Author: NRS Lifespan

Dyslexia Symptoms

Dyslexia Symptoms

 Early Signs (Before School):

●      Delayed speech development.

●      Difficulty learning nursery rhymes or recognizing rhyming patterns.

●      Difficulties accurately forming words, such as mispronouncing words or mixing similar-sounding terms.

●      Difficulties with letter, number, and color recognition.

School-Age Signs:

●      Difficulty in learning and remembering the names of letters and numbers.

●      Slow vocabulary growth.

●      Reading far below the required level for the age; difficulties processing and comprehending what is said;

trouble coming up with the correct term or formulating responses to questions.

●      Difficulties recalling the order of things.

●      Difficulty recognizing (and sometimes hearing) word and letter similarities and differences.

●      Incapacity to pronounce a word that is unknown by sound.

●      Spelling challenges.

●      Taking an abnormally lengthy time to finish writing or reading assignments Staying away from reading-related activities.

Teens and Adults:

●      Reading challenges, especially when reading aloud.

●      Labor-intensive and slow reading and writing.

●      Spelling issues.

●      Avoiding reading-related activities.

●      Mispronouncing terms or names, or other issues obtaining words.

●      Taking an abnormally lengthy time to finish writing or reading assignments.

●      Having trouble condensing a story.

●      Difficulties with arithmetic word problems.

●      Difficulties with learning a new language.

If you are concerned about the possibility of dyslexia, please call our office for a consultation.

Seasonal Affective Disorder: Causes & Treatment Options

It’s getting closer to that time of year where we soak in every last bit of warm weather, yet the days still become shorter, darker, and more bitter. If you feel your best during the spring and summer and start to notice negative changes in mood once fall and winter begin, this may be a sign of Seasonal Affective Disorder (SAD). SAD, also referred to as “seasonal depression” or the “winter blues”, is characterized by recurrent episodes of depression and shifts in mood around the same time each year, typically when there is less sunlight during the day. Most people with SAD, which is approximately 5% of people in the U.S., experience depression in the fall and especially in the winter. Less commonly, a spring-summer variant of SAD may also occur. Symptoms of SAD include, but are not limited to, depression, fatigue, trouble sleeping, feeling agitated, having difficulty concentrating, overeating (especially carbohydrates), weight gain or loss, and social withdrawal.

What causes SAD? Can darkness really trigger all of those symptoms? Quite possibly, according to research. There are physiological components to SAD. Studies have shown that SAD may occur due to reduced levels of serotonin, a neurotransmitter that supports mood, happiness, and eating behavior. There is also evidence that people with SAD produce too much melatonin due to reduced sunlight and greater spans of darkness, affecting the sleep-wake cycle. Another mechanism implicated in SAD relates to the retina, or the part of our eyes that detects and processes light. Receptors in the retina send information about light in the environment to the superchiasmatic nucleus, the “body’s master clock,” as well as the prefrontal cortex, a part of the brain that regulates mood and thinking (cognition). To keep it simple, input/light into the retina triggers other parts of the brain to keep manufacturing certain chemicals (like serotonin) to keep everything running smoothly. When less light input is received, the brain chemical factory slows down production which leads to changes in how we operate on the surface.

To sum up this research, our brain functioning changes seasonally depending upon feedback from the environment. Those who are prone to SAD-type symptoms may be particularly sensitive biologically to these environmental changes. Is there anything that can be done to prevent or treat SAD? Studies propose the following options to mitigate symptoms of SAD, although there’s not totally conclusive evidence that each of these, or all of them in combination, will definitely eliminate SAD symptoms.

  • Light therapy, which involves sitting in front of a light box that emits 10,000 lux for 30 minutes each morning. Clearance by an ophthalmologist is suggested.
  • Psychotropic medications, such as antidepressants; there are a few medications that have been specifically studied in the context of SAD with positive results.
  • Supportive counseling to implement behavioral and thinking changes that can increase serotonin production and reduce negative behaviors that would reinforce SAD symptoms.
  • Vitamin D supplementation, as managed by a physician.
  • Walking outside in the morning when the sun is brightest. Sun exposure within the first hour upon awakening also helps to optimize circadian rhythms.


Before beginning any of these treatments, concerns should first be discussed with a physician to determine the correct and safest treatment options. If interested in getting evaluated or treated for SAD, you can schedule a consultation appointment with a clinical health psychologist at NRS-Lifespan at 732-988-3441.

Lauren Gashlin, PsyD

What is Rejection Sensitivity Syndrome?

Rejection Sensitivity Syndrome (RSS) is a psychological phenomenon that is defined by researchers as “a personality disposition characterized by oversensitivity to social rejection”. Research has shown that individuals who possess higher levels of rejection sensitivity exhibit greater response to social rejection than those who possess lower levels. Interpersonal sensitivity, which focuses on a hypersensitivity to the thoughts and behaviors of others, is a similar phenomenon to rejection sensitivity. A personality disposition noted by researchers is that those who fear or anxiously expect rejection from others may end up leading to a rejection response from another person due to their own fearful behavior, thus creating a self-fulfilling prophecy. RSS is learned through experience, making rejection sensitivity a situational phenomenon, influenced by the situation one is in, as well as the situations that caused the person to develop rejection sensitivity in the first place.

As children enter adolescence, they experience a unique change in life wherein they are expected to develop better emotional regulatory skills. Some children, however, develop maladaptive patterns such as rejection sensitivity, and these issues can be ongoing into adulthood. For those with ADHD, rejection sensitivity may even have more of a basis in reality, with causes stemming from as early as their childhood. Research shows that “disrupted peer relationships are perhaps the most frequent, persistent, and treatment resistant domain of impairment demonstrated by children with ADHD, with estimates of prevalence of peer rejection in children with ADHD ranging from 50 to 80%.” Across the lifespan, individuals who are highly rejection-sensitive defensively expect rejection in social situations. They tend to avoid rejection from others by avoiding people, and isolating themselves from situations where they believe they may experience rejection. Higher levels of rejection sensitivity have been shown to be associated with higher levels of depression, anxiety, loneliness, borderline personality disorder, and body dysmorphic disorder as an individual enters adulthood. Effects of RSS on an individual can include problems with interpersonal skills as well as with self-perception and self-worth. Addressing RSS before or during adolescence can be crucial to helping a child develop neurotypically in this regard.

Working on protective factors with children has been shown to be helpful in promoting healthy, adaptive growth. Rejection-sensitive individuals who are highly capable of exerting self-control to delay gratification are evidenced as having equivalent regulation of effective responses to social stimuli, compared to their non-rejection-sensitive counterparts. Thus, developing strong self-control skills and regulatory skills as a child grows up is important – especially if a child tends to hold negative perceptions of the social information they observe.

If you are concerned about your child having RSS, please call our office for more information.

Steven P. Greco, PhD, ABN
Board Certified, Neuropsychology

Driving Anxiety after a Motor Vehicle Accident: The Importance of Treatment

It is common for car accident survivors to develop various psychological symptoms, including driving or passenger anxiety. While many people recover, some continue experiencing high anxiety related to driving or even being a passenger in a car. The anxiety may also escalate to an overwhelming fear of driving resulting in avoidance of driving. This can seriously disrupt a person’s life, which is why psychological treatment is critical.

Risk Factors:

·       severity of the accident

·       severity of injury

·       coming close to dying

·       flashbacks

·       history of traumatic events

·       pre-existing psychological factors

·       continued litigation related to the car accident


·       uneasy/anxious about driving

·       difficulty driving/riding in a car

·       excessive worry

·       irritability/anger

·       fear of getting into another accident, harming self/others

·       avoidance of driving or driving only when necessary

·       physical symptoms (feeling tense, sweating, trembling, difficulty breathing, heart pounding)

·       panic attacks


Lack of treatment post motor vehicle accident can prolong psychological symptoms and make them worse. At NRS|LS, we provide cognitive-behavioral therapy, including biofeedback that can help overcome driving anxiety and restore confidence in driving.  Early treatment post accident is critical.

If you or someone you know experiences driving anxiety, please contact our office for a consultation.


Basia Andrejko-Gworek, Ph.D.
Clinical Psychology, Chief Post-Doctoral Fellow
Permit# TP #213-03


Caregiver Grief in Loved Ones with Dementia

Grief is a sense of deep sorrow experienced after a significant loss. The death of a spouse or a
close family member is among the five most significant stressful life changes causing grief. With
dementia, spouses and other caregivers often start experiencing grief years even while their loved
one are still with them.

Caregiver grief in dementia is caused by the so-called “ambiguous” loss. The loss is ambiguous
because a loved one with dementia is still physically present but continuously struggles both
cognitively and psychologically. The stress level produced by ambiguous loss is equal to or even
greater than the grief following the person’s loss. Various factors contribute to the experience of
ambiguous loss. Some of the factors include the severity of the dementia symptoms, the burdens
and losses associated with caregiving, uncertainty about the future, the caregivers’ psychological
and physical health, and the ability of the family unit to cope with the changes associated with

The problem with ambiguous loss is that the caregivers often do not even know that they are
going through a grieving process. Moreover, the grieving process due to ambiguous loss is often
not recognized or supported in society, preventing caregivers from sharing their grief with others.
As a result, they have difficulty adjusting to their loss.

At NRS|LS, we offer Medical Adjustment Counseling ® (MAC) for patients with dementia and their
caregivers to help with the biopsychosocial changes of the person with dementia and his/her family members.

If you have any questions, or are in need of MAC, please call our office for more information.

Eleonora Gallagher, Psy.D.
Neuropsychology Post-Doctoral Fellow
NJ Permit: TP# 213-079


This is the last topic of three in our series on Psychoneuroimmunology and Neuropsychology. This current topic will be on the effects of the human gut microbiome (gastrointestinal system) upon thinking abilities, and behavioral functioning.

This series will be expanded into an article that will be submitted to the Journal of Psychoneuroimmunology by the authors.

In recent years there has been rapid growth in the discipline of Psychoneuroimmunology. A more recent area of research is investigating how the gastrointestinal and immune systems interact with the brain and affect brain function in cognition (thinking) and/or emotional behavior. The close connection between the microbiome (gut), nervous, endocrine, and immune systems has become a major challenge for interdisciplinary research. Newly developed methods in neuropsychology, immunology, and imaging have allowed deeper insights and understanding into the mechanisms of neuroimmune interactions.

Additionally, the role of neuroinflammation on cognition and neuropsychology, basics of psychoneuroimmunology, and neuropsychology, including neuropsychological examinations of cognition are providing a greater understanding of the complex relationship between the gut and our thinking. Besides the relationship between the gut, brain, and cognitive problems, emotional disturbance, behavioral abnormalities, and psychiatric systems are starting to become better understood with adults and in children.

Your gut includes the stomach, small intestine, and large intestine which includes the colon, liver, and gallbladder. The gut is responsible for ensuring that you absorb the nutrients of the food you eat, properly expel waste and toxins, and maintain a strong immune system.

Emerging research suggests that the human gut microbiome provides an avenue to improve cognition/thinking. Two design methods understanding the relationship between the gut and the brain (cognition) are correlational and have documented pre/post interventions. These methods have demonstrated that microbiome environment affects cognitive flexibility of thinking and executive functioning, in the form of planning, organization, and efficient daily functioning. The gut/microbiome environment is now clearly establishing a strong relationship between gut health and improved cognition, and behavioral/emotional brain functions. Results have shown improved cognition observed in visuospatial memory, verbal learning, memory, and attention.

The adherence of a proper diet and supplements is also gaining greater importance. Probiotics have recently become extremely popular. What the term really translates to is eating certain fruits and vegetables that feed the productive bacteria in the gut. The truth is every fruit and vegetable that you eat raw feeds good bacteria.

There are also significant supplemental regimens that aid in the gut that affect our thinking and cognition. There are a number of biotics in the form of probiotics, prebiotics, paraprobiotics, and symbiotics. Without diving into the complexity of the variations of probiotics, suffice it to say, that significant relationships between microbiome diversity and its enhancing cognitive flexibility, executive functioning, and memory have now become clearly established. The findings linking the gut microbiome and its relationship to our immune and neurological systems are becoming fact based. The most positive effects are linked to interventions containing probiotic, prebiotic, and a combination of the two (symbiotic).

Finally, new research is investigating the connection between autism and gut health. Comprehensive studies are identifying patterns in gut bacteria profiles to autism, pointing to new advancements. Researchers have identified microbial signatures for autism spectrum disorder, a critical finding that offers information about how the gut microbiome influences our neurological syndrome. Hence, there is hope to focus on improving diet and incorporating supplements that will favorably impact and improve cognition and behavior.

Should you have any questions regarding this new and exciting field in terms of how neuropsychology is affecting our health, please give us a call for a consultation.

Julianna R. Greco
Academy of Allied Health and Science

Robert B. Sica, Ph.D., ABN, FACPN
Board-Certified in Neuropsychology Director, Neuropsychological Rehabilitation Services|LifeSpan


Thank You To Our Summer Interns

Thank you to the 2023 NRS|LS summer interns! This was an impressive group of students, and we look forward to seeing you accomplish your future endeavors.

Francesca M. (Florida Gulf Coast University)
Jasmin S. (University of Pittsburg)
Amisha R. (Biotechnology High School)
Julianna G. (Academy of Allied Health and Science)
Olivia P. (University of Nebraska)
Grace G. (Ohio State University)
Ella R. (Lehigh University)
Rohit S. (Johns Hopkins), not pictured
Yana Z. (Academy of Allied Health and Science), not pictured

nrs lifespan summer interns

When Medicine Can’t Help Chronic Pain

Conventional wisdom suggests that chronic pain is a medical problem and that medical doctors
are the best at treating pain? This may be true. However, decades of research have shown that an
“interdisciplinary” approach to treating a chronic pain condition is superior to any single
intervention (to be clear, chronic pain is not the same as acute pain. Acute pain = being in pain
for under 6 months; Chronic pain = 6+ months of pain). The best long-term outcomes occur
when patients work with many doctors across specialties and, in the best case scenario, these
doctors actually talk to each other regularly and coordinate treatment plans, recommendations,
information, etc. Specialties that may be involved in the treatment of chronic pain include:
orthopedics, sports medicine, pain medicine and rehabilitation, physical therapy, acupuncture,
massage therapy, and psychology.

Many people are confused about the role that a psychologist would play in the treatment of
someone with chronic pain. There are several reasons for this. One reason is that many people
with chronic pain don’t know the extent of the neuroanatomy behind chronic pain, regardless of
where it is felt in the body. For instance, we know that lower back pain doesn’t begin and end in
the lower back or the spinal cord. Pain registers in multiple parts of the brain, including the
thalamus, limbic system, cerebral cortex, and somatosensory cortex. The limbic system and
cerebral cortex do many things, including shaping our emotions and thought process. Activity
that happens in these areas of the brain directly influences pain signals. Simply put, emotions
and thoughts shape the experience of pain. And since psychologists are experts in the domains
of emotions and thoughts, they play a pivotal role in improving the outcomes of those with
chronic pain, especially when it appears that medical interventions aren’t helping.

Psychological approaches to chronic pain aren’t mysterious or random. And the positive
outcomes aren’t simply due to a placebo effect. Neuroscience studies show that psychological
approaches actually reverse the neural changes associated with chronic pain. Effective treatment
combines a variety of techniques (cognitive-behavioral, psychoeducational, mindfulness-based
stress reduction, biofeedback/relaxation, and pacing) to help patients self-manage their pain and
require less medical intervention(s) and medication.

If you are interested in learning more about psychological treatment for chronic pain at NRS|Lifespan,
please call 732-988-3441 to schedule a consultation appointment.


Lauren Gashlin, PsyD
Clinical Psychology

Neuroautoimmune Diseases and Cognitive Dysfunction Part 2 of the 4-Part Series

Cognitive dysfunction refers to a broad range of changes and abnormalities in our  thinking that affects a person’s memory, perception, language, problem-solving, and other mental abilities. Cognitive dysfunction is not a specific medical condition, rather a term used to describe a group of symptoms that can arise from underlying brain conditions. Part 2 of the Neuroimmunity Series will describe cognitive dysfunction that results from three common neuroautoimmune diseases: multiple sclerosis, autoimmune encephalitis, and neurosarcoidosis.

Multiple Sclerosis (MS)    

Multiple sclerosis is a neuroautoimmune disease that affects the central nervous system, leading to inflammation and damage to the protective myelin sheath surrounding nerve fibers. It is believed to be caused by the dysregulation of certain immune cells, which are crucial in defending the brain from viruses and certain bacteria. When these cells become dysregulated, they target the body’s own cells and tissues, leading to autoimmune disorders. Cognitive deficits of MS include poor attention, decreased memory, motor changes, and reduced speed of information processing which occur in approximately 40% of patients.

Autoimmune Encephalitis (AE) 

Autoimmune encephalitis (AE) is a type of inflammatory neuroautoimmune disorder characterized by the immune system mistakenly attacking healthy brain tissue. In patients with AE, the body’s immune system produces antibodies that target specific proteins found on neurons, leading to inflammation and damage in the brain. Since there are many specific proteins affected in patients with autoimmune encephalitis, there can be a wide range of thinking changes. Symptoms of AE include memory problems, mood swings, personality changes, tremors, seizures, loss of coordination, hallucinations, delusions, paranoia, and difficulty understanding language.


Neurosarcoidosis is a rare form of sarcoidosis (a disease involving abnormal collections of inflammatory cells that form lumps known as granulomata) that specifically involves the nervous system. It is characterized by the development of granulomas that can build up on the brain, spinal cord, cranial nerves, or the protective membranes of these areas. This leads to thinking changes in processing speed, attention concentration, memory, to name a few. In addition, physical problems can occur with vision, difficulty swallowing, fatigue, headaches, weakness in sensory nerves, and in some cases seizures.

Neuropsychologist’s Role

The role of the neuropsychologist with neuroautoimmune disorders is to evaluate a person’s thinking and behavioral abilities that typically becomes disrupted as a result of the above conditions. Upon obtaining objective neurocognitive data, the neuropsychologist works with your medical team to address the severity, treatments needed, and outcomes of these patients. Reintegration into work, life, school, etc., is a vital part of treatment. Here at NRS|LS, our board-certified neuropsychologists are prepared to treat you or your family member that may be affected by impaired neuroimmunity causing a variety of psychological and neuropsychological changes.

Stay tuned for Part 3 of the Neuroimmunity Series.

Please call our office for further information.

Julianna R. Greco
Academy of Allied Health and Science

Robert B. Sica, Ph.D.
Board-Certified in Neuropsychology
Director, Neuropsychological Rehabilitation Services|LifeSpan



Migraine Headaches: How Biofeedback Can Help

It is estimated that 39 million of people in America suffer from migraine headaches. Symptoms usually vary from person to person and often involve various parts of the body (e.g., pain/pressure around eyes, temples, jaw, neck, sinuses, sensitivity to light, noise, nausea, vomiting, appetite loss, dizziness, blurred vision). A migraine attack can seriously affect person’s day-to-day life. It may lead to changes in mood (e.g., irritability), muscle tension/pain, low energy levels, and trouble concentrating. Not surprisingly, the World Health Organization (WHO) recognizes severe migraine attack as a seriously disabling condition. Fortunately, biofeedback can help a person learn skills to reduce the headache frequency and severity by up to 45-60% (American Migraine Foundation).

Common Migraine Triggers

  • Emotional/physical stress
  • Poor sleep
  • Certain foods (alcohol, especially red wine, dairy products, chocolate), sweeteners and preservatives
  • Dehydration
  • Hormonal Changes
  • Certain Medications
  • Barometric pressure changes


Lifestyle changes can help reduce the above triggers for migraines. Biofeedback can also be beneficial, especially as it can help mange stress that often triggers migraine attacks. Our bodies change when we are in pain or stressed.  The heart rate increases, breathing is faster/more shallow, and muscles get more tense. Biofeedback can provide skills to slow your breathing, reduce heart rate, including physical tension so that you can regain control over your body. Here at NRS, we offer biofeedback which can help you manage your migraine more effectively. If you or someone you know suffers from migraine headaches, please contact our office for a consultation.


Basia Andrejko-Gworek, Ph.D.
Clinical Psychology, Post-Doctoral Fellow
Permit# TP #213-03