Why Does My Child Need a Diagnosis?

-“I don’t want to label my child.”

-“Teachers are biased against diagnosed children.”

-“My son doesn’t act like most kids with _________ (particular diagnosis).”

 

These are statements that I hear on a routine basis, and they are all valid points. Any diagnosis that a child or adolescent may have carries a certain stigma to it. This is human nature. As a neuropsychologist, one of my biggest tasks is to develop the most appropriate and effective diagnosis for any child. My goal with writing this blog is to help identify the importance of an appropriate diagnosis.

How A Diagnosis Can Help Your Child:

First and foremost, an appropriate diagnosis will help explain and answer the “why” questions. Why does my child continue to struggle to read? Why is it impossible for my child to sit still? Why is it that my child cannot make friends? Once we identify the “whys,” we are on our way to solving the problems.  An appropriate diagnosis is intended to help develop the most effective means of intervention. If I diagnosis a child with Dyslexia, I know that traditional teaching of reading and phonics wouldn’t do much good. I would know instead to utilize an empirical approach consistent with the disorder at hand. Read more

Transition Trouble | How Family Routines and Rituals Can Help

If your child experiences difficulty with transitions, changes or any activity requiring flexibility, you may be wondering what’s making it so hard.

Your child may be hypersensitive to changes in routines or unexpected events for a variety of reasons. Some possibilities include poor organization orplanning skills, sensory issues, developmental delays, inadequate coping mechanisms, maladjustment or an anxiety disorder. If your child also exhibits any of the following symptoms, it could be anxiety that is causing all the commotion:

Symptoms of Transition Caused Anxiety:

• Negative, rigid, perfectionistic or unrealistic thinking patterns

• Irritability, tantrums, anger or aggression

• Constant worry about what might happen

• Avoiding new or unfamiliar people, places or activities

• Excessive clinginess or withdrawal from activities and socialinteractions

• Interruption in sleeping or eating habits

• Psychosomatic complaints such as stomach aches, headaches and fatigue

All children and adults experience anxiety at a natural level, and it’s considered normal until it negatively impacts a child’s functioning at school, home or with friends. If your child is overly anxious for what is expected at their age, it is likely interfering with family life. Adding routine and structure into your home, wherever the opportunity lies, will surely help an anxious child be more successful across his environments. Read more

What Is Executive Functioning?

Disorganized Child“Executive functioning” is a buzzword right now in the academic and parenting worlds. I often hear teachers use the term loosely at staffing and school meetings. What does it actually mean, though, and why do so few children seem to have executive functioning skills?

Executive Functioning Defined:

The definition of executive functioning is actually implied in the name – it is the CEO of an individual’s daily activities. These skills make up the child’s ability to organize, plan, problem solve, inhibit responses, fluidly transition between tasks, monitor work, and effectively change solutions based upon new information.

Examples Of Executive Functioning Skills:

These skills can be seen throughout a child’s day: does the child have a set plan for a morning routine, or is it chaos on a daily basis? Is the child’s room organized so that anyone walking in knows where items should be? What about his/her backpack or locker? Does the child forget to turn in homework assignments that he/she actually completed? Does the child forget to write down daily assignments or forget to bring home necessary materials? What about the social world – does the child struggle planning activities with friends? Read more

Gifted Children And What It Means To Be Advanced

gifted childI was asked to write a blog on giftedness in children – specifically, how to access it and how to ensure that a child with cognitive strength is able to reach his or her potential. This has proven to be a hard topic to write about. I don’t like the term “giftedness” for several reasons, but before I divulge those, I need to discuss what it means to be “gifted.”

A quick review of basic statistics is necessary in order to understand how we assess children has demonstrating superior ability. Traditionally, when we think of giftedness, we are thinking of a child’s IQ score. The vast majority of IQ scores used standard scores. A standard score is a statistical term in which a score of 100 is solidly average (50th percentile) and a standard deviation (the spread of scores from the mean of 100) of 15. In layman terms, scores between 85-115 are considered to be average.

When you are talking about giftedness, we see scores with at least two standard deviations greater than the mean (meaning an IQ score of 130 or higher). So, gifted children are those children that have IQ scores of 130 or higher. Pretty easy to identify, right? Wrong. One of my major critiques of giftedness is that parents and some academic folk rely way too much on the overall IQ score to determine if a child is gifted.

What Are IQ Measurements For Children?

The current gold-standard IQ measure, the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) came out in 2003. On the WISC-IV, children attain a Full Scale IQ score, which is comprised of several factors: verbal reasoning and comprehension, nonverbal reasoning, immediate attention and memory, and processing speed. Here lies one of the concerns in assessing giftedness. Which score should one use? Read more

When To Screen Children For Autism And Other Pervasive Developmental Disorders

Popular media is now teeming with stories about the dramatic rise in autism. Several celebrities have spoken publicly and advocated for increased research on assessment methods and treatment options. Parents are now more keenly aware of even minor deviations in their child’s developmental milestones, and they worry that these delays could be the first signs of a debilitating life-long disorder.

With all of the increased attention being paid to autism, many families wonder how to make sense of the myriad checklists and screening tools available online. In addition, parents struggle to decide if their child’s repetitive behaviors and singular fascination with toys and movies are age-appropriate.

The worry is not just paranoia – researchers have repeatedly concluded that early intervention leads to optimal outcomes for children with autism and other pervasive developmental disorders. To determine whether or not to call your pediatrician, you can look at the key variables that clinicians use in assessing autism..Below are some factors we look for when evaluating a young child (2 to 4 years old).

6 Factors To Look For When Exploring A Possible Autism Diagnosis

1. Shared Interest

Children will begin to develop this skill at around 10 to 12 months of age. Essentially, shared interest is the child’s strong desire to share emotional feelings with others. After this age, when children are confronted with novel and exciting stimuli (bubbles, balloons, etc.) they frequently look from the stimuli to their parents and back. While seeming to be a simple action, this reflects a child’s social connection to their parent and desire to engage them. The absence of this reaction is reason for concern. Read more

All You Need To Know About Learning Disabilities

How common are Learning Disabilities?

LD Boy

Learning concerns are one the most common neurological issues that children and adolescents present with. It has been estimated that approximately 20% of the general population in the prevalence rates indicate that 6% of the general population meet the necessary diagnostic criteria for a diagnosis of a specific learning disorder.

How are Learning Disabilities Defined?

There is great debate regarding how to accurate define, classify, and diagnosis learning disorders. Traditionally, it was assumed that a specific learning disorder exists when there is a significant discrepancy between a child’s ability (IQ, cognitive functioning) and achievement (performance on standardized reading, mathematics, and written expression tasks). However, there have been recent changes within the USA regarding how to classify and diagnosis learning disabilities. Currently, categorization of a child’s learning disability is based upon a multi-tiered process involving early identification and intervention. This multi-tiered process based approach is labeled Response to Intervention (RTI).

What are the Pros and Cons of RTI?

Researchers who are in favor of the RTI Model of learning disabilities argue that a combination of interviewing and behavioral observations are sufficient for identification of problems as well as to determine appropriate interventions. The RTI Model is most beneficial for children who have emotional or behavioral disorders that result secondary from a defined environmental factor, such as: inappropriate or inconsistent reinforcement or punishment. Read more

Sleep Disorders in Children

sleeping childMost families think of nighttime as a period of respite from daily activities of their children, a chance to reconnect with their spouse, relax and unwind. However, for families who are dealing with sleep issues in their children, nighttime is often one of the most difficult and challenging times of their day. Children who have difficulties falling asleep, staying asleep or disorders that disrupt the quality/quantity of their sleep end up with families who are also tired and miserable. Thus, promoting healthy sleep habits and effectively treating sleep disorders in children is often one of the best ways to improve a family’s overall quality of life.

Effects of Sleep Disorders in Children

With the advent of physiological procedures for evaluating sleep, we have gained a better understanding of the role of sleep in children. While children suffer from several of the same issues that effect adults (sleep apnea, restless legs, circadian rhythm disorders and insomnia), the causes and treatments of these conditions in children are often quite different. In addition, the daytime effects of disordered sleep in children are quite different from adults. For example, sleep disordered breathing such as apnea and chronic snoring lead to daytime fatigue in adults at rates of over 80%. However, in children, these same conditions lead to behavioral problems (45%), ADHD-like symptoms (50%) and mild learning difficulties (35%). In fact, reported daytime fatigue occurs only about 11% of the time in children.

Common Sleep Disorders in Children

There are several common sleep problems in children. These include onset and maintenance insomnia, sleep disordered breathing, movement disorders, bedwetting, and night terrors. While this list is by no means exhaustive, it does highlight the common problems parents report to pediatricians and health care professionals.

Childhood Insomnia

Insomnia is generally characterized as primary (in isolation) or secondary (due to another medical or mental health condition) and as onset (inability to get to sleep) or maintenance (inability to stay asleep). My general belief is that children can fall asleep anywhere and anytime the need strikes. So, when families are reporting insomnia, my first concern is to rule out any systemic problems in the family that may interfere with bedtime routines and sleep habits Read more

Vaccines and Autism: Science or Hoax?

Boy getting vaccineThe controversy surrounding the relationship of common childhood vaccines and autism has been raging for nearly two decades. However, the debate is comprised of about 10% science and 90% politics and media exposure. In the wake of the most recent revelation that Andrew Wakefield, MD, the original author of the 1998 article linking autism to MMR vaccinations falsified medical history on nearly all of the patients that comprised his study http://www.cnn.com/2011/HEALTH/01/05/autism.vaccines/index.html, many families are left to wonder if they can really trust any medical advice. The impact of Wakefield’s article has done egregious harm to the general health of children worldwide. While the article was ultimately retracted by the publishing journal and Wakefield himself was stripped of his medical license in May of 2010, many countries noticed a precipitous drop in childhood vaccinations in the past decade. Surges of measles outbreaks rose in the aftermath and the CDC reported that 90% of the outbreaks in th US of measles were in children not vaccinated.

In addition to the impact on general medical care for children, popular media sources were quick to raise concerns about the safety of childhood vaccines and the preservatives used in them. With the most recent revelation that the original data may have been fabricated, many parents wonder if there is any way to make a reasonable decision about vaccinations.

The Relationship Between Vaccines and Autism

There is some science that families can draw upon. Large scale epidemiology studies are available that shed light into the relationship of vaccines and autism. In my own practice, I tend to rely upon studies that track live births over long periods of time in several geographic regions. For example, the city of Yokohama, Japan decided to terminate their MMR vaccine program that ran from 1988 to 1993 and institute an alternative program. With the new system, the rates of vaccinations fell to under 2% of the population between 1993 and 1998. This rapid change provided an ideal model to study the rates of autism since essentially the MMR vaccination rate dropped to nothing. Results from the study indicated that autism rates rose dramatically during the 1993 to 1998 time frame and could obviously not be attributed to MMR vaccines (Honda, Shimizu & Rutter, 2005). Studies conducted in Denmark (Madsen et al., 2002) and the UK (Smeeth et al., 2004) also demonstrated no relationship between autism rates and MMR vaccinations. Read more

Cyber Bullying | How to make sure it doesn’t happen to your child!

Recent media events have highlighted the issue of bullying. A Rutgers University student, for example, committed suicide a few weeks back due to being bullied over the Internet (http://www.huffingtonpost.com/2010/09/29/dharun-revi-molly-wei-charged_n_743539.html ).Cyber Bullying Girl Crying

Bullying is nothing new. Older movies such as Fast Times at Ridgemont High, Pretty in Pink, and The Breakfast Club have all featured some form of bullying behavior. The key difference between bullying in the past and present, however, is in the level of anonymity – changes in technology have made bullying much more anonymous over time. Almost every child is on Facebook these days. Anyone can create an account, and the identifying information as to who “owns” the account can often be limited. The impact of cyber bullying has lead to a great deal of emotional harm as well as actual physical harm, as shown by cases like that of the Rutgers University student.

Tips to help decrease the likelihood of your child being “cyber bullied”:

1. You must closely monitor your child’s computer face time. Have a central location for the family’s computer. Keep it in a den or office room that is accessible for all family members.

2. Social media tools, such as Facebook, can serve as a great avenue for social relationships. They are not necessarily a bad thing, and you should not have your children completely avoid such avenues of socialization. However, if your child is using Facebook, it is imperative that you know your child’s login and password. Let your child know that you will be monitoring the Web site to ensure that nothing dangerous is there.

3. If your child is going to be on the site, you must be on the site yourself. Also, one requirement that you would have for your child is that he or she must be your “Facebook friend.” This way you can monitor what information he or she puts on the Web site and what information people are leaving for him or her.

4. If you suspect that someone is bullying your child, the first thing you should do is click the “Report this person” link on that person’s profile screen. This is done anonymously and will lead to an investigation to determine if that individual’s Facebook page should be censured. Also, ask your child to “de-friend” the person and find out what the situation with the bullying was about.

Bullying has always been around and likely will always be around in some format. With the changing of the times and vast improvements in technology, bullying can now be done anonymously and on the Web. Parents, you need not shelter your children from new technological advances; however, you must take these advances into account when you decide howyou monitor your children.

What is DEVELOPMENTAL DYSLEXIA?

DyslexiaDyslexia is one of the more common conditions to affect school age children. It is estimated that between 5 and 10% of children between the ages of 5 and 20 meet criteria for the disorder. The definition of dyslexia is an inability to read; however, while this is a disorder that is very easy to define, it can be difficult to diagnose and treat. Reading is an intimate and essential skill in our school systems. Children are taught to read in first and second grade; but by grade three they are expected to acquire new information from what they read and children who have difficulties in reading will begin to suffer in all subjects if left untreated.

Dyslexia and The Brain

There has been a wealth of information published on this disorder since first conceptualized nearly a hundred years ago. What researchers have essentially concluded is that we don’t have a formal reading center in our brain. Rather, we utilize language and speech areas to make sense of written words. Thus, any disorder that affects language systems can impact reading. In fact, in adult stroke patients, there is an unusual condition called alexia (can’t read) without agraphia (can’t write), which means that a person could write a sentence but be unable to read what they had just written. Through the advent of neuroimaging, we have been able to trace the pathways that lead from the visual perception of written text to the decoding of that text for meaning and have a pretty good understanding of how children with dyslexia read (or don’t read) differently than normal children. We have not been as successful in figuring out the cause of this disorder.

The current thinking is that our visual system is built to recognize objects from a variety of different angles because we are creatures that move in the world. For instance, if I turn a chair on its side, it won’t take you longer to figure out it is still a chair. However, letters and words need to be identified in the same orientation and in the same order if they are to have meaning. The visual system, therefore, “cheats” by funneling letters and words over to the language centers for processing instead of in typical object recognition centers. If this process occurs correctly, most children will be able to read as early as five years of age. If they don’t funnel this information correctly to the left side, they will continue to treat letters and words just like objects in the environment. For instance, a child might see the word “choir” but say the word “chair” since they are visually so similar in appearance. However, their meaning is quite different and clearly comprehension is going to be affected if many of those errors occur.

Signs of Dyslexia in Children

Some of the common signs of dyslexia in younger children can be the omission of connecting words (i.e., in, an, the, to, etc.), taking the first letter or two of the word and guessing, or converting words that they have never seen into words that they already know, even when the meaning is quite different. I hear often that parents become worried because their child reverses letters and, while this does occur in children with dyslexia, it is also a fairly common phenomenon with children who are learning to read, particularly with letters that look similar (i.e., b and d). Thus, it often does take a trained professional to differentiate children who are poor readers or who are developing slowly or in a patch-like fashion from children who actually have dyslexia.

Dyslexia in School

One of the challenges with this condition is that many of the schools have gone to an RTI Model (Response To Intervention) for reading. This means that they wait to see how a child responds to a normal classroom and if they fail, they move them to additional services, and if that fails, they move them to further intense services. Failing that, an evaluation is ordered. In real life, this means that many children are not evaluated properly for several years and by that time there are major gaps in their learning and acquisition. We do know of several methods for remediating dyslexia, although they often involve multiple hours a week of tutoring on a one-on-one basis and some school systems are simply ill-equipped to provide those types of services for children.

Most children that we see here at the clinic with dyslexia are bright and capable children who become increasingly frustrated with school because they are unable to bring their intellect to bear on many of the activities they are asked to perform in the school system. Even subjects in which they find much enjoyment are limited in terms of their ability to access the material because so much of it is done through written form. They often look poor on standardized reading and math testing; but because they are bright they can usually “muddle along” just enough to escape attention until they have fallen several years behind by middle school.

Treatment for Dyslexia

Fortunately, several treatment methods have been developed over the years that lead to a “normalization” of the reading system within the brain on imaging studies and to a dramatic increase in reading scores on educational tests. Only a trained professional can determine if your child has a developmental delay, dyslexia, or some other condition that is impacting their reading; but these are often critical evaluations to get done early since the remediation process can take 12 to 24 months.

I have evaluated hundreds of children for this condition and seen rather dramatic improvements when these children are placed in evidence-based programs for even a short amount of time. I urge all families who have children who struggle with reading to at least get a consultation with a trained professional to determine an accurate diagnosis and appropriate treatment planning.