Category: News

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

More than 8 million Americans currently suffer from Alzheimer’s disease, and that number is likely to rise to 16 million by 2060.

Alzheimer’s accounts for 60% to 80% of dementia cases.  Vascular dementia–linked to strokes and problems with blood flow to the brain–accounts for 10%.  Lewy body dementia, frontotemporal dementia, and mixed dementia make up the remainder. Neurological changes, vascular disease, and inflammation are the main sources that cause dementia symptoms.  However, research is showing a whole list of underlying triggers that may lead to cognitive decline. Here are some examples:

1.     Bad sleep habits and sitting a lot are a dangerous duo. Lack of physical activity and poor sleep are linked to the build-up of Alzheimer-related proteins in the brain.

2.     Diabetes seems to have a direct link to dementia through elevated blood sugar that changes activity in the brain.  These elevated blood sugars can impair working memory in ways that are similar to what happens to neurons in Alzheimer’s.  One study found that people with Type 2 diabetes had an 88% higher risk of dementia than those without the disease.

3.     Your liver’s health affects your brain’s health. Some proteins are produced in the liver and travel to the brain, which could cause health concerns.

4.     Gum disease may be a trigger for dementia. It is suggested that mouth bacteria when gums are inflamed damage blood vessels that provide blood flow to the brain.

LIFESTYLE TIPS TO PREVENT DEMENTIA

So what can you do to reduce your risk?  Here are four of the latest tips:

1.     Research shows that if you have diabetes, keeping five to seven of the risk factors for dementia (smoking, elevated A1c levels, blood pressure, BMI, lack of physical activity, and your diet) within guideline recommended ranges will reduce your risk for dementia to the same level as for people without diabetes.

2.     Vitamin B12, along with other Vitamin Bs, may also have a role in protecting you from Alzheimer’s.  Have your blood level tested, eat foods that supply vitamin B12 (sardines, trout, tuna, and fortified cereals), and take supplements to boost your level.

3.     A healthy liver protects your brain.  Your diet should contain little saturated fat, reduced red or processed meats or added sugars, and lots of healthy fats found in olive oil and salmon.

4.     Weight loss. Obesity changes fat in your arteries into inflammatory problems that causes blockages, a contributor to dementia.

If you or any family members are suffering cognitive changes due to a dementia diagnosis, please call our office for a consultation to learn more about preventing and treating dementia.

Robert B. Sica, PhD, ABN
Board certified, Neuropsychology
Founder, Director

“Brain-gut connection,” “mind-body,” “big brain”, “little brain.” These phrases are catchy in popular press articles but get little attention in traditional medical and mental health practices. One simple reason for this disconnect is that the brain-gut pathway spans across a large portion of our body and, in a health system that compartmentalizes the body into one specialty area at a time (how many specialists exist now?), it’s hard to understand conditions in a true “mind-body” approach.

But let’s break it down simply. The brain-gut connection is like a two-lane highway between two destinations: the brain (“the big brain”) and the gut (“the little brain”). The gut is called the “little brain” because its chemical makeup is remarkably similar to our “big” brain, especially regarding neurotransmitter functioning. Traffic flows in both directions (top-down AND bottom-up) and there are a bunch of exits along the GI tract. In situations where there is gut dysfunction (think IBS, leaky gut, fibromyalgia-rooted stomach issues, etc.), the traffic signals going back up to the big brain can cause symptoms of depressed mood, anxiety, brain fog, etc. And, vice versa, problems in the big brain can jam up traffic going down the GI tract and cause nausea, constipation, stomachaches, etc.

The complexity of this relationship often causes confusion amongst medical providers leading to delays in proper diagnosis and treatment. Mental health professionals have been slow to incorporate this knowledge into more sophisticated treatment plans. However, at NRS|Lifespan, our clinical health psychology program integrates this information into a scientifically-informed evaluation and treatment approach. The strategies we use aim to optimize the health of the brain-gut pathway and complement medical treatments to undo the damage of undetected brain-gut conditions.

If interested, call our office at 732-988-3441 to schedule a consultation appointment with our clinical health psychologist.

Lauren Gashlin, PsyD
Licensed Clinical-Health Psychologist

Visual processing deficits are common sequelae in individuals who have sustained a brain injury.  Visual processing includes the acquisition of visual information and the appropriate use and manipulation of that information based upon task or environmental demands.  Following brain injury, visual processing deficits can manifest in various ways, and will likely interfere with the patient’s progress and rehabilitation outcome.

Vision is the most important sensory system that humans use to obtain information about the surrounding environment.  The visual system consists of the eyeball, the optic nerve, and several areas of the brain, which interact in complex ways that are currently only partially understood.  Many people use the term “visual perception” to describe how the visual system operates, although the actual process of visual perception enables us to make sense of information processed by this sensory system.

There are a large number of identifiable visual processing skills operating within the visual system, and there have been several attempts to describe them in some kind of rational framework.  These include the Deficit Skill Approach, which categorizes visual processing into specific deficits, and the Information Processing Models, which describe the reception, organization, and assimilation of visual information on a continuum from simple to complex.

The rehabilitation of visual processing deficits begins once the visual assessment is completed and specific deficits are identified.  Treatment can be multi-disciplinary and be provided by a variety of professionals including optometrists, neuropsychologists, and vision, cognitive, and occupational therapists.  As with other areas of cognitive rehabilitation, there are two broad approaches to the treatment of visual processing deficits: adaptive and remedial.  Utilizing these approaches in combination may result in the most successful rehabilitation outcome.  Adaptive treatment is provided in activities of daily living (ADLs).

It is well documented that visual processing deficits are a common problem following brain injury.  The impact of these deficits is likely compounded by associated or coexisting problems along with cognitive, behavioral, psychological, and medical conditions.  Proper and comprehensive visual assessment is vital in identifying potential visual deficits.  Once these deficits have been identified, visual (cognitive) rehabilitation strategies can be implemented.  Undoubtedly, effective treatment and rehabilitation for visual processing deficits will result in improved functional adaptation, better rehabilitation outcomes, and a more favorable prognosis.

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

When we think, we time travel. If we are not present, then we are either thinking about the past or the future. These are the three psychological time zones: Past, Present, and Future. Being aware of what “Time Zone” you are in—i.e. Past, Present, or Future–is an important first step in controlling maladaptive thoughts and behaviors. There are appropriate times to be present, to reflect, and to imagine. First, we must establish if we are in the appropriate zone.

I once heard on the radio an excellent metaphor to better explain this point. Imagine your zones as though it were a car. A car is designed with a very large front windshield for optimal visibility. There are also small rear-view and side-view mirrors to see either yourself or things behind you. When we drive, we want to spend most of our time looking at the things directly in front of us and a little bit ahead. If we look too far down the road, our view is obstructed, and it would be dangerous to focus on things you can’t yet see for excessive periods of time. If we spend all our time looking behind us, then we never see where we are going.

We should strive to spend most of our time being present (through the windshield). Thinking about the past is not necessarily bad; who doesn’t like sitting with friends over an old photo album or rehashing memories? History teaches us to learn and adapt. However, if we don’t take away lessons from our past, we can find ourselves cycle of negative thoughts and behaviors.  Therefore, learn from past but be present focused. Regarding future thinking, it’s critical to plan. But, to worry and try to look beyond what we can anticipate will increase anxiety and reactive stress. By being aware of “your time zone” and adjusting to your thought process, we can improve both your feelings and behaviors.

To summarize:

1) Mindfully establish your zone

2) Evaluate if it’s helpful in the moment

3) Shift if not appropriate time zone

3) Adjust if engaging in a time zone in a maladaptive manner (i.e. negative self-talk about a mistake we made)

4) Practice daily mindfulness exercise to help improve awareness

George Corradino, LPC
Professional Licensed Counselor

About 20% of adults in the U.S. experience chronic pain every day or almost every day. Chronic pain is different from acute pain. Acute pain resolves typically within twelve weeks. Chronic pain persists either beyond twelve weeks or the expected time for healing. Chronic pain is often secondary to traumatic injury or medical conditions like diabetes, cancer, etc. Examples of neurological disorders accompanied by chronic pain include multiple sclerosis, stroke, Parkinson’s disease, etc. Most commonly, chronic pain can affect your back, hips, knees, feet, head, etc.

A variety of factors influence the severity and time course of pain. According to the U.S. Pain Foundation, older age, gender, genetics, history of having surgery, being overweight, and stress- and trauma-related psychological conditions can have an influence on pain.

Your brain is primarily responsible for pain perception on biological and psychological levels. Since pain is unpleasant, the awareness of pain contributes to its interpretation as a threat of actual or potential damage occurring to the body. Not surprisingly, this interpretation results in increased stress, leading to elevations in anxiety, irritability, problems with thinking, fatigue, sleep disturbances, and other psychological and neuropsychological symptoms. Depression and anxiety are psychological conditions that affect people with chronic pain bidirectionally. For example, chronic pain can lead to depression and vice versa.

The current recommended treatment of chronic pain includes a combination of pharmacological interventions, no-pharmacological interventions, and psychological treatment. The types of psychological treatment used for patients with chronic pain may include Medical Adjustment Counseling®, Biofeedback therapy, Physical therapy, etc.

Here at NRS|Lifespan, our comprehensive team offers a unique approach to treating chronic  pain via Medical Adjustment Counseling® (MAC). MAC® is a specialized, counseling approach that is tailored to the individual’s unique health needs.  The goal is to improve coping skills, understand your medical condition, and learn to apply practical strategies to deal with your chronic pain.

For more information, please call our office.

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

References

1. Hadjistavropoulos, T., & Craig, K. D. (2004). Pain: psychological perspectives. Psychology Press.
2. Johnson M. I. (2019). The Landscape of Chronic Pain: Broader Perspectives. Medicina (Kaunas, Lithuania), 55(5), 182. https://doi.org/10.3390/medicina55050182
3. Yong, R. J., Mullins, P.M., & Bhattacharyya, N. Prevalence of chronic pain among adults in the United States. PAIN: February 2022 – Volume 163 – Issue 2 – p e328-e332doi: 10.1097/j.pain.0000000000002291
4. www.uspainfoundation.org

Balancing caregiving with work and other family obligations can be stressful. Don’t overlook the stressful impacts of caregiving. It is important to reassess your loved one’s needs periodically – and your ability to provide care. It is important to get help and relief from the stress of caregiving. These tips can help you find the support you need:

1.     Ask for help: a) make a list of ways others can help, b) ask a friend or relative to help out for an hour each week, and c) don’t wait for a crisis, ask for and accept help on a regular basis.

2.     Take time for yourself: a) consider using respite care, homecare, or adult day care, b) schedule regular time for yourself, and c) plan to spend an hour each day or an afternoon once a week away from caregiving.

3.     Express your feelings and avoid isolation: a) recognize that feelings of frustration, sadness, anger, and depression are common under the circumstances and b) join a caregiver support group.

4.     Take care of your health: a) make sure to eat and rest, b) get moving, even 10 minutes of exercise a day can help, c) learn and use stress reduction techniques (visualization, meditation, breathing exercises), and d) don’t put off your own medical care.

5.     Learn about the condition: a) find out about different forms and stages of dementia so that you are not taken by surprise when new behaviors occur and b) if you can, provide information to family and friends so they will know how best to support you.

6.     Look for signs of burnout: Not taking care of your own health? Feeling lonely? Crying or losing your temper more than usual? These are all signs that you may need help.

Remember, you will be better able to care for another if you don’t take time for yourself. No one can do it all. You have to be your first priority.

Additional information and resources for caregivers:

• Community Resource Finder
•  Ways to Manage Stress & Be a Healthier Caregiver
• Caregiving for Dementia: What to Expect
• Caregiver Education & Training Videos
• Caregiver’s Guide to Managing Challenging Dementia Behavior
• Family Caregiving Guide
• Relaxation Techniques: Steps to Reduce Stress

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

PMT stands for Parent Management Training. PMT is a type of evidenced based counseling designed to help parents observe, cultivate curiosity and improve understanding of their child’s behaviors.  The goal of PMT is to develop techniques to help your child or adolescent manage their emotions and behaviors.

All behaviors have meaning!

In PMT, the psychologist and parents work together to develop a tailored approach that works best for your specific family’s needs and goals. As a parent, you will be acting, as the therapist in your home to help support your child, learn to anticipate challenges, and problem solve or apply skills effectively.  On average, a course of PMT counseling ranges from 11-15 sessions, but may be longer depending on response to intervention.

Why PMT?

•   PMT is effective for learning strategies to help children with ADHD, Autism, Mood Disorders, Anxiety Disorders, etc.
•   PMT can improve academic skills, executive functioning, behaviors in home and classroom, improve social skills, and assist in activities of daily living.
•   PMT is effective in improving parent-child relationship and reducing arguments.
•   Help troubleshoot parenting woes and receive guidance on typical parenting issues.
•   PMT can help sibling relationships and improve the ‘family culture’.

If you have any questions, please contact our office.

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

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