Author: NRS Lifespan

Forensic Neuropsychological Assessment

In the past, the major focus of neuropsychology has been largely diagnostic and primarily concerned with relationships between lesion localization and subsequent cognitive/behavioral alterations.  Currently the primary issue, especially in forensic and clinical settings, is to determine an individual’s functional capacity.

An individual’s ability to be successful in activities of daily living (ADL), is vitally important during personal injury litigation.  Plaintiff and defense attorneys undoubtedly are interested in determining how an individual is functioning post-injury.  Plaintiff and defense attorneys have different roles and view assessment outcomes according to their client representation (e.g., maximize deficits; minimize deficits).  The neuropsychologist will assist the attorney referral sources, and the trier of fact in answering specific questions related to an individual’s pre and post-injury status (e.g., level of functioning).  Neuropsychological test results provide information to assist in childhood, adult, and geriatric neurocognitive and behavioral conditions, particularly when neurologic, radiologic, and laboratory data are inconclusive (e.g., MTBI, post-concussive syndrome).  Forensic neuropsychological assessment also establishes an objective baseline of function, which can be later compared with re-assessment results, that is invaluable in determining the course of cerebral dysfunction.  The contribution of a patient’s personality and mood to his or her symptoms is also estimated via formal assessment.  Furthermore, neuropsychological test data assists in predicting a patient’s short and long-term prognosis.

In summary, the purpose of a forensic neuropsychological assessment is briefly described below:

  • To describe the degree of cognitive impairments and explain the reasons of their existence.
  • To measure behavioral impairments that result from brain injury.
  • To establish a baseline of function that allows for comparisons over time
  • To provide a plan for cognitive and behavioral rehabilitation treatment.
  • To guide the planning and development of remedial education or vocational rehabilitation.
  • To calculate the individual’s ability to resume his/her premorbid lifestyle.
  • To provide documentation for litigation concerned with the functional impact of documented or suspected brain injury on cognitive and behavioral functioning.

In legal proceedings, the neuropsychologist as expert will assist both plaintiff and defense attorneys, as well as the tier of fact, in understanding neuropsychological evidence as referenced above.

For additional information or to schedule a consultation, please contact our office at 732-988-3441.

Michael J. Raymond, Ph.D., ABN, FACPN
Board Certified Neuropsychologist #232
Licensed Psychologist #35S100252900

What is the consequence of Problematic Digital Media Use?

The rapid rise of digital media use has been shown to worsen ADHD symptoms and the overall state of adolescents with ADHD. This phenomenon is called Problematic Digital Media Use (PDMU) which includes use of social media, video games, television shows, etc.

During COVID and the increased use of screen time/technology has significantly increased since the pandemic. A recent study showed children ages 8-16 who had ADHD with problematical digital media use were compared to those who did not have problematical digital media use. They compared both groups and the group with the high amount of digital media use depicted substantially worse ADHD symptoms:

  • ADHD Core Symptoms – ADHD adolescents with high digital media use had a much lower ability to focus and was distracted more easily.
  • Emotional Problems – ADHD adolescents with high digital media use had much higher rates of anxiety and depression disorders.
  • Executive Function (EF) – ADHD adolescents with high digital media use had worse EF, which includes a lack of self-control, self-regulation, and behavioral inhibition. This leads to difficulties in daily life management.
  • Parent-Child Relationships – ADHD adolescents with high digital media use had more problems such as confrontation and disobedience, which can cause strained relationships.
  • Learning Motivation – ADHD adolescents with high digital media use had a lower motivation to learn, higher stress levels, and learning problems compared to the ADHD group without problematic digital media use.
  • Physical Activity – ADHD adolescents with high digital media spend more time on social media and video games than doing physical activity. A decreased amount of physical activity may cause depression, anxiety, and low self-esteem.

There is a correlation between high digital technology use and ADHD and because of COVID, ADHD in adolescents only became worse as digital media became more used. It is important to reduce screen time on social media and video games to prevent this from happening. A systematic, tailored approach is recommended via the counseling process. If you would like more information regarding this strategy, please contact Dr. Steven Greco, board certified neuropsychologist.  

Shuai, L., He, S., Zheng, H. et al. Influences of digital media use on children and adolescents with ADHD during COVID-19 pandemic. Global Health 17, 48 (2021).

How you have a family member with dementia?

Has your family member or partner been having increasing difficulty with independent living skills, including paying bills, food shopping, driving, or completing daily activities such as getting dressed, bathing, or eating? These difficulties, along with memory and other thinking problems, often bring families of the individuals affected by these symptoms to a neuropsychologist. The Neuropsychological Examination (NPE) is our means of identifying whether these symptoms are due to dementia or some other condition.

If your partner or family member has been diagnosed with dementia, the neuropsychologist will explain the dementia subtype. For instance, some examples of dementia subtypes include vascular dementia, dementia due to Alzheimer’s disease, mixed dementia, dementia with Lewy bodies, and frontotemporal dementia. All dementias are progressive, meaning that the decline in daily functioning worsens over time as the condition accelerates. The diagnosis of dementia is always stressful for families, and many are unprepared to deal with the challenges presented by this medical condition.

Our office offers Medical Adjustment Counseling® (MAC) as a treatment option for families of the patients diagnosed with dementia. MAC® is based on the results of the NPE of the patient. The unique information about the patient’s brain functioning obtained from the NPE is used by your doctor as a guide for treatment. MAC® will help the family understand the patient’s condition, develop adjustment strategies for dealing with their thinking and emotional symptoms, and prepare for the future. MAC® will also help the family acknowledge and address their own emotional issues associated with the increase in caregiving responsibilities and, as a result, improve the functioning of your family unit.

If you have any additional questions about MAC®, please call our office.

WHAT IS THE DIFFERENCE BETWEEN PSYCHOTHERAPY AND MEDICAL ADJUSTMENT COUNSELING®?

Psychotherapy today includes a number of different approaches.  In order to be effective, it is important to understand the type of patient you are treating, and the ability of the neuropsychologist or mental health professional to deliver the appropriate care.

First, what is psychotherapy?  Psychotherapy is the treatment of emotional and personality problems by psychological means.  There are many approaches today helping patients understand their motivations and focus upon correcting their symptoms.  For example, today cognitive-behavioral therapies (CBT) have captured the focus of the psychological and medical fields.  The problem with these approaches is they are based upon the judgment of the neuropsychologist or mental health professional.  There is a wide variety of ability among professionals basing their opinions only on observation of the patient, their intake process, and medical records.  Yes, these are important, but hardly objective, i.e., information free of doctor bias, nor scientific.  Without a structured approach understanding the patient’s symptoms, treatment will be nothing more than guesswork based upon the mental health professional’s impression.

On the other hand, Medical Adjustment Counseling® is based upon just that – A structured approach called the Neuropsychological Examination (NPE).  This is an assembly of tests that determine thinking (cognitive), and behavioral changes due to a variety of brain conditions.  The results of the NPE become the basis for treatment (Medical Adjustment Counseling®), based upon a scientific approach, free of doctor bias or merely listening to the patient-reported symptoms.

The findings of the NPE become the “blueprint of the patient’s condition and free of the patient’s personal interpretation of their condition.  For example, what surgeon would operate on a patient solely based upon the patient pointing to where the pain is?  He/she would do all their tests first, regardless of what the patient says.  Medical Adjustment Counseling® is just that – The application of neuropsychological principles and evidence-based procedures that create the basis for treatment through counseling.

Medical Adjustment Counseling® focuses upon the patient’s understanding of their thinking and behavioral changes and the necessary changes to achieve effective treatment.  Medical Adjustment Counseling® is a simple, straightforward conversation with the patient regarding their brain condition.  What they have got, the symptoms, and what they have to do to move forward.  The conversation is free from the oftentimes bizarre explanations rendered by mental health professionals.  The difference between Medical Adjustment Counseling® and other psychological treatment approaches is the dependence between thinking and brain functions.  This is made clear by the NPE results from which now the neuropsychologist has an orderly direction for treatment.

Medical Adjustment Counseling® is started after reviewing the results of the NPE with the patient.  It is divided into four stages:  Validation, education/explanation, accommodation, and integration.

Validation provides an opening opportunity for the patient understanding the nature of their diagnosis, that it is a medical situation, and not a psychological one whereby they are mislabeled when referred for psychotherapy.  Next, the educational phase explains the NPE results and how they will show themselves in daily functioning.  This becomes the basis of their care through counseling, biofeedback, cognitive rehabilitation, and family therapy options.  Furthermore, the third stage, accommodation, is the most complex window in achieving successful adjustment to the patient’s brain condition.  It is here that traditional psychotherapy, so often applied by mental health professionals and physicians referred, that is ineffective and counterproductive.  The patients with brain conditions have a different set of needs not provided by traditional psychotherapy.  Finally, reintegration consists of the successful change in the patient’s functioning across a continuum of social, work, and educational areas.

If you are dealing with a brain condition and do not want the stigma of being referred for, “psychiatric care and psychotherapy”, give us a call and we will address your neuropsychological needs as a medical patient with no “psycho-babble”.

 

Robert B. Sica, Ph.D., ABN, FACPN
Board-Certified in Neuropsychology #84, #255
Director, Principal, Neuropsychological Rehabilitation Services|LifeSpan
Fellowship-Residency Supervisor
Jersey Shore University Medical Center, Neuroscience Division
Clinical Assistant Professor, Rutgers-Robert Wood Johnson Medical School
Clinical Assistant Professor, Seton Hall – Hackensack Meridian School of Medicine

 

Things to look for in the Gifted Child…

The gifted child is very much misunderstood, at times academically neglected, and difficult overall to identify. Many gifted children are inaccurately diagnosed with ADHD, Oppositional Defiance Disorder, Obsessive Compulsive Disorder or Mood Disorders.

Here are some traits consistent with a gifted child:

  • Thirst for knowledge, discovery, questioning, introspective, and keen observation.  However, can be critical and argumentative.
  • Vivid imagination, imaginary friends, inventions, preference for the unusual.  However can mix truth and fiction and have low tolerance for boredom and stress.
  • Great depth and intensity of emotional life-wide range of feelings, compassion, and constant self-examination.  However, signs of timidity, shyness, difficulty adjusting to change can also be experienced.
  • Enhanced senses. However, can become easily distracted by sounds, textures, smells, etc.
  • Constantly intense drive, high energy, could also be restless, compulsive talking, nervous habits, etc.

Many children who are diagnosed as Gifted may also have co-occurring neurocognitive or emotional conditions.  Therefore, care and thorough assessment of the child is critical to create an accurate diagnosis and treatment plan.

If your child is experiencing any of these symptoms and you would like to know more, please call our office.

Michelle Blose, PsyD
Neuropsychology, Post-Doctoral Fellow
NJ Permit: TP# 203-032

 

Tis the Season for…Sleep Disorders

In theory, winter is a season for rest, hibernation, and rejuvenation. In actuality, many people struggle with restlessness, insomnia, and seasonal blues. Insomnia is a sleep disorder that is associated with different causes, patterns, and targets for treatment. For instance, some people struggle with “delayed sleep onset”, meaning that it takes them an unusually long time to fall asleep. On the other hand, others wake up frequently throughout the night and struggle to get back asleep. Unfortunately, the struggle with falling asleep, wake up frequently through the night, and experience very poor-quality sleep will affect your day to day life.

When episodes of insomnia develop and persist, individuals can easily spiral pretty quickly into different versions of themselves – irritable, frustrated, anxious, depressed, etc. Regardless of the cause of insomnia (which there could be many), many find themselves in bad patterns that chase sleep away instead of aiding their cause. A discussion of sleep medication, aids, and supplements is beyond the scope of this blog but can be addressed with a health psychologist and medical professionals. However, behavioral (i.e., non-medicinal) approaches have high success rates when individuals are committed to developing a healthy relationship with sleep instead of leaping to quick fixes.

Let’s scratch the surface…

(1)   Falling asleep is about the relationship between cortisol and melatonin. In healthy sleepers, cortisol falls during the day while melatonin (naturally produced by your body) increases to create what is called “sleep pressure”. There are many daytime behaviors that can subtly hijack cortisol and melatonin levels leading to the experience of “I feel like I’m ready to sleep but just can’t fall asleep…”

(2)   Staying asleep is about your bodies ability to bridge together sleep cycles. It is normal to cycle from light stages of sleep into deeper stages with very brief periods of awakening in between cycles. Again, there are many behavioral factors that affect this aspect of sleep quality, such alcohol and caffeine use, napping, inconsistent wake-up times, etc.

(3)   Attitudes about sleep matter a great deal. The ways in which individuals think, talk, and feel about sleep directly impact the physiological processes that regulate sleep. Medications, supplements, and sleep aids do not “fix” this component of insomnia. Cognitive-behavioral and mindfulness therapies provide education and skills to provide long-term solutions to sleep problems.

There are several great resources, books, apps, and reputable experts on this topic but sometimes this information is more overwhelming than helpful. If you or someone you know is struggling with insomnia or other sleep-related challenges, contact our office at 732-988-3441 to schedule a consultation appointment with our clinical health psychologist.

 

 

Grief versus Depression: Recognizing Symptoms and Knowing When to Seek Help

Grief is a natural response to loss. Most people associate grief with death of someone in their lives, however it can also occur due to other major losses (e.g., job, relationship, physical disability). While there is no rule for how long the suffering should last, most individuals improve within six months after the loss. Unfortunately, some people will continue experiencing troublesome feelings which could trigger a major depressive disorder (MDD). It is important, therefore, to understand the difference between grief and depression, including how they might be similar, and know when to seek help.

GRIEF vs. DEPRESSION

Similarities:

  • Intense sadness
  • Reduced sleep, appetite, low energy levels
  • Changes in memory
  • Reduced interest in life
  • Social withdrawal
  • Irritability/anger

Key Differences:

GRIEF

  • Intense sadness, emptiness
  • Difficulty accepting the loss, guilt
  • Waves of emotions that decrease in intensity/frequency over time
  • Periods of hope, comfort, and even humor
  • Thoughts focused on the deceased or loss
  • Generally intact self-esteem
  • Thoughts of “uniting” with the deceased

MDD

  • Persistent sadness, hopelessness, emptiness
  • Feelings of guilt unrelated to loss
  • Upsetting emotions are constant/unchanging
  • Inability to feel positive emotions
  • Self-critical, hopeless about life in general
  • Preoccupied with feelings of worthlessness or shame
  • Thoughts of suicide to end pain, despair

Grief symptoms get better without treatment while depressive symptoms persist, affecting the person’s ability to function in daily activities.

If you are struggling adjusting after a loss or are depressed, it is best to seek professional help. Here at NRS|LS, we offer counseling specific for your needs, including biofeedback, and will teach you skills to help you recover, regain control over your life, and move forward in your daily functioning.

If you or someone you know is struggling with symptoms following a major loss, please call our office for a consultation.

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

 

 

NVLD – A Learning Disability

Nonverbal Learning Disability (NVLD) is a learning disability that causes difficulty with motor, visual-spatial, social skills, etc.  Individuals with NVLD are often well-spoken and can write well, but struggle with subtle social cues and comprehension of abstract concepts.

It is not uncommon for NVLD to go undiagnosed until adulthood, and Chris Rock can attest to that.  In a 2020 interview with The Hollywood Reporter, he spoke about the challenges he experienced and ongoing therapy sessions.  He indicated that it was not until his friend suggested that he might have Asperger’s syndrome (a form of autism, no longer recognized in the DSM-V) and underwent a comprehensive neuropsychological examination and was diagnosed with NVLD.

Lack of distinct definition as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-V) and the variability in its presentation from person to person has resulted in misdiagnosis and/or lack of identification.

Statistically, 65% of all communication is conveyed nonverbally.  Researchers estimated that 2.2 million to 2.9 million children and adolescents have NVLD.  Furthermore, 1 in 100 children in the United States may have NVLD.  Lastly, NVLD affects boys and girls equally (1:1).  Given these numbers, approximately 3% to 4% of individuals under 18-years-old struggle with NVLD.

Those with NVLD are at much higher risk for developing emotional difficulties, including but not limited to anxiety and depression.  The tendency to approach things with a detail-oriented process are similar to those with severe anxiety. These people tend to process details over and over, missing the bigger picture, which can result in an increased susceptibility to emotional dysregulation.

Signs of Nonverbal Learning Disorder

  • Often misses social cues such as facial expression or tone of voice, making it hard to make and keep friends
  • Needs to verbalize things to understand them
  • Struggles with reading comprehension or mathematical problem solving (fractions, geometric shapes, word problems)
  • Thinks of things in literal terms and struggles with metaphors or abstract concepts
  • Fine motor skills (using scissors, tying shoelaces, pencil grip, etc.)
  • Gross motor skills (throwing a ball, riding a bike, etc.)
  • Spatial awareness (bumping into people and things)
  • Organization and planning
  • Activities that require multitasking
  • Recalling visual information
  • Handling and understanding new and novel situations
  • Understanding charts and diagrams, like maps and graphs

Steps to Take if you Notice Signs of NVLD

  • Take notes – make note of when and where you see these behaviors, as these observations are important to have when speaking with a specialist such as a neuropsychologist.
  • Talk with child’s teacher and/or family member – bring list of concerns and ask whether these behaviors are affecting the individual’s performance.
  • Be proactive and trust your feelings – since individuals with NVLD are often articulate and well-spoken, NVLD interventions may seem unnecessary. However, the symptoms of NVLD will become more apparent with age. So, the earlier the intervention, the better.
  • Request an evaluation and/or consult with a neuropsychologist who can test the individual’s cognitive abilities including language, visual-spatial, executive functioning, motor skills, and more.

Common NVLD Myths

  • NVLD affects social skills, but not schoolwork
  • NVLD is common only among school-age children
  • Children with NVLD are not smart
  • NVLD, Autism, and ADHD are different terms for the same disorder
  • Symptoms of NVLD get better with age

If you witness the aforementioned signs and/or have concerns with learning difficulties, contact NRS-Lifespan to schedule an initial consultation.

Diagnostic clarity and appropriate treatment can help both children and adults manage NVLD symptoms for improved daily functioning and overall well-being.

Mihir J. Shah, Psy.D.
Clinical Neuropsychologist

 

References:

Chris Rock Revealed He has the Learning Disorder NVLD- Here’s What that is. Retrieved from http://www.health.com/condition/neurological-disorders/vld-chris-rock-learning-disorder

Non-Verbal Learning Disabilities. Learning Disabilities Association of America. Retrieved from http://Idaamerica.org/types-of-learning-disabilities/non-verbal-learning-disabilities/

Understanding Nonverbal Learning Disabilities. Understood. Retrieved from https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/nonverbal-learning-disabilities/understanding-nonverbal-learning-disabilities

Nonverbal Learning Disorders. LD Online. Retrieved from http://www.Idonline.org/article/6114/

Nonverbal Learning Disabilities. Greatkids. Retrieved from http://www.greatschools/org/gk/articles/nonverbal-learning-disabilities/

Where There’s Smoke, There May Be Fire.

I’d like to present a case I treated that may help other families.

An early 50s male was referred to me by a neurologist because of recent thinking and behavioral changes. He had seizures due to a condition he was born with called Chiari malformation causing a mild learning disability in school and missed by the school system. Nonetheless, he managed through school, work, and his personal life.

But there were changes in his functioning over the past year and his wife, family, and friends were concerned.

His family doctor thought he should see a mental health professional (and what does that mean?) and a neurologist who referred the patient to our practice to help determine the nature of his condition, a diagnosis, and treatment plan.

He was administered a neuropsychological examination (NPE) which is our form of a CT/MRI of the brain showing all the thinking and behavioral components of the brain.

The NPE not only identified the source for the seizures, but also a pattern of findings consistent with a learning disability, again missed by the school system.

Finally, the most significant finding from the NPE was a pattern of results consistent with a type of dementia called Frontal Temporal Dementia (FTD). This type of dementia causes significant problems with thinking, daily efficiency, insight/judgement, proper behavior, organization, and skills that enables normal daily functioning.

Also, this type of dementia affects the frontal lobes of the brain which is the seat of our personality. I asked his wife if he had any unusual thoughts and beliefs and the entire family reacted YES, out of character for him, plus finally a doctor validating what they have been witnessing for a while. This is common with FTD. For e.g., he accused his wife of having an affair with his friends. These are called delusions and could easily be misunderstood as a psychiatric symptom, rather than a brain-based condition.

Once this was explained to the family in a follow up office visit after the NPE, they understood what to do and now we could start appropriate treatment.

The tragedy today with our aging population is this story is oftentimes not identified causing undue stress.

If you feel you have concerns regarding a family member’s behavior, don’t waste time. Get an answer. Give us a call and we shall direct you accordingly.

 

Robert B. Sica, PhD, ABN
Board certified, Neuropsychology
Founder and Director of NRS|LS

 

 

 

Connected Check-in Time: A strategy to Reduce Low Self-Esteem in Children and Adolescents with Mood Disorders and Improve Parent-Child Relationships.

A transactional model exists between a parent and a child. A child is born with sensitivities and emotional reactivity that can stress an environment, especially when the environment is not well suited to meet the child’s needs.  Meaning, the interaction between the child’s behavior and the parent’s reaction to it can further emotionally dysregulate the child if the environment is unable to respond appropriately. This leads to a vicious cycle.

Children with self-regulation difficulties or mood disorders are at a greater risk to receive negative interactions from their social worlds (i.e., parents focusing on what their child is not doing or teacher’s frequently redirecting their behaviors), which impacts their self-esteem because they feel they are always getting into trouble. These children/adolescents tend to receive mixed reactions from their social world which leads to internal confusion and lack of trust in their feelings. This directly impacts their self-esteem and relationships as they develop.

One step, parents and children can take to break the vicious cycle and provide a positive alternative is by incorporating “connected check-in” time daily.

What is connected check in time?  It is special time set aside daily for 10-15 minutes.

·       During this time, the parent follows the child and/or adolescent’s lead in whatever play or topic of conversation the child/adolescent chooses.

·       This time is special because it is free of demands, directives by parents, consequences, requests, judgments, or feedback.

·       Instead, the parent’s role is to actively listen, observe their child’s/adolescent’s words and behaviors, validate their child’s/adolescent’s feelings, provide positive labeled praise (i.e., I really like how well you explained or showed me that toy/topic), and reflect the child/adolescent’s words back to them, so they feel understood.

·       Often children with self-regulation and mood disorders feel their feelings have been invalidated by being told “you’re overreacting,” “it is not that big of a deal,” or “calm down.”

**By having the parent join in on whatever activity or topic the child and/or adolescent would like to engage in and providing positive labeled praise and reflecting what your child has said validates their experience and offers a positive alternative.

·       Connected check in time improves the child’s and/or adolescent’s self-esteem by allowing them to be in control and have positive interactions with their parents instead of arguing. It strengthens the parent child relationship because it offers a time to repair the relationship and work as a team.

If you have any questions, please contact our office.

Tali Frankfort, PsyD
Neuropsychology Postdoctoral Fellow
NJ Permit #213-056