Author: NRS Lifespan

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

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 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

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/

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

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

Chemo brain, also known as cancer-related cognitive impairment or chemotherapy brain fog, is a condition that can be caused by chemotherapy treatment, the cancer itself, or other cancer treatments. Of note, chemo brain is not dementia and there is no evidence that it leads to dementia.

“It feels as if you’re wearing a cap on your head that’s made of fog.” – Cancer survivor

Symptoms of chemo brain include forgetfulness, word finding difficulties, poor focus and concentration, difficulty multitasking, taking longer to complete routine tasks, disorganization, and feeling sluggish.

Chemo brain is extremely common. In fact, as many as 75% of cancer patients have experienced it during their treatment, and approximately one third of patients continue to struggle with it after treatment. For most individuals, the effects resolve within 6-9 months. But for others, the fog persists for years and sometimes even decades.

Unfortunately, the cognitive side effects of cancer treatment can be debilitating, leading to a cancer patient’s inability to return to work and/or school. The goal is for individuals not only to live as long as possible, but also live a high-quality life.

Research has shown that individuals with chemo brain benefit from Cognitive Rehabilitation, which is a treatment focused on learning to adapt and cope with the above symptoms. The NRS|LS Cognitive Rehabilitation Program offers an individualized treatment plan with a full range of services, from consultation to treatment completion.

If you or a loved one is suffering from cognitive changes secondary to a cancer diagnosis, please call our office for a consultation.

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

Have you asked yourself:

Am I just tired?
What is the difference between being tired and having “fatigue”?
Is there something physically wrong with my body to cause me to feel tired or is this stress?

“Being tired all the time” is quickly rising to the top of the list of complaints to medical doctors who have the difficult task of trying to identify whether a patient is tired (AKA chronically sleepy) or fatigued (AKA chronically lacking energy). Hard to tell the difference, right?

There are actually three different forms of fatigue:

• Physical fatigue – which may occur at the end of a long, busy day
• Pathological fatigue – refers to tiredness brought on by overworking the body’s defense system (the “stress-fatigue” connection)
• Psychological fatigue – result from constant worry, excessive productivity, depression, boredom, and isolation

Medical doctors may refer to clinical health psychologists to evaluate and treat fatigue brought on by stress and emotional factors. Psychologists also consider the behavioral and cognitive elements that often accompany the physical feeling of having very little energy, such as:

• the inability to initiate activity (how hard it is to start something)
• reduced capacity to maintain activity (how long one can do something before burning out, “stamina”); and
• difficulty with concentration, memory, and emotional stability (“brain fog”-type symptoms).

Seeing your medical doctor is a great first place to start if you’re concerned about these issues. It is important to rule out medical causes for diminished energy and potential sleep disorders. If you would like to meet with a clinical health psychologist to discuss, call the scheduling department at 732-988-3441 to set up a consultation appointment.

Lauren Gashlin, PsyD
Clinical Health Psychologist

There are about six million motor vehicle accidents (MVAs) that occur in the U.S. each year, with 2.5 million resulting in injuries. Many times injuries sustained are psychological and emotional in nature. In fact, the National Institute of Mental Health (NIMH) research found that 39.2% of MVA survivors develop symptoms of posttraumatic stress disorder (PTSD).

What is PTSD?

PTSD is triggered by a life-threatening event. The American Psychiatric Association (APA) defines PTSD as a psychiatric disorder that develops when an individual experiences or witnesses a traumatic event with secondary psychological symptoms. Traumatic events could include a serious car accident in which a person is threatened with serious injury or death.

Common PTSD Symptoms

• Anxiety
• Depression
• Fearfulness
• Sleep problems
• Recurring nightmares
• Flashbacks from the accident
• Headaches
• Avoidance behaviors (e.g., avoiding driving or being near a car)
• Irritability
• Guilty feelings

Risk Factors for PTSD after MVA

• Dissociation (e.g., feeling of being detached from reality) during or after the accident
• High emotionality during or after the accident (e.g., fear, helplessness, horror, guilt)
• Perceived life threat to self or others
• History of mood disorders (e.g., depression, anxiety)
• Prior experience of trauma
• Obsessive thinking and avoidance behaviors
• Lack of social support after accident

Treatment

High emotionality can follow after an MVA. Most victims report experiencing shock, guilt, fear, and helplessness. Typically, these symptoms subside over time. But if symptoms persist or get worse, one should seek treatment. There are many effective treatments available for PTSD, and recovery is possible. At NRS|LS, we offer cognitive behavioral therapy (CBT) for PTSD, including Biofeedback. Here, you can learn necessary skills to cope with emotional symptoms and regain control over your life.

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

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

Autism Spectrum Disorder, or ASD, is a neurodevelopmental condition that represents with a variety of clinical characteristics.  Some signs could be weaknesses in social skills and communication, restricted interests, repetitive behaviors, etc. The CDC estimates that 1 in every 54 US children has autism. However, not all children, adolescents or adults are diagnosed equally.  The male-to-female ratio for ASD diagnoses in the US is widely reported as 4:1 (Green et al., 2019). The disparity widens as intelligence increases, suggesting that females with higher cognitive and language abilities tend to receive diagnoses later or go unidentified completely (Jamison et al., 2017). This ratio is likely a misrepresentation of the true prevalence of ASD across gender, a complex issue underpinned by a number of contributing factors.

The diagnostic gap is, in part, caused by bias towards the detection of male symptoms in existing diagnostic techniques. Meta-analysis studies on how clinicians diagnose ASD show that female patients, on average, have less restricted and repetitive behaviors and interests.  These gender discrepancies have created a body of data with drastically greater male representation than female representation, upon which further analysis is performed, perpetuating the diagnostic gap.

There are also differences in the presentation of ASD in male and female persons, observed throughout the lifespan. Childhood and adolescence are two highly sensitive periods for the detection of ASD and are also where these differences in presentation are most observed (Jamison et al., 2017). A 2014 study on the “female phenotype” of ASD found that, beginning in childhood, the speech of females contains more vocabulary words related to emotions when compared to males. Females with ASD are also reported to have restricted interests related to people and animals instead of inanimate objects, common in males (Green et al., 2019). In adolescence, there is a notable gender divergence in the psychiatric comorbidities reported in individuals with ASD. Compared to females, males show heightened rates of externalizing disorders, including possible oppositional tendencies, hyperactivity, and inattention. After the age of 15, females with ASD have “exceptionally high risk” of developing depression and experience elevated rates of internalizing disorders, like anxiety and eating disorders, compared to adolescent males with ASD (Green et al., 2019). On average, females are diagnosed later in life than males. This can mean a lifetime of feeling misunderstood, possibly contributing to this observed pattern.

It is also important to consider the contributions that social constructions of gender make in the diagnostic gap in ASD. Stereotypes and socialization play a role in how parents, educators, and clinicians interpret certain behaviors and recognize them as symptoms of AS

As these factors are identified and discussed in ASD literature, progress is being made to close the diagnostic gap. Recent studies show a trend towards a lower gender ratio and a dissociation of gender from intellectual disability, which suggests that improvements are being made in identifying high-functioning females (Lai et al., 2015). With sensitivity to the differences between male and female presentations, ASD research should focus on identifying all persons on the spectrum and to identify each person’s strength/weakness and grow to be more inclusive in the future.

If you have any questions, please call our office.

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

References:

Green, R. M., Travers, A. M., Howe, Y. & McDougle, C. (2019). Women and autism spectrum disorder: Diagnosis and implications for treatment of adolescents and adults. Current Psychiatry Reports, 22, 1-8. DOI: 10.1007/s11920-019-1006-3

Jamison, R., Bishop, S. L., Huerta, M. & Halladay, A. K. (2017). The clinician perspective on sex differences in autism spectrum disorders. Autism, 21(6), 772-784. DOI: 10.1177/1362361216681481

Lai, M., Lombardo, M. V., Auyeung, B., Chakrabarti, B. & Baron-Cohen, S. (2015). Sex/gender differences and autism: Setting the scene for future research. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 11-24. DOI: 10.1016/j.jaac.2014.10.003