adults I have seen who have ADHD report frustration with their lives. They often describe the sense that they are capable of doing more, but can not do what needs to be done to achieve their goals. Many adults with ADHD, particularly women, have other mental health problems related to their ADHD symptoms. As is the case with children who have ADHD, adults with ADHD are at higher risk for anxiety or depression. Because ADHD runs in families, coping with a child who has ADHD may be particularly difficult for a parent with the same disability. The relatively high rates of anxiety and depression are not surprising when you consider the unpleasant consequences of living with the symptoms of ADHD. Dr. Russell Barkley has reported on findings that adults with ADHD have higher rates of car accidents and driving violations than the general population. College students with ADHD are less likely to meet their educational goals, and more likely to underperform in the workforce. The impulsivity associated with ADHD can lead to unwise choices about sexual behavior, relationships, spending, or risk taking.

It is also common for individuals to be diagnosed later in life than we used to expect. Many people do not seek assessment or treatment until they are adults, when problems have become intolerable. Just because symptoms of ADHD could be kept at bay for years does not mean that the disorder is not present. Many bright individuals develop ways of compensating for their disabilities. I have tested adults and older adolescents who managed to hide their disability by never having to study, or charming their teachers or bosses into giving them leeway. Adults with ADHD typically find jobs that allow them to keep active, such as being a paramedic or artist. They may also seek out environments that are very supportive, or rely on loved ones to manage the organizational details of life (like filing the taxes on time). The key is that the symptoms of ADHD were always there, even if it took until adulthood for those symptoms to have a serious impact on a person’s success and happiness. If a person has a longstanding pattern of symptoms associated with ADHD, it is an excellent idea to seek assessment.

At this time, ADHD is diagnosed by assessing symptoms. Psychologists and neuropsychologists use tests to formally measure a person’s ability to pay attention, sustain focus, work efficiently, and be strategic. It is important for the diagnosing clinician, be it a psychologist, psychiatrist, or general practitioner, to gather data as part of the assessment. Symptoms of ADHD can also be caused by other mental health disorders, such as depression or anxiety, or even medical conditions. Many problems can superficially resemble ADHD. The doctor should be careful to consider other mental health disorders as well as ADHD, given the high frequency of ADHD occurring with other mental health problems such as anxiety.

The good news about adult ADHD is that it is a disorder that typically responds well to treatment. A ‘multi-modal’ approach is often recommended, meaning that treatment includes both medication and psychotherapy combined. Stimulant medications or alternatives (e.g. Atomoxetine is a non-stimulant medication used to manage symptoms of ADHD) are considered among the safest of psychotropic medications. Side effects are common, yet a skilled prescriber can adjust the dose, choice of medication or how the medication is released to maximize patient comfort. In addition to medication, psychotherapy is invaluable in helping people overcome the problems that ADHD has caused in their lives. Psychotherapy can assist adults with ADHD in developing better habits, managing their mood, and improving important relationships. Obtaining an accurate diagnosis is an important first step towards improving quality of life for both the adult with ADHD and the people count on him or her.

Rebecca Resnik, PsyD
Licensed Clinical Psychologist
MindWell Psychology

To learn more:
ADHD in Adults: What the Science Says by Dr. Russell Barkley, also see www.russellbarkley.com
Children and Adults with Attention Deficit Hyperactivity Disorder www.chadd.org

Dr. Larry Silver’s Advice to Parents on ADHD by Dr. Larry Silver

June 2009, Medscape CME, Psychiatry and Mental Health, Dr. David Goodman, Dr. Anthony Rostan, Dr. Richard Weisler discuss: Adult ADHD and the DSMV, www.medscape.com

The Dreaded Power Struggles!

2008-06-20T17:06:00.000-04:00

I do not know of any parent who does not dread power struggles. This is one of the most popular things that brings families into therapy. There is nothing like a battle with your own child to cause intense frustration and self-doubt. Not to mention that our kids seem particularly adept at picking times when we are late for work or when your mother in-law is there to see the whole thing.

The only power struggles you truly win are those that you avoid. Once a child has engaged you in a negotiating, arguing, or tantruming battle, everybody loses. From the toddler who throws himself down and screams to the teen who becomes a prosecuting attorney, your best bet is to avoid ever being drawn into battling like an equal. It is very strange to think about it, but power struggles keep undesirable behavior going. Its not that they are pleasant for children, but during a 'battle' with you, your child is actually getting something he wants. When he can engage you, the child gets your full attention, ‘blows off steam’, and sometimes gets you to give in. Even if you are only loosing the occasional power struggle, that rare reinforcement of the unwanted behavior is enough to make it worse over time. Once your child learns that every now and then you will give in, it is just like he’s playing the slots in Vegas. He will keep going with more and more determination until the next big ‘pay off’ comes. Then the pattern becomes very difficult to break.

So the real answer is to keep power struggles from happening as much as humanly possible. First off, you can be proactive. Watch out for situations that make a power struggle more likely. The big triggers include: video games, low blood sugar, fatigue, an anxiety provoking situation, having to share, going to/staying in bed, not enough opportunity to burn off energy, and transitioning from a preferred activity (watching TV) to an unwelcome activity (going to school). We parents can anticipate most of these things coming and plan our strategy in advance by setting up expectations. Give lots of warnings and let the child know explicitly what to expect (“In 2 minutes, it will be time to turn off the TV and put on your coat”). If you are going to a trouble zone like a grocery store candy aisle, tell the child in advance what you will and will not be buying. Set a timer to tell your child when it is time to stop playing computer games. If you are going out, let the child know what behavior you expect to see, and what behaviors will lead to having to leave. Once you set an expectation, make sure to stick to it!

The other two big ways to avoid the power struggle is giving choices and just plain empathizing. I am borrowing here from a terrific book called How to Talk so Kids will Listen and Listen so Kids will Talk, which I can not recommend enough. Your kids will be less likely to battle with you if you give them two things everyone wants, including choices and the feeling that you understand their perspective. While the ‘forced choice’ does not work every time, it can stave off many battles. Give kids lots of little choices whenever you have wiggle room. Choices are great for their sense of independence and for helping them learn to take responsibility for their own decisions. You can offer choices related to when the child will do something (now or in 5 minutes), how it will be done, and what the child would like (which cereal, which shirt, which homework assignment first etc.)

If you can not give your child a choice, such as when its time to leave for school, let him know that you understand how he feels about it. We all feel so much better about unpleasant things when we feel that the important people in our lives care what we are thinking. This is NOT the same thing as giving in to our child’s demands! Empathizing is about helping your child tolerate the frustrations we all face in our day to day lives, not trying to make the frustration go away. We all have to do things like get shots and wait our turn, and kids need to learn to cope. However, we can help kids feel better with such simple statements like: “You wish you could play that game all day instead of going to Grandma’s”, “You’re really disappointed about not being able to have more cake” or “Having to leave your teddy bear feels sad, you miss him when you’re at school.” By empathizing with our children and giving voice to their feelings, we can help them feel that we are on their side, and that we care about their experiences. For an older child or teen, tell them to write you a letter/email describing their grievances. A little empathy goes a long way towards making them feel willing to go along with our directions.

Finally, the important thing in managing power struggles is to diffuse them if you can not prevent them. Keep in mind, it is always better to be proactive in managing behavior than reactive. When you have to be reactive, start by labeling the feeling (“You look frustrated” “I can see you are getting annoyed about this” or “This makes you very grumpy.”), and then state your expectation firmly (“And now we are going to have to leave for school” or “But I expect you touch the dog gently” or “Use words, not fists!”). If the child starts to calm down, you can offer a forced choice at this point (“Now, do you want to wear your coat or your jacket to school?”). If the child escalates with negotiating or a tantrum, it is time to get very firm and direct about what you are going to do (“If you do not choose, I will choose” or “We can discuss it later, right now it is time for school”, “If you need to calm down, I expect you to sit on the steps for two minutes.”). You’re your statements short. Then once you have told the child what you expect, it is time to ignore him until he complies. Some children will become very provocative trying to re-engage you, but ignore all behavior except something that puts your child or someone else in danger. Once the child complies or gets close enough towards acceptable behavior, praise and give attention again.

Across the board, your goal is to give lots of attention, descriptive praise, and affection for desirable behavior, and as little as possible for unwanted behavior. In most families, we tend to pay little attention to the kids when they are doing what we want, and give then our undivided attention when they are being inappropriate. A power struggle is our children’s way of trying to get control over us, so keep in mind that once we are engaged in battling like equals, they have already won. Lastly, it is important to remember that our children do NOT really want to win power struggles. A child who wins power struggles is not a happy child, instead he becomes anxious, angry, and contemptuous (Remember Veruca Salt from Charlie and the Chocolate Factory?). What truly makes a child feel happy and calm is when he knows that his parents are in-control, protecting him even from his own worst impulses.

Dr. Rebecca Resnik
Licensed Clinical Psychologist
Mindworks Clinical Psychology

Developmental Assessments: Testing for children Five and Under

2008-04-08T14:01:00.000-04:00

A psychologist conducts a developmental assessment to evaluate your child’s progress in meeting important milestones of early childhood. Important ‘milestones’ occur in the areas of language, visual motor integration, self-regulation, motor skills, and emotional development. While every child is unique, and develops on his or her own timeline, sometimes there is cause for concern. The American Academy of Pediatrics recently recommended that pediatricians conduct more formal screenings of early childhood development. This is easier said than done. Most pediatricians have to compress their exploration of your little one’s progress into a 15 minute appointment, while also conducting a physical and giving shots, all while the child is crying or running around the room. Its more difficult for pediatricians in a practice where the child sees a different physician every time. Pediatricians refer patients to other professionals such as psychologists, developmental pediatricians, and speech-language pathologists when they suspect that something about the child’s development is either delayed or atypical.

When I use the words ‘delayed’ and ‘atypical’ to describe early childhood development, I mean that some children develop skills more slowly than others (a developmental delay), while other children’s development does not follow the expected course. Atypical development (also misleadingly referred to as a ‘developmental delay’) may mean that a child has an autistic spectrum disorder, suffers the effects of living in an orphanage, or has a genetic difference. For example, children with autistic spectrum disorders may acquire and then ‘lose’ some ability to communicate, while a child with a speech-language delay reaches the typical language milestones (one word, two words, phrases, sentences), just later than his peers.

Parents often want to know what I do during an early childhood evaluation. My job is to study several areas of development, including: social relatedness, intellectual functioning, receptive and expressive language, attention, memory, information processing, adaptive functioning, visual motor integration, behavior (especially play), and sometimes I look at how well they are mastering pre-academic goals like learning their numbers and letters. The trick is to do all of this with the most reliable, child friendly assessment tools I have in the brief time window when I can access the child’s best performance. I have to be ready to be anything from Mr. Rogers to a circus clown to help the child feel comfortable. After data collection, I want to consult with as many of the child’s teachers, doctors and related service providers as I can to get the full picture and to help me interpret what I have observed.

Sometimes when a pediatrician refers a child, the nervous parent will ask me if all this is really necessary, if perhaps their child will just ‘grow out of it’. I am a parent too, and I understand that fear that something is wrong with your child, and how much you hope it will just go away. When a parent calls, here are the ‘red flags’ I am listening for: the child’s expressive or receptive language are well behind schedule, the child is having trouble relating to other people, the child is having temper tantrums that are causing problems at home/school/daycare, the child is having trouble learning at school, the child is exhibiting behaviors that are unusual or severe as compared to same aged peers. Testing gives us answers that we need to address our concerns effectively and with compassion. Testing helps answer what I call the “can’t versus ‘won’t” question. The test data help us make a plan to develop what the child can’t do and guide him toward what he won’t do. The last thing you ever want to do is punish a child for something that is beyond his control.

Sometimes people ask me if I do in-home testing. I strongly prefer to see a child in my office. Generally, home is a very accommodating environment. The child knows all the routines, where everything is, and what every object is called. However, life is not about staying home and functioning in that soft nest of familiarity, it is about transitioning to school, the playground and developing relationships with people outside of your family. I need to see how your child copes with being in a room with a new person, strange toys and unfamiliar tasks. I also need to be more objective than a parent or grandparent, and that includes following standardized testing procedures. Since becoming a parent, I know how hard it is to be objective about your own child, especially when you’re afraid something could be wrong. Using standardized tests and making careful observations allows me to systematically measure your child’s strengths and weaknesses as compared to same aged peers.

Finally, parents come to Mindworks wanting a diagnosis. As psychologists, we do diagnose. This is different from the school system, where the goal is to determine eligibility for special education services (typically under the catch-all early childhood label ‘Developmental Delay’). I believe obtaining a diagnosis is valuable beyond that it helps you access special education services (speech-language therapy, occupational therapy, self-contained pre-school, physical therapy, applied behavior analysis etc.). A diagnosis helps you to empathize with your child, advocate for him, meet his needs, and most importantly to plan for the future.

Unless a child was born with a congenital condition, there is often very little time in between when a delay is identified and when that child will go to school। Early intervention therapies take time. The earlier they begin the more effective they are likely to be. Each family only has so much time, money and energy, and you want to devote those resources to interventions that will matter most. Early childhood services are critical in helping ensure that the transition to elementary school goes a smoothly as possible for a child with a delay or disability. At the end of the day, the reason to do testing is to answer those nagging questions, and to let each family go forth with confidence that they are making the best choices for their child.

-Rebecca Resnik, PsyD
Licensed Clinical Psychologist

Attention Deficit Hyperactivity Disorder (ADHD): Accurate Diagnosis is the Key to Effective Interventions

2008-02-12T20:15:00.001-05:00

At Mindworks, we frequently receive inquires from parents concerned about ADHD. In this article, I will try to present some general information to help parents become a bit more familiar with this relatively common disability. One of the first things we all associate with ADHD is hyperactivity—the kid you see running around like he’s wearing a jetpack with a frantic mother chasing him. While hyperactivity does occur in many children with ADHD, the fact that your child is very active does not necessarily warrant a diagnosis. The Diagnostic and Statistical Manual of the American Psychiatric Association contains three subtypes of ADHD, including Hyperactive, Inattentive, and Combined. ADHD is a constellation of symptoms and behaviors that cannot be explained by any other cause (such as anxiety, learning disability, or a thyroid disorder). Contrary to what many people assume, ADHD is not just having a short attention span. Many parents are confused by the fact that their child can happily spend two hours playing a video game, yet can not complete a short homework worksheet. ADHD is a neurological disorder that has a significant, pervasive impact on learning and behavior.

As Dr. Larry B. Silver has noted, ADHD is a ‘life disability.’ It is not just problems at school. Children with ADHD experience difficulties across settings, meaning that these children have problems with tasks that require sustained attention to detail wherever they go, from the Cub Scout meeting to the homework table. There are two major characteristics of children with ADHD that make life harder for them and the people who love them. One is a weakness with ‘Executive Functioning.’ Executive functioning is our ability to work efficiently, strategically, and to execute our plans mindfully. For example, writing and reading comprehension tend to be the downfall of many children with ADHD, because successful reading and writing depend on executive functioning. Another problematic symptom is difficulty with impulse control (also known as behavioral disinhibition). The child with ADHD has little ability to control his or her impulses, and may routinely violate rules, irritate other people, make careless mistakes, or complete tasks in a haphazard manner.

When talking to parents about testing for ADHD, I recommend investing in at least one very through, comprehensive psychological evaluation. One of the reasons for this is that I want to be able to recommend the most effective academic and behavioral interventions that will match the child’s particular pattern of strengths and weaknesses, but just as importantly, I do not want to be wrong in my diagnosis. ADHD is known as a ‘diagnosis of exclusion,’ meaning that you must make sure that nothing else could be causing the symptoms. Doing a quick parent interview or a couple of symptom checklists is not adequate. Additionally, it is currently estimated that as many as 50% of children with ADHD also have specific learning disabilities. Not only are these children at risk for school problems, they are far more likely than peers to have significant levels of anxiety, depression or behavioral problems. Researcher Dr. Russell Barkley has described children with ADHD as being several years less emotionally mature than typical peers. This means that both parents and child are likely to need additional support.

-Dr. Rebecca Resnik

Licensed Clinical Psychologist

“Too hard to say NO”

2008-02-12T20:15:00.000-05:00

It is too hard to say “no” to your intensely protesting child even though in your heart of hearts you know it is the right answer? Given that a blog on this question is being posted, at least you know that you are not alone with this dilemma. First, children are very good at what they do. Indeed they are wired to be experts in survival. And while we are also wired to be caretakers, the challenge of parenting is much more complex and demanding than being the child. All that having been said, when children are fighting hard against their mother’s and father’s wishes and using every possible strategy they can find, from screaming in the middle of a crowded store to telling you adoringly how much they love you (with a kiss kiss here and a kiss kiss there) to get what they want, you needn’t be fooled. These brilliant young folks are likely testing your strength as the parent and the one in charge as much, if not more than trying to get their way.

It is hard to be a child and so dependent upon others for security. Not surprisingly, these smart little people need to test the limits of their security – when they learn their environment is safe, they can relax and engage more deeply in their environment – a good thing for healthy development. How do they test the limits of their security – by seeing how far they can push you – who is stronger, me or you,

Who is in charge here, how much distress can you tolerate and still prevail?

To test this theory, try refusing your child’s unreasonable requests with this in mind. Hopefully, this discussion will make saying “no” easier. After the initial “storm” do they seem calmer, more at ease, more solicitous of your affection? And how are you doing? Do you feel more “in charge” and self confident? Are you feeling more affectionate towards your child rather than resentful of their victory?

We hope this little experiment is helpful as setting limits effectively with you child not only greatly enhances the quality of your relationship with them, but it is an important component in healthy development, internalized security and respect for others. Another good reason to do this sooner rather than later is that it makes the adolescent years much more enjoyable for all.

Dr. Barbara Mazer

Clinical Psychology Resident and soon to be MindWorks clinician!

Some Thoughts about Behavior Plans

2008-02-12T20:14:00.001-05:00

Behavior plans are one of the most popular approaches for trying to systematically change a child’s behaviors. Decades of research has shown that even an earthworm can respond to a simple behavior plan. So why do so many frustrated parents come to us at Mindworks with the classic lament “We tried that, it didn’t work.”? As with most things in life, it’s because there is almost never a simple answer to a complex problem.

Helping our children develop self-control is one of the most challenging tasks we parents face. One reason behavior plans can fail to make lasting changes is that people understand them as ways of making a child to comply. Getting people to comply is pretty easy. I can get you to do anything I want if I threaten you with a nasty enough consequence. However, once I’m not around or I can’t make good on my threat, you’re going to go right back to doing what you want. While we all need our children to comply with our rules, the true goal of a behavior plan is to teach the child to do something new.

When we take a teaching approach to modifying behavior, we come at the problem differently. Now our goal is to help the child choose a better set of behaviors than whatever behaviors are causing problems. As the psychologist Reginald Lourie noted, we must not eliminate a behavior without giving the child an attractive option for how to handle a stressful situation. If we just focus on stamping out a particular behavior, the child will find another way of dealing with his anger, frustration, boredom or shame (e.g. the child goes from hitting to biting). Remember, the goal is not just short-term compliance, its long-term development of self-control. Behavior plans have many common pitfalls. A major problem is lack of consistency, or using the plan sporadically or for too short a time period. This inconsistency creates a situation like a person gambling at a slot machine. Your child is the gambler, hoping for a pay-off (i.e. you giving in!). Guess who is the slot machine? When the ‘gambler’ never knows when the machine will ‘pay-off’ he is very, very, motivated to keep pushing buttons until it does. Kids are always looking for how to ‘beat the system’ and many parents give up as soon as the child finds a weakness in the plan that he can exploit. Every plan has weaknesses your child will find. That’s a delicate phase in implementation.

A psychologist can help you get through it without having the whole plan go down in flames. It is vital to get help from an expert to make sure your plan is developmentally appropriate! Lots of great plans fail because they are better suited to older children or for those without disabilities. The child must have the maximum chance for success, because there’s nothing harder than trying to implement a second, third, or fourth plan after failed attempts. A psychologist can also help you avoid pitfalls like inappropriate consequences. Too many well meaning people enact consequences that make the situation worse for everybody. For example, some people take recess from a child who desperately needs to let off steam, cancel birthday parties, or put a withdrawn, avoidant child into time-out.

Keep in mind that changing troublesome behavior does not happen overnight, and can be incredibly discouraging. The good news is that when behavior plans are proactive, fair and a good match for the child, they can and do help children change!

-Dr. Rebecca Resnik

Of note, Dr. Resnik was just interviewed with the Voice of America to present a televised series of parenting tips in Urdu speaking Pakistan. It's a reminder that behavioral problems and parenting challenges are universal!

Me First and the Gimmie Gimmies*

2008-02-12T20:14:00.000-05:00

The holidays are supposed to bring out the best in all of us, but it can bring out the worst in our children and in us as parents. The winter holidays is a time of stress and high expectations, and both are hard for children to handle. Pretty much all humans, except for Gandhi or Mother Theresa, are insatiable beings. We all have limitless wants and wishes. Our desires can lead us to great things and achievements, and they can also lead us towards greed and envy. Children have those same feelings, but unlike adults, they don’t understand why all of their wants can’t (and shouldn’t) be granted.

This time of year, children are bombarded with toys, Santa, treats, and commercials. We really can’t blame them for craving all the terrific things they see, especially when so many of them believe that Santa will bring whatever they want. While we would love to curb their greed, the usual methods reasonable parents try don’t work very well against the holiday hype. We try to explain to children about limited budgets, how we need to save for college, and how it’s impossible for grandma to know exactly what Barbie is the perfect one. But kids don’t understand, not really. You can talk yourself blue in the face to a four-year-old who wants a toy NOW, and he’s not going to understand anything beyond what his experience tells him. He knows that you could buy whatever it is he wants (you’re his parent, you can do anything right?), but you won’t until he convinces you that he really, really needs it. We parents all know that this becomes a cycle. First the child demands, then the parent refuses. The child gets more upset, and the parent starts feeling guilty, then frustrated, then angry. The child escalates until the parent punishes, leaving both people feeling terrible. Another awful situation arises when you give a child a beautiful gift, only to have him cry that he doesn’t like it. The holiday combination of stressed-out parents, too much excitement, and unrealistic expectations sets our kids up for meltdowns.

So here are some ideas for the holidays that might help take the edge off a bit:

Avoid the danger zones. Try not to take your child to the toy store, the mall, and turn-off the Saturday morning cartoon line-up (where all of the toy commercials are). The stores are overwhelming and crowded this time of year. All those toys are just too tempting for a child to ignore gracefully. If you must take your child shopping, let her know at the outset what you will and will not be purchasing. Be ready to leave the store if your child is not cooperative.
Focus on the giving. Keep your child’s attention directed towards all of the things he is going to give to others. Take him to the craft store and get lots of supplies for making ornaments, menorahs, scrapbooks, paintable coffee cups and cards (get lots of glitter). Help your child buy gifts online so you won’t have to go to the stores. Shoot for having your child have a gift or card for everyone who will be giving him a gift. Teach your child about giving to charities. A child can pick out a Toys-For-Tots (just have him pick out one for a child of a different age or gender so he can part with the toy without tears) or help choose items for a care package to a solider in Iraq (www.anysoldier.com). Don’t forget your child’s teacher!
Limit the Loot. Limit yourself and your relatives in the gift giving department. Keep it to one or two gifts at any one occasion, and put a cap on the amount people will spend. Don’t let a young child see a gift that he can not open and play with immediately (such as one that takes hours to assemble), otherwise you are sure to provoke tears.
Practice how to accept gifts. Role play how to accept a gift, even if you don’t like it or already have it. Teach the child to say a warm ‘thank you’ and to write or color thank-you notes.
Empathize. Children sometimes do get disappointed at the holidays; we can’t ever get them every wonderful, expensive gift they desire. Part of our job as a parent is helping our children deal with disappointment. Resist the urge to lecture or call your child ungrateful. Instead, find that part of yourself that can relate to being a sad little kid who didn’t get what she wished for Christmas morning (I never did get a pony). Give a hug, give some cocoa, and then gently help steer your child’s focus back on all the things to be grateful for. Empathy is one of our best gifts we can give a struggling child.

Dr. Rebecca Resnik, mom and psychologist, and fellow Target goer.

* Title inspired by the rock band by that name

New Assessment Measures

2008-02-12T20:13:00.000-05:00

At MindWorks, we are dedicated to keeping our assessment tools up to date to keep up with research regarding how to measure a child's strengths and weaknesses, whether it be in academics, sensory issues, or social skills. We have recently acquired the NEPSY-2 (Neuropsychological Test of Development for Children), K-CPT (Kiddie Continuous Performance Test), and the PALS-Version 2 (Process Assessment of the Learner) in Reading, Writing, and Math. These tests are vital pieces of our assessment battery because it allows us to work with children as young as three. We can now detect precursor reading, writing, and math problems in very young children, allowing for earlier prevention. The NEPSY-2 has integrated more subtests that measure for social perspective and inhibition problems. The K-CPT is one computerized test that we use to evaluate for attention and vigilance in children as young as age 4.

These three new tests add to our 50+ meausres that we choose from when we create an individualized battery for your child.

When you are deciding who should work with your child, be sure to ask if the clinic, agency, school, or individual psychologist is using the most updated, emperically validated measures and is not just limited to a cookbook assessment battery.

At MindWorks, we only have doctoral level licensed clinical psychologists (PhD or PsyD) and thus our entire practice is dedicated to excellence in testing and therapy practice, rather than spreading ourselves thin in too many directions.

If you would like more information about the new NEPSY-2, CPT-2, or PALS-2, please give me a call.

-Rachna Varia, PhD, Director of Testing

A feedback letter from a client

2008-02-12T20:12:00.000-05:00

I received an e-mail from a family I worked with earlier this year. With her permission, she is allowing me to post it on this blog (alias used for her son's name)

Dear Dr. Varia,

I thought I'd write and update you on Michael's status since we met with you in August. I am SO grateful for your testing and advice. It gave us the information we needed to understand Michael's struggle with school, and to get him the help he clearly needs.

Michael was determined "Eligible" for help with his "Specific Learning Disability". An IEP was created on October 23. He had been placed in an 8th grade team of students that had special ed teachers already in the primary course classrooms on the second day of school, "just in case" he qualified for help. I am quite sure that just having those extra teachers available to help, for they help all of the kids, not just the ones assigned to them, helped him accomplish all A's and B's on his first quarter interims!

Michael has expressed relief in knowing that there is an explanation for his school difficulties, and that he is not alone moving forward. He's been very receptive to the help of his new teaching team, and continues to work hard at home.

I am so glad we were referred to you, and for the work you did with Michael. I just wish we'd caught it sooner. I know that if Michael had been identified sooner, it would have saved him, and me, much anguish. The silver lining is that it has been caught, and his future will be enhanced. I am so grateful for your work with Michael. Sure, we paid for the evaluation, but knowing it was done by a highly educated professional that specializes in this sort of assessment, and who prepared reports that were detailed and specific to him made it clearly worth the investment. His future was at stake, and has been brightened by your help.

When should my child be tested?

2008-02-12T20:11:00.001-05:00

Parents often ask us when is the right time for a child to receive testing or therapy services. They may have heard people tell them to wait until third grade, or until a child is 7, or even “Don’t worry, he’ll grow out of it.” There is no magic age for testing and therapy, and if your instinct as a parent is telling you that something is not right, its time to act. Time is one of our most valuable assets in helping children. Most problems that took a while to develop take a while to improve, and when better to make changes than at a time in life when the brain is most adaptable? Early intervention is vital if you have concerns about a very young child (under 5) or if things have been getting steadily worse and worse for your child over time.

For children with ADHD and learning disabilities (as many as half of all children with ADHD also have learning disabilities), testing is critical as soon as problems are noted at school and home. Children with average intelligence can usually cope with the demands of the first grade curriculum, at least for the first part of the year. First grade is a time when the basic skills are introduced. Each task is short, involving only a few steps to complete. First grade work is highly structured, and most things the child reads will have helpful pictures. Homework can usually be completed in a half-hour. If your child is having learning problems in kindergarten or first grade, this can mean that the problems are particularly important to address. If the first year of school is unsuccessful, children may become convinced that they will never be able to do well. Feelings of frustration can lead to school avoidance or disruptive behaviors. As a former teacher, I have observed that some children quickly get a reputation among teachers for being 'trouble.' Once it sticks, the label is one that follows the child from year to year. It is much harder to develop a working partnership with school staff when everyone in the school has decided that your child is a 'problem.'

Many of the children I see come during the third grade. The reason for this is simple if you are aware of the scope and sequence of the elementary school curriculum. Third grade is when academic tasks require sustained attention to detail. Almost everything takes more time to complete and involves more steps. Instead of taking five seconds to complete a math problem, it can now take a few minutes to complete each problem (e.g. borrowing and carrying operations). Instead of writing a single word or sentence, the child must do a book report. Children with reading comprehension problems have an exceedingly difficult time understanding chapter books and text books. The helpful pictures they depended on are gone. Projects can take a week or more of planning, which is the downfall of a child with executive functioning impairment. These changes in the curriculum can cause child's academic progress to stall. Children who can not sustain attention or understand most of what they read fall behind their classmates very quickly. This can be a disheartening event for the child. Some develop anxious fears that they are not smart enough to learn. Many cope by convincing themselves that they don't care anyway, that school is stupid or that all teachers are against them. This state of affairs should be a thing of the past now that we have so many treatments and educational interventions, yet I still see children who have gone for years without receiving the help they need.

When deciding whether or not to test, it is important to understand that troubling symptoms can happen for a lot of different reasons. Symptoms like irritability can indicate conditions such as ADHD, depression, anxiety, obsessive compulsive disorder, sensory integration disorder, or even a medical problem like a sleep or elimination disorder. Children are complex beings who, unfortunately, do not often know how to tell us what is wrong. When we ask a child questions like "Why aren't you doing your work?" or "Why can't you sit still?" we get answers like "I don't know." Testing can give us the answers the children can not. I have yet to meet a child who is unsuccessful because he chooses to be. I believe that all children want very badly to make their parents and teachers proud. Research has shown that when children can not meet adult expectations at school and home, they are at-risk for secondary mental health problems like depression or anxiety. Children with undiagnosed disabilities often feel terrible. When kids feel terrible they may become disruptive, avoidant, or even aggressive. It makes sense if you think about it from the child's perspective, who can be happy spending six hours a day feeling like a failure or getting punished? As adults, we would quit a job like that, but kids don't have that option. Children are stuck with school, whether it goes well or not. Children who feel chronically frustrated, irritated, stupid or disliked need help before they become so discouraged that they give up school, or worse, on themselves.

Rebecca Resnik, PsyD, Licensed Clinical Psychologist and Former Special Education Teacher

A Call for Routine Psychological Check Ups for Children

2008-02-12T20:11:00.000-05:00

The tragedy at Virginia Tech last spring precipitated a long needed debate about the interaction of mental health services, courts, law enforcement and other social systems. Hopefully, risk assessment procedures and community responses will continue to improve for at-risk youth. As a child psychologist, I must articulate the value that could be gained by instituting standard psychological check ups.

There is inadequate attention given to the mental health needs of children. While there are uniformly accepted schedules for immunizations and annual physicals, we lack a similar strategy to track and treat our children’s emotional and behavioral health. Mental health check ups should be as widely accepted as dental check ups. This is a simple idea that has been discussed in the mental health community for some time; however, it hasnot received adequate attention among the public at large.

Five, twelve and seventeen.

When children start kindergarten, enter puberty and launch into adulthood they are prone to significant social and emotional upheaval. These transitions are widely believed to be critical time-windows in child development. Thus, at these three intervals, every child
would benefit from a standard psychological check up. This service would be affordable and simple to conduct. In one hour, a clinician could conduct a parent interview, a child interview and score a brief psychological test completed by the parent within 15 minutes.

We currently have remarkably useful, scientifically validated tools at our disposal which differentiate normal developmental struggles from clinical symptoms. Commonly used behavior rating scales compare a parent’s ratings about their child to thousands of other parent ratings. This provides the psychologist with data about how extreme a particular problem may be. For instance, a psychologist can quickly let a family know if their ratings about, say, aggression or thought problems were at the 50th, 75th or 90th percentile compared to other children the same age.

Symptoms that can be assessed in this manner include social problems, attention problems, mood problems, anxiety, adaptability and the like. Check ups could yield three simple outcomes. Parents could be told if a child appears to be growing up normally, is at-risk, or requires formal assessment and treatment. This would not, as some people fear, lead to an overwhelming trend of labeling or pathologizing healthy children.
Psychologists are well trained to appreciate the signs of adaptability and health in children and families. Well-trained clinicians recognize that children and families thrive when their competencies are validated and praised.

Preventative psychological care makes good sense. If recognized early, many moderate “warps” in a child’s personality can be improved with simple interventions. I have seen children overcome school phobias, cease aggressive behavior, pull up failing grades and begin using respectful language at home after only a few therapy visits. Problems such as
these can often be treated quickly, protecting children from unnecessary suffering. We must also recognize that there are children facing severe and chronic mental health conditions requiring intensive and long-term treatments. Even children in this category need systems in place to reassess their progress at critical ages. Child psychologists, who are trained in a scientist-practitioner model, can use validated measures to assess if clients are maintaining a healthy developmental trajectory.

The coordination of psychological care and medical care must become routinized. A significant number of pediatric office visits pertain to psychological issues. Children are frequently brought in to see their pediatrician or family doctor because of symptoms such as mood changes, phobias, temper problems, tics, sleep difficulties, learning problems, or attention problems. Unfortunately, it is rare for families to be granted a full-hour to discuss these matters and it is even less common for families to receive a multi-modal assessment that combines interview, play observation and psychological testing. When
the expertise of physicians and psychologists are combined, children and families are far better served.

Five, twelve and seventeen.

This simple schedule should remind us of the new standard in mental health care for children.

Lisa Bennett, Ph.D.; Licensed Clinical Psychologist, Certified School Psychologist

Why should I have a private psychological assessment?

2008-02-12T20:10:00.001-05:00

I recently spoke with a very happy father. He told me that he was cancelling our appointment for psychological testing because his insurance company was going to arrange for him to have his child tested for only $15. And as I wished him well and hung up the phone, I understood why he sounded so excited. Fifteen dollars compared to the cost of a private assessment, well who wouldn’t be thrilled? And if you get an assessment though the school system its free. Free sounds awfully good compared to expensive private testing, but the problem is that like with many things in life, if it sounds too good to be true to be, it probably is.

So what are you paying for when you invest in a private assessment? You are paying for time, expertise, and information you can trust. One of the first considerations is time. There’s no getting around the amount of time that a psychologist spends producing a quality report, and ideally it is the psychologist’s time. Some psychologists do not do their own testing, instead they pass you off to a technician or a student after the initial interview. The test administration, consulting, scoring and writing is very labor intensive, and it should be. No one wants to be treated by someone who is in a rush or taking short-cuts. Its worth paying for someone to make your case a priority. A private psychological evaluation should be custom designed around what you want to determine, as well as your child’s strengths and weaknesses. Tests and procedures should be thoughtfully selected, not simply used because they are the only ones you have. It is crucial to find a psychologist who has many tools at his or her disposal and the expertise to know how to use them.

It is unlikely that a psychologist will make useful recommendations unless he or she takes the time to study how an individual solves a variety of problems in the form of tests, tasks and even play. When you walk out of a psychologist’s office, you should have a large document in your hand that gives you insight into how your mind (or your child’s mind) works and lays out a plan for what steps to take next. A comprehensive assessment should lead to specific, concrete recommendations that address educational interventions, therapy, strategies for home, parenting advice, and information to inform medical treatments as appropriate.

When I do a psychological evaluation, I begin by budgeting six hours of ‘face to face’ time with the individual and his/her family. This is as much as three times the amount of time many people spend doing a psychological evaluation. My psychological evaluations resemble the neuropsychological assessments that I learned to do as in intern at a pediatric hospital in Baltimore. I study the person’s functioning exhaustively until I’m satisfied that I understand the problem, both what it is and what I can safely determine that it is not. After those six hours, I start calling everyone I have permission to consult with (physicians, teachers, tutors, even relatives) to get a complete picture of how the person is doing across home, school, and work. I review old testing reports and work samples. Then I set up to work writing your evaluation that takes me hours upon hours. I do not fill your name into a template. I do not dictate my reports to a transcription service. I do not cut and paste ‘cookie cutter’ recommendations into the report. Finally, the family and I sit down and have a feedback session, where we talk about the findings in detail and spend time problem solving. People who come to see me generally complete the entire process in a month or less.

Rebecca Resnik, PsyD - Licensed Clinical Psychologist

If your car is making a screeching noise, do you only want the battery checked?

2008-02-12T20:10:00.000-05:00

We often get requests for "ADHD testing."

I understand that there is a lot of media attention (excuse the pun) on ADD, ADHD, impulsivity, inattention. However, symptoms of inattention or restlessness are common in many learning and emotional problems such as learning disabilities, anxiety, moodiness, and motivational issues.

So if I go to the car mechanic and ask him or her to check only my battery because of the screeching noise, I would be remiss in not also having the whole car looked at. The engine, brakes, and all that other car stuff that I know very little about but may in fact be part of the problem. Thus, I have to trust that the mechanic should look at the whole car so he can ultimately not only fix the screeching sound but also make the car run more smoothly.

After years of doing different types of testing, we have now made it a MindWorks policy not to do "just ADHD testing." If you really want to find out why your child is having certain symptoms that may be affecting him or her at school and at home, we need to understand how the child learns, processes information, rule/out learning disabilities, and make sure that anxiety or depression is not creating these symptoms.

In the past, when we have only done "ADHD testing" (an IQ test, a checklist for attention symptoms, and a computerized test for viglilance and reaction time), we are often left with unanswered questions about why the child is struggling to read or is not doing well in geometry.

Like everyone, I am always a little suspicious when the car mechanic needs to check the entire car and am afriad that he is going to tell me that I am going to have spend money on x, y, and z, when I was only expected x. However, our testing comes from a health based perspective, so that we are identifying the strengths in your child to help overcome and compensate for the possible relative weaknesses.

So, next time you call ask for ADHD testing, expect me (or one of the other clinicians) to talk about why we feel it is important to take a whole child approach and not just focus on the battery. : )

-Rachna Varia, PhD; Director of Testing

Our Mission Statement and Philosophy

2008-02-12T20:08:00.000-05:00

MindWorks Philosophy and Mission Statement
What Makes MindWorks Work.

MindWorks, Clinical Psychology is committed to providing the highest-quality therapy, consultation, and assessment services by having specific standards for its:

Clinical Services
Staff
Environment

1) Clinical Services. MindWorks believes in a family systems model of therapy where children are not treated in isolation, but parents are made active participants in creating change. Assessments are based on creating a roadmap for clinical concerns and are individualized and thorough. MindWorks believes in communication with other parties and a collaborative model of care.

2) Staff. MindWorks believes that high quality services can be provided to clients by having excellent clinical staff. Staff is carefully selected to have a combination of professional acumen, personal warmth, sincerity, and approachability. MindWorks offers contractors a flexible schedule, steady stream of clients, and the ability to focus on clinical work instead of administrative and insurance tasks. MindWorks’ contractors are encouraged to create niche clinical services for professional and business satisfaction and growth. In addition, MindWorks is dedicated to a family friendly work environment where personal needs are prioritized (time off, child-care, pregnancy, professional development).

3) Environment. MindWorks provides a client-friendly office atmosphere where both adults and children feel comfortable. MindWorks strives to create an environment where clients are not anxious about receiving services and rather experience the clinic as a secure place. This Environment is created through clinician warmth, speedy communication and coordination, and a décor that is inviting and colorful.