Author: NRS Lifespan

Developing Children and Oppositional Defiant Disorder (ODD)

Many parents may have difficulty identifying why their child is having behavioral issues and they don’t know why their child is often uncooperative and acting defiant. Oppositional Defiant Disorder, known as ODD, is a behavioral disorder that causes children to display these behaviors, and it may be the answer as to why your child is having problems. There is not one specific reason a child may be diagnosed with ODD, but many factors can contribute to this condition. ODD can be influenced by relationships, environment, genetics, and other psychological health factors, which can lead to a child being uncooperative and defiant. ODD often coexists with other psychological conditions such as ADHD, anxiety, and depression which are becoming more and more prevalent in children today.

The common signs of ODD consist of, but are not limited to;

·       Frequent loss of temper

·       Being uncooperative/unwilling to follow rules

·       Argumentative to authority figures and/or peers

·       Lack of ownership for mistakes/blaming others for their problems

·       Opposition to small and unimportant rules and requests

Along with the different behaviors, the severity of ODD may depend on the setting the behaviors are taking place. Mild cases of ODD may occur in one setting such as at home with a parent or at school with a teacher, whereas more severe cases can be observed across many different settings. The frequency of these behaviors must also be monitored because not every child who shows opposition is subject to ODD. These signs and symptoms typically need to surface consistently at least once per week over the course of six months in order to show that an issue may be present.

Without proper intervention, ODD can cause issues for children as they develop into adolescents and adults. Early intervention is essential to helping your child reach their full potential and prevent further issues related to ODD. If you believe your child may be showing signs of ODD, contact our office for a consultation to learn more.

Oppositional defiant disorder. (ODD) – Signs, Symptoms & Treatment | Nationwide Children’s Hospital. (n.d.). https://www.nationwidechildrens.org/conditions/oppositional-defiant-disorder

Substance Abuse and Mental Health Services Administration. (n.d.). Table 18, DSM-IV to DSM-5 oppositional defiant disorder comparison – DSM-5 changes – NCBI bookshelf. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t14/

Cerebrovascular accidents (CVA’S) more commonly known as stroke, remains a major health concern around the world.  Within the United States, approximately 800,000 individuals are diagnosed and treated for stroke annually.  It is the 4th leading cause of death behind cardiovascular disease (e.g., heart attack), cancer, and accident-related trauma.  When symptoms arise, it must be considered a “medical emergency” and one that requires acute medical attention.  The acronym (FAST) is associated with stroke:

·        FACE, does the face droop to one side?

·        ARMS, does an individual have motor weakness in one arm as opposed to the other?

·        SPEECH, does the individual present with slurred or difficulty repeating words?

·        TIME, this is of the essence, call 911 or seek emergency medical attention immediately if you notice these symptoms!

As noted above, typical symptoms associated with stroke include, but are not limited to numbness, weakness, or paralysis, generally involving one side of the body including the face, arm, or leg, speech difficulty (e.g., slurred speech, inability to repeat words or phrases), imbalance or poor coordination during walking, or severe headache.

Two primary causes of stroke are the result of a blocked or clogged artery in the brain (ischemic stroke) for leaking/perforation of a blood vessel in the brain (e.g., hemorrhagic stroke).  The latter may also be due to a rupture of an irregular or thin-walled group of blood vessels known as an arteriovenous malformation (AVM).  A transient ischemic attack (TIA) may manifest with symptoms associated with stroke but only occur briefly and rarely resulting in any type of permanent brain damage.  However, TIA’s are clearly a precursor for a future stroke.

While emergency medical treatment, medications, and rehabilitation often reduces the risk for permanent and disabling symptoms, the “best medicine” is undoubtedly prevention.  While you cannot change a person’s age, race or ethnicity, sex, or genetic predisposition, there are many ways to prevent or reduce the risk of stroke, as noted below:

·        Monitor or control blood pressure; high blood pressure is the leading cause of stroke

·        Lower cholesterol levels; having a balanced diet, exercises, using prescribed medication

·        Control blood sugar levels; diabetes is a contributing factor to stroke

·        Limit alcohol intake; excessive heavy or binge drinking raises an individual’s blood pressure

·        Stop smoking or vaping; these activities increase the risk for stroke

·        Never use illegal drugs; only used prescribed medication

·        Watch your weight; be aware of your weight and body mass index (BMI) as obesity increases the risk of stroke

·        Participate in a regular exercise program; this should include both cardio and weight lifting training

·        Maintain a healthy diet; this should include eating fruits and vegetables and limiting the intake of sugar, salt, and unhealth fats

·        Comply with prescribed medications; this will help in the management of high blood pressure, high cholesterol, and diabetes

·        Stress management; there is a positive correlation between any stroke and high levels of anxiety and life-stressors

In summary, common strategies for stroke prevention are best identified and implemented through the recommendations of your primary care physician and other appropriate medical specialists.  More importantly, you as the patient, must comply with the aforementioned strategies for stroke prevention and treatment recommendations.

For additional information regarding stroke treatment or prevention, please contact our office at 732-988-3441.

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

The diagnosis of ataxia for your child is a difficult experience for any parent.
Ataxia is a very complex disease and can be challenging to understand and diagnose, especially
when working with young children. In simple terms, ataxia can be interpreted as impaired
coordination and medically understood as a disease of the nervous system. This can
impact balance, speech, and fine motor skills. Additionally, it is not a singular condition but instead a
symptom to underlying neurological concerns.

When recognizing the development of ataxia it is important to be aware of the various forms
that can be present. Prominently, deciphering whether the ataxia is acute or chronic is crucial.
Following this, most cases of acute ataxia stem from underlying causes, while chronic ataxia can
arise from either primary or secondary factors. The diagnostic process consists of a thorough
neurological and physical examination, as well as review of medical and family history. In some
cases brain imaging tests are needed to make further distinctions, including MRI or CT scans.

Following the diagnosis, the focus shifts to managing symptoms and, if identifiable,
addressing the underlying cause. While advances have been aquired for some disorders that
correlate to ataxia in recent years, most hereditary disorders that are associated with it are not fully
treatable. At present, treatments are limited to addressing vitamin E deficiency and ataxia alongside
coenzyme Q deficiency. Although there is an increasing number of disorders undergoing clinical
trials and product development, the focus primarily revolves around only two forms of ataxia,
Friedreich ataxia and Ataxia Telangiectasia. Symptoms can be alleviated and improved through
other remedies such as occupational, speech, and physical therapy, medications and adaptive
technology. Additionally, comprehensive genetic testing results can help eliminate the possibility of
other medical conditions, offering clarity and accuracy in diagnosis. The insights gained from an
in-depth genetic analysis not only aid in ruling out alternative diseases but also empower patients
and their families with knowledge to make informed decisions about their healthcare and familial
risks.

Most importantly, it is essential to care for your child emotionally and physically, and
approach this disease with a well informed mindset. Continue to educate yourself about ataxia in
order to advocate and support your child effectively. With appropriate care, many children with
ataxia have fulfilling lives and are capable of achieving their goals and aspirations. Embrace the
journey, celebrate milestones, and remember that you are not alone. Together, as a family and with
the support of healthcare professionals and community resources, you can navigate the challenges
of ataxia and help your child thrive.

David R. Lynch, Ashley McCormick, Kimberly Schadt, Elizabeth Kichula, Pediatric Ataxia: Focus on
Chronic Disorders, Seminars in Pediatric Neurology, Volume 25, 2018, Pages 54-64, ISSN
1071-9091, https://www.sciencedirect.com/science/article/abs/pii/S1071909118300019

Chronic Traumatic Encephalopathy (CTE) is a brain condition usually associated with boxers and football players.  Recent American Medical Association Journal (JAMA Neurology) revealed surprising evidence:  Of 152 brain examinations from contact sports athletes under the age of 30, more than 40% had evidence of CTE, suggesting that it can start much earlier than expected.

What happens in the brain?  When the head receives a blow or a sudden stop and acceleration as happens with a football tackle, the brain moves inside the skull, creating shearing forces that could damage tiny blood vessels (microhemorrhages), and nerve connections (axonal injuries).

As the brain bounces back and forth, the damage causes an abnormal protein called Tau to build up inside the folds of the brain surface called the cerebral cortex sulci.  Tau protein eventually builds up in the sulci and is diagnostic for CTE.  The cortex is the part of your brain responsible for thinking, memory, reasoning, emotions, and learning.

Who is at risk?  There are 4 million sports-related concussions occurring in the US each year, and about 70% of people with repeated concussions may develop CTE.  A big question is why some people develop it and others do not.  It may be that some athletes are at higher risk genetically.

Diagnosis

Researchers are developing guidelines for before-death diagnosis based on history and symptoms called Trauma Encephalopathy Syndrome (TES).  To diagnose TES, an athlete must have:

• A history of repeated head trauma.
• CTE symptoms, at least 12 months.
• A history of symptoms getting worse.
• No other diagnosis that could cause the symptoms.

CTE develops in stages.  The earliest symptoms are subtle cognitive, emotional, and behavioral changes.  These stages include:

• Mood symptoms – Depression, anxiety, and paranoia.
• Behavioral symptoms – Impulsive or aggressive, and anger.
• Cognitive systems include confusion, short-term memory, and poor judgment.
• Motor signs walking and balance problems, and trouble speaking.

There is no cure for CTE, but symptoms can be treated.  Here at NRS|LS, we are one of the seven original programs treating concussion and traumatic brain injury, extending back to 1978.  The following are the stages that need to be applied in order to help the individual:

1.     Consultation.  The athlete needs to understand the nature of his/her changed profile.

2.     A neuropsychological examination.  This is a “blueprint” that describes the functional expression of the physical changes that have occurred in the brain in the form of thinking changes, and behavior.  It enables a rehabilitative program to help the athlete understand what they have, what the adjustment strategies are, an understanding of the functional expression of these problems in daily functioning, and what they can do about it.

3.     Biofeedback.  Many of the athletes develop significant adjustment reactions in the form of depression, as well as agitation.

4.     Cognitive rehabilitation.  These are cognitive exercises enabling the athlete to develop compensatory strategies adjusting to their thinking problems.

5.     Medication.  There are medications for mood changes, depression, and anxiety.  Some medications used for Parkinson’s and Alzheimer’s may help memory and movement problems.

In closing, untreated CTE may increase the risk of accidental death or suicide.  Life expectancy for people with CTE is about 70 years old.  Education and intervention is critically needed for this population.

If you have a history of repeated head traumas, be it sports, accidents, etc., please call us and we will certainly be able to help you understand your situation and what you can do about it.

______________________________
Robert B. Sica, Ph.D., ABN
Board-Certified in Neuropsychology
Director, Neuropsychological Rehabilitation Services|LifeSpan
Director, Post-Doctoral Fellowship Supervisor
Jersey Shore University Medical Center, Neuroscience Division
Department of Neurology and Psychiatry
Clinical Assistant Professor, Rutgers-Robert Wood Johnson Medical School
Clinical Assistant Professor, Hackensack Meridian School of Medicine

Some Facts About Concussion

Concussion, also called mild traumatic brain injury, can occur due to motor vehicle accidents, hitting the head during a fall, or playing contact sports. Symptoms following the event depend on the severity of the injury and vary from mild confusion and disorientation to a complete brief loss of consciousness. These symptoms occur due to an abnormal movement of the brain inside a skull, which disrupts the functioning of the brain cells at the molecular level. These changes are often undetectable during the neuroimaging studies. Neuropsychological testing is method that is sensitive in identifying neurocognitive changes after a concussion such as problems with attention, information processing, memory, reasoning, etc.

The most severe symptoms are experienced within minutes and hours after the injury and gradually improve within days or weeks. Most people fully recover after 3-6 months. The length of recovery depends on many factors, such as the specifics of the injury, the person’s age, medical conditions, history of previous concussions, stress, previous psychological history, and current psychological symptoms, including anxiety and depression. Some people continue to experience headaches, sleep problems, fatigue, vision or balance abnormalities, and behavioral changes after the expected time of recovery. These symptoms, with proper treatment, can also improve.

The research indicates that it is essential for patients to receive accurate information and education about concussion and have positive, realistic expectations about the recovery process. A lack of information leads to a so-called ‘misattribution bias’ where patients think of common mild cognitive fluctuations caused by fatigue, pain, or psychological symptoms as symptoms of severe and permanent brain injury.

At NRS|LS, patients receive comprehensive care (i.e. neuropsychological and psychological testing, counseling, cognitive rehabilitation, etc.) for concussion and post-concussive symptoms. Please call our office if you have any questions or would like a consultation.

Eleonora Gallagher, Psy.D.
Clinical Psychologist #7297
Neuropsychology Post-Doctoral Fellow

.

Aphasia is a language condition that affects an individual’s ability to understand and express language, as well as their ability to read and write. Aphasia most often occurs suddenly as the result of brain injury caused by a stroke, head injury, or brain tumor, but it can also present slowly in progressive neurological conditions such as Alzheimer’s or different types of dementia.

While there are multiple different types of aphasia, many of them fall into two broad categories that are referred to as fluent and non-fluent. The most common type of fluent aphasia is called Wernicke’s aphasia, and it is caused by damage to the temporal lobe. This condition is characterized by an individual who can speak fluently, but what they are saying may be confusing and lack meaning to others. In addition, people with Wernicke’s aphasia are often unaware of their spoken mistakes, which can cause a great deal of frustration.

Moving to non-fluent aphasia, the most common type is Broca’s aphasia. This is caused by damage to the left side of the frontal lobe, which is an area that is responsible for speech and motor movements. People with this kind of aphasia may speak in short, fragmented sentences that lack connecting words such as “but,” “or,” and “and.” Despite their lack of fluency, individuals with Broca’s aphasia are still able to use words in the correct context.

Neuropsychological evaluation is an excellent tool for identifying the different types of aphasia. In addition, it is always recommended to evaluate the totality of brain functions in order to best serve the patient. If you or a loved one is experiencing symptoms pertaining to a neurological condition, please call our office to schedule a consultation.

Gianna Scimemi, M.A.
Psychometrician & Doctoral Student

“Family History Is Not Useful in Screening Children for Dyslexia” Journal of Pediatric Neuropsychology, Volume 8, pages 15–21, published 2022 

New Research in Dyslexia Screening

Dyslexia is a learning disorder that involves difficulty in reading due to problems in identifying speech sounds and how they relate to letters and words. Early assessment and intervention are very important in helping children with dyslexia. This assessment usually involves looking at family history and completing tests. Recently, a study by Emilio Ferrer, Bennett A. Shaywitz, John M. Holahan, and Sally E. Shaywitz titled “Family History Is Not Useful in Screening Children for Dyslexia,” published in volume 8 of the Journal of Pediatric Neuropsychology, challenged the idea of using family history as a screening tool for dyslexia.

The study tracked 398 children from age 5 through adulthood to evaluate the effectiveness of using family history as a screening measure for dyslexia. The researchers compared the predictive value of family history against evidence-based early screening measures. The researchers looked at how sensitive family history was in predicting dyslexia. They found it was ineffective across all family member groups, with its sensitivity rates ranging from as low as 5% (for grandparents) to a maximum of 51% (for first- and second-degree relatives). These low sensitivity rates indicate that relying on family history alone would result in many dyslexic children being misclassified as typical readers. Evidence-Based Screening, however, was significantly more effective in detecting dyslexia, and even adding family history to the screening process did not improve the accuracy.

The findings suggest that using family history to identify dyslexia is not only inadequate but potentially harmful because misclassification can delay intervention for dyslexic children, negatively impacting their education. Instead, evidence-based screening tools that are specifically designed to identify early signs of dyslexia are encouraged. These tools focus on measurable skills such as letter knowledge and phonological awareness, which are more reliable indicators of dyslexia risk.

Effective early screening for dyslexia is crucial for timely intervention and support and validated, evidence-based screening measures can help to improve the accuracy of dyslexia identification and provide better outcomes to ensure that all children at risk of dyslexia are accurately identified and receive the necessary support to thrive in their educational journey.

If you are concerned about your child’s reading abilities, please call our office to schedule a consultation.

Sincerely,

______________________________
Steven P. Greco, Ph.D., ABN
Board-Certified in Neuropsychology #485
Partner, Neuropsychological Rehabilitation Services|LifeSpan
Post-Doctoral Fellowship Supervisor
Jersey Shore University Medical Center, Neuroscience Division
Department of Neurology and Psychiatry
Clinical Assistant Professor, Rutgers-Robert Wood Johnson Medical School
Clinical Assistant Professor, Hackensack Meridian School of Medicine

Supplemental Magnesium 

With social media being an ever-expanding source of information, there is always new advice about supplements and medicines. One new, viral trend has been taking magnesium supplements to improve sleep and reduce anxiety. There is always research to be done, but current work has shown that magnesium can help combat anxiety and sleep disturbances.

Magnesium is an essential mineral in the human body, and much of the United States population does not meet the recommended daily allowance (RDA) for magnesium and is at risk for possible insufficiency. Magnesium has been used to treat migraines, arrhythmias, and acute asthma exacerbations, and as a laxative. It is also used in obstetrics for the treatment of eclampsia and pre-eclampsia and in neuroprotection for premature infants.

Neurobiologically, magnesium ions function as NMDA receptor antagonists, meaning they stop the NMDA receptor from producing a response by binding to the receptor in place of calcium. The NMDA receptor is the primary excitatory neurotransmitter in the human brain, so magnesium prevents the excessive activation of the receptor. Magnesium also binds to and stimulates GABA receptors in the brain, which also relaxes the brain.

One review of many articles looking at the relationship between magnesium, sleep, and anxiety has shown that in higher doses it can help to improve sleep and reduce anxiety. Four out of the five studies using MgO reported positive results, and a study using magnesium L-aspartate also showed improvements in sleep quality. Further, five out of seven studies featuring anxiety-related outcomes reported positive results, with higher doses causing greater reductions in anxiety. Variations in the results are attributable to differences in the form of magnesium, dosage, and time period; however, overall, magnesium improved sleep quality and reduced anxiety.

Examining the Effects of Supplemental Magnesium on Self-Reported Anxiety and Sleep Quality: A Systematic Review.

Alexander Rawji, Morgan Peltier, Kelly Mourtzanakis, Samreen Awan, Junaid Rana, Nitin Pothen, & Saba Afzal (2024, Cureus).

The lead author, Dr. Alexander Rawji, is currently completing a neuropsychology rotation at NRS|LS. 

Disclaimer:  Always consult and obtain approval from your primary health care physician before taking an over-the-counter medication.

Unfortunately, many women with autism go undiagnosed. Historically, autism has been diagnosed more frequently in males than females, leading to a gender bias in research and clinical understanding. This bias stems from the fact that autism presents differently in females, often manifesting in subtler ways that may be overlooked or misinterpreted.

Females with autism often exhibit different behavioral patterns and coping mechanisms compared to males. They may display stronger social skills, as they tend to have a larger emotional vocabulary, greater awareness and desire for social interaction, and an ability to mimic others in social situations. They also tend to have intact symbolic and imaginary play and may develop a few close friendships. Their restricted interests may be more related to people and animals rather than inanimate objects, which is often seen in males.

Often, women will go undiagnosed because their behaviors may be mistakenly attributed to shyness, anxiety, or other conditions. Autism in females is a complex phenomenon, but by recognizing the distinctive characteristics, more women can get the support they need.

Camouflaging in ASD

Some people with Autism Spectrum Disorder may hide or camouflage their symptoms, making it harder to recognize and diagnose. Research points to this being a protective effect, more common in females. This “Camouflaging Effect” is because females are more likely to hide behaviors associated with Autism Spectrum Disorder likely because of social pressures, leading to higher rates of internalizing disorders like anxiety, depression, and eating disorders.

There are three categories of camouflaging. The first one is compensation, which is how an individual compensates for social challenges. This is often in the form of copying the behaviors of other people. The second category is masking, which is how an individual attempts to hide autistic characteristics. This can be done by forcing eye contact and tolerating overwhelming situations even when in distress. The third category is assimilation which is how an individual fits in with others in social contexts like forcing interactions with others. Camouflaging in Autism Spectrum disorder is a complex trait that can make identification harder.  Hence, comprehensive neurodevelopmental assessment is recommended in order to provide a thorough understanding of the child or adolescent.

If you have any concerns about a social emotional developmental condition, please call our office to schedule a consultation.

A frequent referral to our practice is to diagnosis and differentiate complex neuropsychological presentations. A common example is to differentiate different types of conditions, such as, Bipolar Disorder, Oppositional Defiance, Disruptive Mood Dysregulation Disorder, Conduct Disorder, ADHD, OCD, etc.  This blog post focuses on mood related conditions.

Bipolar disorder, intermittent explosive disorder, and disruptive mood dysregulation disorder (DMDD) are three main mood disorders that may be difficult to differentiate between.

In bipolar disorder, children present with symptoms of both major depressive disorder and mania. In children, depressive episodes may present as a decrease in interest in life, agitation, inconsistent sleep (too much or too little), appetite changes, lower energy and activity levels, inability to concentrate, sadness, feelings of worthlessness or guilt, and thoughts of self-harm, etc. Manic episodes would include an elevated, euphoric mood inflated self-esteem, increased energy levels, decreased need for sleep, increased talkativeness, racing thoughts, distractibility, and increased impulsivity. Children can cycle through these states significantly faster than adults with bipolar disorder, but they still have distinct depressive and manic episodes.

Intermittent explosive disorder is classified by repeated, sudden episodes of impulsive, aggressive, violent behavior or angry verbal outbursts, which are too extreme for the situation. The outbursts are short and not premeditated, examples of this can include road rage with adults. The onset of recurrent, problematic, impulsive aggressive behavior is most common in late childhood or adolescence and rarely begins for the first time after age 40 years. This condition cannot be diagnosed before 6 years of age.

If the child’s irritability is persistent and particularly severe, they may, instead be disruptive mood dysregulation disorder (DMDD). Outbursts characteristic of DMDD are more frequent, and the child’s mood between the outbursts is persistently irritable or angry most of the day, nearly every day. The outbursts start before the age of 10 and can be diagnosed only between the ages of 6 and 18 years old.

Children experiencing sudden outbursts or irritability and aggression may have intermittent explosive disorder rather than bipolar disorder.  Sudden outbursts of irritability and aggression could be mistaken for Bipolar Disorder; however they are more consistent with Intermittent condition.  As a result, a thorough assessment of the child including collateral information is necessary.

At NRS|LS we employ a comprehensive approach to assessing mood disorders. Our data is collected from parents, teachers, other significant family members, medical team providers of the child’s care, objective data pertaining to the child, etc. Treatment recommendations will vary depending upon accurate diagnostic procedures and outcomes.

Please call our office if you have any questions or would like a consultation with our neuropsychologist.