Category: News

By Dr. Scott Mathias
ABN Committee Chair

In  the most recent publication from The American Board of Professional Neuropsychology (ABN) (summer 2022), NRS|LS was chosen as a featured training site through the Academy of the American Board of Professional Neuropsychology (AABN) for exceptional training experience in neuropsychology.

The following was taken from the publication,

“Every so often we like to feature one of our AABN sites to highlight the exceptional training experiences in neuropsychology being offered through AABN. Neuropsychology Rehabilitation Services|LifeSpan (NRS|LS) in Tinton Falls, New Jersey has been an approved AABN site since 2015. Neuropsychology Rehabilitation Services|LifeSpan is a joint practice consisting of a neuropsychological rehabilitation program, a multi-specialty health psychology program and a behavioral health program treating a variety of mental health conditions. The Director of Training is Robert Sica, PhD, ABN, FACPN, though he has a partner, Steven Greco, PhD, ABN, as well as another neuropsychologist, Michael Raymond, PhD, ABN, who contribute to the neuropsychology training experience. Dr. Sica was the first clinical neuropsychologist on staff at Jersey Shore University Medical Center, Neuroscience Division, and Riverview Medical Center, both hospitals part of Hackensack Meridian Health. Dr. Sica has academic affiliations with Rutgers-Robert Wood Johnson Medical School and Seton Hall – Hackensack Meridian School of Medicine. He has expertise in brain injury rehabilitation. He developed an APA approved internship program in neuropsychology. He also provides legal/forensic neuropsychological support in judicial settings at a state and local level. Dr. Sica obtained his first board certification in neuropsychology in 1984 from the American Board of Professional Neuropsychology, and his second in 1992. Through his wealth of experience in the field of neuropsychology, Dr. Sica and the ABN post-doctoral training program at Neuropsychology Rehabilitation Services|LifeSpan offer neuropsychological residents a broad and enriching professional experience with a predominant focus upon the clinical application of neuropsychology in the community.”

Weight loss is consistently identified as a major health-related goal of many Americans, and yet, many fail to have sustained success in both losing weight and keeping it off. Relapse is extremely common due to difficulties transferring gains made in the “action” phase of weight loss to the “maintenance” phase of weight loss. The action phase is where the rubber meets the road, so to speak (e.g., changing daily habits and routines, starting a nutritional plan, exercising). But the maintenance phase is where the road becomes a long stretch of highway called “healthy living”.

Ideally, the behavioral changes made during the action phase of weight loss coincide with greater education and awareness about the relationship between our thoughts, emotions, and lifestyle habits. For instance, research consistently finds that suppressing caloric intake (“I can’t eat more than 1,000 calories a day”) as well as thoughts about eating comfort foods (“Don’t think about cake or candy or chips or ice cream…”) actually increases food intake long-term. So while these strategies work temporarily, they ultimately have to be adapted into a system that is realistic in the daily grind of life.

Approaches that emphasize psychological skills like self-monitoring, emotion regulation, impulse control, intuitive eating, mindfulness, and stress management plus the behavioral weight loss components (recording physical activity and nutritional habits) are favored for long-term healthy weight management. The clinical health psychology program at NRS-Lifespan incorporates these principles and approaches into counseling. If you are interested in learning more, call our office at 732-988-3341 to schedule a consultation appointment with one of our clinical health psychologists.

Lauren Gashlin, Psy.D.
Clinical Health Psychologist
NJ License #5553

Stress is considered a global epidemic, affecting 350 million people worldwide and well recognized as a risk factor for various chronic conditions, including depression. Sources of stress range from daily “hassles” to major life events (e.g., serious accidents) and all involve a response to survive. The ability to effectively adjust requires us to alter our emotional responses to changing circumstances, which makes us psychologically flexible.

Unfortunately, adjustment is not always easy, especially for individuals who experience unhealthy, repetitive and negative thoughts (e.g., regrets about the past, self/other criticism). Dwelling on things is a risk factor for the development and maintenance of major depressive disorder (MDD). It is characterized by inflexible negative emotions. A common feature is brooding,  which also consists of unproductive thoughts such as “Why can’t I handle problems better?” or “Why do I feel this way?” Some people become stuck in their repetitive negative thoughts which undermines their ability to regulate and control emotions as they respond to stressors. This leads to unhealthy coping efforts (e.g., socially isolating, giving up) adversely affecting a person’s sense of control over their situation.

Deep breathing, also called diaphragmatic breathing, can break the vicious cycle of negative ruminative thinking, allowing an individual to regain control over their emotions when faced with stressors. A component of the mindfulness approach, deep breathing involves focusing attention on breathing, separate from repetitive thoughts. By detaching from negative thoughts, the individual focuses on the present, moment-to-moment experience, which induces calmness, peace, and relaxation. Any wandering thoughts are viewed as simply events occurring in the mind rather than representing a true reflection of how you truly feel. Thus, instead of changing the content of thoughts, you change your relationship to thoughts. Deep breathing represents a powerful self-control strategy. In fact, research findings support deep breathing practice as an intervention that significantly reduces repetitive thinking and associated depression, stress levels, and emotional reactions.

If you or a loved one is struggling with worry and/or depression, please call our office for consultation.

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

A controversial topic…. a neuropsychological review.

• Thanks to vaccinations and more widely available treatments, many patients who contract COVID-19 can avoid getting seriously ill, being hospitalized for treatment, or even dying.
• But even a symptom-free case of COVID can result in “Long COVID”, a condition that includes a wide range of symptoms from fatigue, difficulty thinking, behavior change, to a new diagnosis of diabetes or heart and lung problems.  People with Long COVID may be dealing with a single symptom or several at the same time.  The symptoms can last from days to weeks to months.
• The National Institute of Health (NIH) refers to long-term COVID-19, with many names.  One of them used here is Long COVID, and these patients are referred to as “long haulers.”
• The most common symptoms of Long COVID include fatigue, shortness of breath, cough, dizziness, palpitations, hair loss, gastrointestinal symptoms, heartburn, altered sense of smell and taste, and finally, brain fog, the area we shall focus upon here.
• Let’s review the research literature* investigating cognitive (thinking) functioning in patients with persistent complaints.  Persistent means a more chronic stage of recovery approximately 5.5 months after the COVID-19 diagnosis.  The studies showed mild cognitive deficits seen on neuropsychological testing that involved attention, processing speed, and organizational abilities.  The findings suggested that psychological factors and other persisting symptoms (example, sleep, fatigue) play a significant role in patients reporting thinking deficits in the long haulers of COVID-19.
• Thinking changes were found in patients during the acute or the early stage of the illness; however, the source of the thinking changes beyond five and a half months is unclear.  There were patients requiring higher levels of acute care who did not demonstrate greater cognitive deficits during comprehensive neuropsychological examination.  Nonetheless, findings are conflicting in the research.
• One possible explanation for the cognitive findings is that other factors such as mood difficulties, sleep dysfunction, and fatigue contribute to a person’s thinking.
• The most striking finding in many of the studies is that over 70% of patients had previously been diagnosed with depression or anxiety prior to the COVID-19 infection.  This high prevalence of prior psychological symptoms is consistent with previous findings in the clinical literature on COVID-19.
• The research suggests the importance of assessing and addressing psychological and cognitive symptoms in patients beyond five to six months.
• For “Long COVID”, there are many effective treatments for symptoms such as heart and lung-related issues, but fewer treatments for other COVID symptoms such as cognitive complaints and chronic fatigue have been established.
• There is no current specific treatment for Long COVID, and each symptom should be assessed and treated.  For example, the psychological changes of anxiety, depression, and PTSD – all possible symptoms – often respond well to available treatments such as medication and medical adjustment counseling focusing on compensatory strategies for the cognitive inefficiencies that patients experience.

Robert B. Sica, PhD, ABN
Board Certified, Neuropsychology
Principal and Director of NRS|LS

*Archives of Clinical Neuropsychology, Volume 37, Issue 4, June 2022, Pages 729-737

Post-traumatic stress disorder (PTSD) is considered a major health problem worldwide.  The aftermath and long-term effects of trauma often results in physical and behavioral difficulties.  The American Psychiatric Association published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).  Specific DSM-5 diagnostic criteria for PTSD is well established and supported by the National Center for PTSD.  Diagnostic criteria for PTSD is based on an individual who is exposed to a traumatic event that meets specific stipulations and symptoms from four symptom clusters including intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity.  Within those categories are eight (A-H) criteria.  Below is a brief explanation of all criteria A-H:

Criterion A:  The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence.
Criterion B: The traumatic event is persistently re-experienced.
Criterion C: Avoidance of trauma-related stimuli after the trauma.
Criterion D: Negative thoughts or feelings that began or worsened after the trauma.
Criterion E: Trauma-related arousal and reactivity that began or worsened after the trauma.
Criterion F: Symptoms last for more than 1 month.
Criterion G: Symptoms create distress or functional impairment (e.g., social, occupational).
Criterion H (required): Symptoms are not due to medication, substance use, or other illness.

Following the diagnosis of PTSD, an individual often benefits treatment interventions provided by a trained professional such as a psychologist, psychiatrist, or counselor.  During treatment, PTSD is often divided into four phases as noted below:

• Impact phase (addressing initial behavioral reactions)
• Rescue phase (period when an individual begins to accept aspects of trauma)
• Intermediate recovery phase (an individual begins to adjust to “normal” life experiences)
• Long-term reconstruction phase (period of learning and accepting the long-term effects of trauma)

In essence, it is imperative that an individual be diagnosed and treated as quickly as possible to minimize the potential adverse effects of trauma and to expedite a successful return to “normal” life experiences.  If you or a loved one is experiencing PTSD symptoms, please call our office for consultation.

Michael Raymond, PhD, ABN
Board Certified, Neuropsychology

 It has been well documented that there are co-occurring conditions with pediatric epilepsy.  The following is a recent review of the literature as to “what to look out for” when your child is diagnosed with epilepsy.

• In a study that included 6635 children with epilepsy, Aaberg et al (2016) found that 78.3% of the children had one or more co-occurring disorders.  These comorbidities included 55% medical disorders, 41% neurologic disorders, and 43% developmental/psychiatric disorders.  In addition, children with complicated epilepsy (epilepsy with additional neurologic or developmental disorders) had higher overall levels of comorbidity than those with uncomplicated epilepsy.
• In another study of 119 children with epilepsy, Dagar et al (2020) found that 41% screened positive for depression on a self-report instrument.  This study reported a strong correlation between anxiety and depression in participants with pediatric epilepsy.
• LaGrant et al (2020) also found a link between pediatric epilepsy and depression/anxiety, 25% of 1042 children had depression and/or anxiety.
• Dagar & Falcone (2020) found ADHD prevalence was 2.5 to 5.5 times higher in participants with epilepsy than those of the healthy participants.
• Record et al (2021) found most common co-occurring conditions with epilepsy was developmental delay at 56%, intellectual disability at 20%, and ADHD at 23%.  There were also 7% of participants that reported autism as a comorbidity.
• Behavioral disorders have also been observed to co-occur with pediatric epilepsy.  In a study of 50 participants, Elkarray et al (2021) concluded that 28% of the epileptic group studied were diagnosed with a behavioral disorder and another 14% were diagnosed with anxiety.  Oppositional behavior was the most common diagnosis at 52%, followed by ADHD at 44%, and major depressive disorder at 18%.

As neuropsychologists, we treat the entire child.  Therefore, if a child was diagnosed with epilepsy, treatment will focus on the neurological condition (i.e. epilepsy), however, also on possible co-occurring conditions.  The aim is to always treat the ‘whole child’ and capture the entire clinical picture.  Accurate diagnosis is the first step to determine appropriate treatment.  Identifying all co-occurring conditions is critical in order to provide thorough and accurate treatment.

If you have any questions regarding your child, please contact our office.

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

References

Aaberg, Kari Modalsi. (2016). Comorbidity and childhood epilepsy: A nationwide registry study.  Pediatrics 138(3).

Dagar, Anjali. (2020). Screening for suicidality and its relation to undiagnosed psychiatric comorbidities in children and youth with epilepsy. Epilepsy &Behavior 113.

Dagar, Anjali & Falcone, Tatiana. (2020). Psychiatric comorbidities in pediatric epilepsy.  Epilepsy & Behavior 113.

Elkarray, Rana A.Y. (2021).  Prevalence of psychiatric and behavioral comorbidities in pediatric epilepsy. Scientific Journal Pediatrics, 5(4). 813-818.

LaGrant, Brian. (2020). Depression and anxiety in children with epilepsy and other chronic health conditions: National estimates of prevalence risk factors. Epilepsy & Behavior 103.

Record, E. Justine. (2021).  Risk factors, etiologies, and comorbidities in urban pediatric epilepsy. Epilepsy & Behavior 115.

Forgetfulness can be an early warning sign of dementia, but it can also be part of the normal aging process.  The crucial question is:  How can you tell the difference?  Here at Neuropsychology Rehabilitation Services/LifeSpan (NRS|LS), we have been addressing this question for many years; however, with the assistance of the neuropsychological examination (NPE), we have been able to note a difference in patterns regarding clinical populations.

By the time we reach our mid-40s, there is a cognitive change in the average person. That change or cognitive decline is normal.  It is generally stable but slowly worsens with time.  Mild Cognitive Impairment (MCI) and forms of dementia, however, intensifies the person’s difficulties to a greater degree.

MCI is the middle stage between normal aging and the beginnings of dementia.  In MCI, forgetfulness and other thinking changes occurs, but it does not substantially interfere with daily functioning.  With dementia, forgetfulness, language changes, confusion, etc. now becomes more severe.

Here are some common differences between normal aging and signs of dementia:

• It is normal to temporarily forget an acquaintance’s name; it is not normal to forget the names of family members.
• It is normal to misplace things such as car keys; it is not normal to put them in unusual places, such as in the refrigerator.
• It is normal to need to think longer about things or have problems multitasking, but it is not normal to get easily confused.
• It is common to have trouble finding the right words, but it is not common to have trouble taking part in conversations.
• It is normal to forget the day of the week, but it is not normal to forget the season or year.
• It is normal to feel down occasionally, but it is not normal to withdraw or lose interest in activities that you once enjoyed.
• It is normal to get irritable when a routine is broken, but it is abnormal to get upset when in a new place.
• Getting lost while driving, frequent fender benders or traffic violations.
• Repeating the same questions over and over.
• Others notice thinking changes more than the person does who often will deny his/her problems or cover up their mistakes.

While the progression of dementia cannot be stopped, drugs and lifestyle modifications, particularly with MCI can stabilize your condition for as long as several years.  Regular exercise, and maintaining social contacts, reduce stress, and supplements are very helpful.

If you notice that either you or a loved one is struggling with the situations mentioned above, please give us a call for a neuropsychological consultation.  Our staff can direct you in a proper course of action and provide answers for what is going on.

Robert B. Sica, PhD, ABN
Board Certified, Neuropsychology
Principal and Director of NRS|LS

Sometimes it is hard to know if an experience we are having is “normal” or if we should seek help. It can be hard to track progress and know if the things we are doing to improve are working.

If we want to understand something better, we need to break it down into smaller, more digestible pieces. When we look at something in its totality it can feel too big and overwhelming. Let use anxiety as an example.

Anxiety and stress are not always detrimental to our health. In fact, there are very important evolutionary reasons why humans experience these emotions, but we’ll save that for another post. To evaluate our anxiety, we can use these three simple words – FREQUENCY, INTENSITY, and DURATION.

First, we want to take inventory of how often we feel anxious. Is anxiety experienced on a daily basis? If so, is there a specific reason for the anxiety? Do we always experience anxiety in certain situations or environments? What are they? Why? When an unwanted emotion is experienced on a very frequent basis it can evolve into an ever-growing and expanding problem, further impacting areas of our life.

Next, we want to look at the intensity of the emotion. For example, experiencing a moderate amount of anxiety spontaneously when someone cuts you off while driving is considered “normal”. However, experiencing moderate anxiety all day long for no explicit reason is very unsettling. Some people experience very intense moments of anxiety, called panic attacks. Breathing is a very important component to return the nervous system to a more relaxed state.

Lastly, we want to evaluate how long the experience lasts. In addition to making improvements by reducing the frequency or the intensity of an experience, we can look to shorten the length of time we experience an unwanted emotion. If we can reduce the length of a panic attack from 10 minutes to 5 minutes, we have made very significant progress. Finding ways to control these stressful situations is important in order to see success, maintain motivation, and put forth the necessary effort to make change last.

One helpful tip we can follow is to create a sheet to track our experiences and practice efforts. Use this sheet to log the frequency, intensity, and duration of your emotion and focus on using techniques such as diaphragmatic breathing or thought challenging to improve in one or all of these specific areas. If we see our efforts working, it will motivate us to continue and expand our new abilities.

If these situations do not improve with these self-coping mechanisms, please call NRS|LS for a psychological consultation and evaluation.

George Corradino, LPC
Licensed Professional Counselor

Lack of motivation, procrastination, sluggishness, inability to finish tasks in a timely manner, disorganized, scattered, and overwhelmed.  These are some of the common complaints that result in many adults feeling defeated and ineffective.  The underlying cause could be undiagnosed ADHD.

Many adults live with Attention-Deficit Hyperactivity Disorder and don’t recognize it.  The inability to recognize that they are struggling with Adult ADHD could be that symptoms may be mistaken as those resulting from a stressful and chaotic lifestyle.

As such, myths, stigmas, coinciding symptoms, and limited understanding makes identification and diagnosis of ADHD difficult in adults.

ADHD is predominantly considered to be a developmental/pediatric disorder, but there are extensive longitudinal research studies that conclude the prevalence of ADHD-symptomatology in adults.  In simpler terms, these are children who never outgrow their symptoms.

Below are some questionnaires from the Adult Self-Report Scale (ASRS) Symptom Checklist developed by the World Health Organization (WHO), which can be used as a starting point to help you recognize the symptoms of Adult ADHD.  However, it is not meant to replace consultation with a trained health-care professional for accurate diagnoses and treatment recommendations.

Please answer the questions below, rating yourself on each of the criteria shown as occurring Never, Rarely, Sometimes, or Often.

1.     How often do you have difficulty keeping your attention while doing something for work or school, a hobby, or a fun activity?
2.     How often are you easily distracted by something in your environment?
3.     How often do you avoid or delay tasks or work that require a lot of mental effort or thoughts?
4.     How often do you have trouble listening to someone, even when they are speaking directly to you?
5.     How often do you have difficulty organizing an activity or a task that you need to get done?
6.     How often do you make careless mistakes in things such as schoolwork, a chore, or activity, or something at work?
7.     How often do you forget to do something you do all the time, such as missing an appointment or forgetting things such as keys, phones, lunch, etc.?
8.     How often do you have trouble completing your schoolwork, a project, or a responsibility at work, once all the challenging or fun parts have been done?
9.     How often do you feel fidgety, especially when sitting for long periods of time?
10.   How often do you feel like you’re “on the go”, compelled to do things, or feel like you’re “driven by a motor”?
11.   How often do you begin to answer a question before it’s done being asked?
12.   How often do you feel restless – like you want to go out and do something?
13.   How often do you find it difficult to relax, unwind, and just spend quiet time with yourself?
14.   How often do you interrupt others or butt into their conversations?

If you answered “sometimes and/or often” to the above questions, contact NRS|LS to schedule an initial consultation to discuss the concerns for diagnostic clarification and to inform treatment planning.

Diagnostic clarity and appropriate treatment can substantially reduce ADHD-symptoms for improved daily functioning and overall well-being.

Mihir J. Shah, Psy.D.
Clinical Neuropsychologist

Like anxiety, Americans have become so familiar with depression as a commonplace emotional ailment that it is easily overlooked or accepted as state of being (even pre-COVID-19). Clinical depression, though, is a term that describes a cluster of symptoms – cognitive (thinking-based), emotional (mood-based), and physical (body-based) – that undermine functioning and relationships. It can show up in many forms; subtle and insidious like ants eroding the foundation of a house over the course of many years, alarming and implosive like a bridge collapsing one pillar at a time, or anywhere in-between.

For decades we have studied, diagnosed, and treated depression from the outside. We assume it from someone’s pattern of behavior or the consequences it has on grades, absences from work, quality of relationships with other people, weight gain, sleep problems, etc. But, science is increasing clear that the damage that depression is having on the inside is equally troubling. Depression produces inflammation in every cell of our bodies, including our brains, which is why depression can show up in so many physical symptoms in multiple parts of our bodies, such as brain fog, gut issues, chronic pain, skin problems, etc. If depression is long-lasting, the inflammatory response will be long-lasting as well. Over time, the effects of this pro-inflammatory response dysregulates our immune system, meaning that it reduces its ability to turn on when it should (i.e., like a new virus entering our bodies) and turn off when it should (i.e., virus defeated, threat is over).

For this reason, depression is now falling under the umbrella of autoimmune conditions, similar to rheumatoid arthritis, fibromyalgia, Lyme’s, Alzheimer’s disease, and other chronic conditions. Fortunately, depression is more treatable than those conditions. Further, prevention of depression before it initiates those cascading autoimmune effects is highly advised. If interested in preventative or active counseling for depression, contact our clinical health psychologist.

Lauren Gashlin, PsyD
Clinical Health Psychologist