Category: News

HRV biofeedback is a unique service offered at NRS|Lifespan. While some patients seek out this treatment intentionally, others are referred for biofeedback by their medical doctors and, therefore, have little knowledge about this treatment and how it may be useful to them. Here are some FAQs about HRV biofeedback to provide some brief background:

(1)   What is biofeedback?

Biofeedback is a tool that clinicians use to gain real-time metrics about an individual’s emotional and physiological status, similar to how a thermometer reads your body’s temperature at any given moment. In essence, it forges a connection between what you consciously think and feel in the moment and how your body is responding to it “under the surface”. Usually the major goals of biofeedback include building awareness into the mind-body relationship and then learning which coping mechanisms actually change your mental state and body for the better.

(2)   What is Heart Rate Variability (HRV)?

HRV is one type of metric that is an extremely useful global indicator of health, physical and emotional. It captures level of physical conditioning, balance between the sympathetic and parasympathetic nervous system, reactivity to stress and the body’s ability to recover from stress with respect to cardiovascular and immune system functioning. High HRV levels are correlated with lower levels of disease, depression, anxiety, and stress-influenced symptoms while low levels of HRV reflect the opposite – greater cardiovascular and autoimmune risks as well as higher levels of depression, anxiety, stress reactivity, and cognitive complaints (e.g., brain fog, short-term memory).

(3)   What types of issues does HRV biofeedback target?

Some of the positive effects of HRV training include: lowered heart rate, blood pressure and blood lipid panel; reduced inflammatory markers; increased pain tolerance; reduced cortisol levels; increased sense of well-being and sleep quality; reduced symptoms of depression and anxiety; better focus and ability to screen out distractions; improved executive functioning skills; and better clarity in thinking accompanied by creativity. Therefore, individuals with stress-driven physical, emotional, and cognitive complaints are good candidates for HRV biofeedback.

(4)   What does a typical course of HRV biofeedback look like?

In an outpatient setting, HRV biofeedback is intended to be a short-term treatment (6-10 sessions on average) that focuses on patient education, increasing awareness into the mind-body relationship, acquisition of skills, and application to everyday life. Clinicians customize the plan of care based on a patient’s medical and emotional complaints. This program is designed to be collaborative and highly dependent upon the motivation and participation of the individual. Therefore, its course and completion date are based on the patient’s goals, baseline status, and biofeedback metrics showing that HRV is trending in a positive direction.

(5)   How do I schedule a consultation appointment to learn more?

Call our main office number, 732-988-3441, to schedule a consultation appointment with our staff clinical health psychologist to find out if you could benefit from HRV biofeedback.

• Neurodivergent describes people whose brain differences affect how their brain works
• The word “Neurodivergent” is not a medical term. It exists as a way to describe people using words other than “normal” and “abnormal”
• Some Neurodivergent people struggle because of systems or processes that limits their abilities to demonstrate their strengths or that create new or more intense challenges for them
• For someone who is Neurodivergent, an accommodation is a way to accept that they are different or have challenges, and give them skills to succeed

• Common conditions of those who are described as Neurodivergent:
  • Autism Spectrum Disorder (ASD)
  • Attention-Deficit Hyperactivity Disorder (ADHD)
  • Down Syndrome
  • Dyslexia
  • Sensory Processing Disorders
  • Tourette Syndrome

Here at NRS|LS, our Pediatric Section is trained to address Neurodivergence in a subjective and objective manner, via Neuropsychological Examination and Treatment.

Please call our office for further information.

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

Major depressive disorder (MDD) is a common mental condition experienced by millions of people. Based on National Institute of Mental Health research, more than 17 million adults in the U.S. experienced a major depressive episode the previous year.  While most people can manage depressive symptoms on their own, unfortunately some depression leads to severe impairments, affecting the ability to manage daily life. This warrants immediate attention due to increased risk for suicide. It is important, therefore, to recognize depressive symptoms/ suicide warning signs and seek professional help.

During major depressive episodes, symptoms occur most of the day, nearly every day for a period of two weeks.

Common Depressive Symptoms:

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Irritability/anger, frustration
• Loss of interest/pleasure in activities once enjoyed
• Sleep problems (sleeping too much or not enough)
• Lack of energy
• Reduced appetite (weight loss) or increased food cravings (weight gain)
• Anxiety, agitation or restlessness
• Trouble thinking, concentrating, making decisions and remembering things
• Feelings of worthlessness or guilt
• Frequent/recurrent thoughts of death, suicidal thoughts or attempts

Common Suicide Warning Signs:

• Talking about suicide/making statements such as “I’m going to kill myself” or “I wish I were dead”
• Obtaining means to commit suicide (e.g., purchasing a gun, stockpiling pills)
• Withdrawing socially
• Being constantly preoccupation with death
• Feeling hopeless/trapped in a situation
• Engaging in risky behaviors (driving recklessly, using drugs)
• Giving away belongings/getting affairs in order without rational reason
• Saying goodbye to people as if seeing them for the last time
• Experiencing shifts in personality (being severely anxious, agitated)

If you have depression and you’re struggling to cope, help is available. Here at NRS|LS we provide effective treatments for depression like cognitive behavioral therapy (CBT) and Biofeedback. We can teach you skills to effectively cope with your depression and restore your ability to function in your daily life.

If you or someone you know is struggling with symptoms of depression, please call our office for a consultation.

If you or someone you know is in crisis:

• Call 911 in an emergency
• Contact Suicide and Crisis Lifeline: In U.S., call or text 988 to reach the 988  Suicide & Crisis Lifeline 24 hrs./day, 7 days/week
• The Suicide & Crisis Lifeline in the U.S.-Spanish speaking: 1(888) 628-9454

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

• Social Pragmatic Communication Disorder is a disorder in understanding pragmatic aspects of language.
• SPCD is characterized by reduced verbal and nonverbal communication abilities that cannot be explained by low cognitive ability, whereas ASD includes communication problems, but also has restricted, repetitive behaviors (RRB’s).
• Communication problems in SPCD can include inability to communicate appropriately in different social contexts, inability to change communication to match context, difficulty following conversational rules, and difficulty understanding what is not specifically stated (DSM-5).
• RRB’s in ASD can include repetitive motor movements or use of speech or objects, inflexible adherence to routines, and highly fixated interests (DSM-5).
• One reason that SPCD became a diagnosis was to encompass individuals affected by language and communication difficulties that did not fall within the range of typical Specific Language Impairments (Amoretti 2021).
• One study led to implications that children with SPCD may diverge more in comprehension than children with ASD (Svindt, Suranyi 2021).
• ASD must first be ruled out for SPCD to be diagnosed and therefore they cannot cooccur.
• A study conducted by Ward et al. (2020) found that 19 of their participants met the criteria for an SPCD diagnosis, but 18 of those also met the criteria for an ASD diagnosis, so therefore SPCD was ruled out for the 18 participants.
• Weismer et al. (2021) found that children that likely had SPCD reported lower levels of RRB’s than children with ASD.
• A study comparing prevalence’s of DSM-IV and DSM-5 disorders found that children diagnosed with DSM-IV Autistic Disorder, Asperger Disorder, and Pervasive Developmental Disorder had 99%, 92%, and 63% DSM-5 ASD prevalence’s respectively whereas only 1%, 8%, and 32%, respectively, met criteria for a DSM-5 SPCD diagnosis (Kim et al. 2014).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Amoretti, M. Christina; Lalumera, Elisabetta & Serpico, Davide. (2021). The DSM‑5 introduction of the Social (Pragmatic) Communication Disorder as a new mental disorder: a philosophical review. History and Philosphy of the Life Sciences 43(4).

Kim, Young Shin, et al. (2014).  A comparison of DSM-IV PDD and DSM-5 ASD prevalence in an epidemiologic sample.  J Am Acad Child Adolescent Psychiatry 53(5).

Svindt, Veronika & Suranyi, Balazs. (2021). The comprehension of grammaticalized implicit meanings in SPCD and ASD children: A comparative study. International Journal of Language & Communication Disorders 56(6).

Ward, Audrey; Boan, Andrea D., Carpenter, Laura A. & Bradley, Catherine C. (2020).  Evaluating the rate of Social (Pragmatic) Communication Disorder in children at risk for Autism Spectrum Disorder. Children’s Health Care 49(4).

Weismer, Susan Ellis; Rubenstein, Eric; Wiggins, Lisa & Durkin, Maureen S. (2020).  A Preliminary Epidemiologic Study of Social (Pragmatic) Communication Disorder Relative to Autism Spectrum Disorder and Developmental Disability Without Social Communication Deficits.  Journal of Autism and Developmental Disorders 51.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.