Assessment, Consultation, And Evaluation

Please Note,

Please note, evaluation processes as well as fees differ based on the specific assessments which were conducted. Every patient’s evaluation is individualized, the above is a brief generalization.

Fees will be applied hourly for in-office assessment services, testing, scoring, and report writing at $150.00 to $280.00 (per hour) for more details please call the office. Psychotherapy will also be charged at $270.00 per hour. Total cost will differ by each evaluation.

We accept payment in Cash, Check, Visa, Master Card, American Express, HSA (Health Savings Account), and FSA (Flexible Spending Account)

Assessments we offer,

  • Neuropsychological Assessments for ADD, ADHD, OCD, Anxiety, Depression

  • Play Therapy

  • Educational Assessments

  • Personalized Treatment Plan

  • Aptitude Testing 

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What Does An Evaluation Entail?

Our evaluation process includes the following:

  • Face-to-face testing in our office (about 3-6 hours)

  • Scoring and Report Writing (about 4-8 hours) done behind the scenes and can be done on different day and time than the actual Face to Face Evaluation

  • A review of previous records

  • Collaborating with involved professionals

  • Final results session to review all findings and discuss recommendations

  • A final copy of the report (12-15 pages)

  • Before results of the evaluation are released, payment must be received by our office. Methods of payment can be discussed with the doctor.

  • If requested, after our final results session, Dr.Boscan or staff will connect with involved parties, such as schools, tutors, physicians, etc. to review evaluation results and assist with the initiation of interventions and accommodations.

WHAT TO EXPECT IN AN ASSESSMENT OR EVALUATION?

 

Through a wide range of diagnostic tools we aim to compose a diagnostic evaluation with utmost completion and accuracy. Through recognizing and molding to suit unique patient circumstances and situations, my and my colleagues diagnostic examinations assess problems with awareness of physical, genetic, developmental, emotional, cognitive, and social components of the case at hand.

Our goal is to create a working diagnosis and a fully individualized, comprehensive treatment plan, for the patient and his or her family. Each diagnosis and treatment will take into consideration patient individuality, challenges, and strengths. Both I and my colleagues are trained and experienced in relevant forms of therapy and able to execute a customized treatment plan in collaboration with all individuals invested. Treatments can be expected to involve a combination of individual psychotherapy, medication management, yoga, nutritional consultation, a personal trainer, family meetings and group therapy, marital therapy, or play therapy for children as agreed to by the patient’s family member.

You can expect us to:

• Arrange a diagnostic interview with the patient and parent/significant other

• Detailed review of medical history including medications, medical illness, and a detailed medical assessment

• Review of previous testing, evaluations, school or work reports, medical and psychiatric records

• Coordination with pediatricians/primary care physicians and therapists, only with full patient consent, and collaboration with teachers

• Diagnosis, Treatment Plans, Review, Explanation, and Discussion of all aspects of evaluations

WHAT DOES THE EVALUATION OR ASSESSMENT INVOLVE?

By examining thinking, behavior, social and emotional functioning through standardized tests and procedures, our evaluative procedure will include measures of:

  • Intelligence

  • Problem Solving

  • Attention

  • Planning, organization, impulse control, ability to multitask

  • Learning and Memory

  • Processing Speed

  • Language

  • Academic Skills

  • Visual spatial/perceptual skills

  • Depression and anxiety

  • Social skills

WHAT IS THE DIFFERENCE BETWEEN A SCHOOL EVALUATION AND A NEUROPSYCHOLOGICAL EVALUATION?

  • School evaluations focus on qualifications for special education programs or school interventions, strictly focusing on enhancing academic achievement within the school setting

  • The school evaluation determines IF a child exhibits a problem with an academic skill, while the neuropsychological evaluation focuses on WHY a child is having problems in school, home, and community settings.

  • Neuropsychological evaluations work across settings and apply knowledge of neuroanatomy and brain behavior for greater understanding of a child’s strengths and weaknesses

  • Neuropsychological evaluations are comprehensive evaluations of academic skills such as thinking, problem solving, language, attention, learning, and memory skills, etc.

  • Neuropsychological evaluations provide intervention recommendations across all areas of life, not just school

  • The benefits of neuropsychological assessments for families and professionals

  • Quantitative, evidence based data of individuals skill in various areas

  • Comparing said skills with the skills of other individuals of similar age, indicating nature and severity of the patient’s problem

  • Helping detect the effect of developmental, neurological, and medical problems, and provide a baseline against which to measure of various interventions or a child’s development over time

  • A differential diagnosis (as for example, whether a child’s attention difficulties stem from anxiety, depression, language or a primary attentional deficit disorder)

  • Allowing for a better understanding of each individual and a starting point for developing interventions and target areas to maximize success across various settings

WHY ARE PEOPLE REFERRED FOR NEUROPSYCHOLOGICAL ASSESSMENT?

Children are frequently referred to me by a counselor or psychologist, doctor, teacher or parent due to one or more of the following:

  • Difficulty learning, reading, shortened attention span, behavioral, social, or emotional difficulties

  • A developmental problem that affects the brain (i.e. autism, epilepsy, prematurity, etc.)

  • A brain injury from an accident, birth trauma, or other physical stress

Common diagnostic considerations:

  • ADHD

  • Learning disabilities (reading, writing, math)

  • Depression and anxiety affecting cognitive skills

  • Autism Spectrum Disorders

  • Developmental disorders

  • Epilepsy, Stroke, Tic disorders

  • Genetic Disorders

  • Concussion/Brain Injury

Adults are frequently referred for a neuropsychological assessment to address concerns such as:

  • Memory or longstanding attention problems carried over from childhood which impact work, relationships, etc.

  • Depression, anxiety, or other emotional difficulties which are impacting cognitive functioning

PSYCHO-EDUCATIONAL ASSESSMENT

This method of evaluation examines a child’s learning strengths and learning patterns through the detailed review of cognitive, processing, academic, and social skills, and emotional well-being. With the assessment, interventions can be put into place to insure improvement in school performance, social relations, and the child’s general positive adjustment.

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The benefits of neuropsychological assessments for families and professionals include:

  • Quantitative, evidence based data of individuals skill in various areas

  • Comparing said skills with the skills of other individuals of similar age, indicating nature and severity of the patients problem

  • Helping detect the effect of developmental, neurological, and medical problems, and provide a baseline against which to measure of various interventions or a child’s development over time

  • A differential diagnosis (as for example, whether a child’s attention difficulties stem from anxiety, depression, language or a primary attentional deficit disorder)

  • Allowing for a better understanding of each individual and a starting point for developing interventions and target areas to maximize success across various settings

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ADHD, ADD & Other Disability Evaluations

WHAT DOES AN ADHD/ADD EVALUATION CONSIST OF?

Our comprehensive ADHD/ADD evaluation includes:

  • Clinical interview and evaluation by an experienced educational psychologist

  • Teacher and Parent Rating scale for ADHD / ADD while also screening for other disorders such as depression and anxiety

  • ADHD Self-Report Form

  • Conners’ Continuous Performance Test (CPT), which is a task-based assessment of attention disorders and neurological functioning and can also screen for or diagnose ADHD/ADD, monitor treatment, test the effects of medication, and optimize drug dosage.

  • Feedback and education of symptoms and recommended treatments with a detailed Q&A Session

 

EVALUATION AND TREATMENT

The diagnosis and treatment of ADHD involves active collaboration of parents, teachers, and experienced health professionals. Determination of a true Attention Disorder includes a combination of medical and family history, information provided by parents and teachers, questionnaires and clinical interviews, and the administration of a brief continuous performance test (CPT). These tests will determine whether these symptoms are consistent with the diagnosis of ADHD or are caused by other factors such as anxiety or depression. ADHD alongside other co-existing disorders are important to individually identify and address in the evaluation in order to insure correct treatment. Further difficulties such as executive functioning and/or sensory processing issues can indicate attention difficulties. All of these areas are included in the ADHD evaluation to analyze an individual’s day to day functioning with these added difficulties.

The foremost goal of our evaluation is to determine the underlying cause or causes of the current difficulties experienced by the patient. After an evaluation and diagnosis has been performed, information will be provided to help the patient best understand how the patient’s specific type of ADHD impacts your functioning in the school, work, and home environment. Our treatment plans are individualized and may include recommendations for counselling, skills training (organizational, social, academic, and/or workspace), accommodations, and a consult for medication. We also focus on providing ongoing support in the form of educational material, Parent Support Groups, updated information accessible through our website, school consultations, and follow-up testing to assess the effectiveness of medication and other treatments.

Our modified Adult ADHD evaluations are designed for adults who may have suspected ADHD but have never been formally assessed or diagnosed. Many adults may come to a conclusion about themselves during the process of their child or adolescent receiving a diagnosis, or encounter difficulties with their job or relationships after years of struggling with focusing, time management, procrastination, organization issues or impulsivity. This evaluation is similar to our general evaluation, however it is intended for adults only and can be used to share with a provider for possible medications. To learn more about what options work best for you, please email or call us directly, to schedule a consultation.

WHAT VARIETIES OF OTHER LEARNING DISABILITY EVALUATIONS DO YOU PROVIDE?

Through an academic assessment, our evaluation will help identify how the child learns best in regard to their strengths and weaknesses.

  • Individualized Education Plan (IEP) and Section 504 Plan Assessments /Meetings

    • In collaboration with teachers, school counselors, and other practical personnel involved with your child we help schedule a school Individualized Education Plan (IEP)/504 meetings to insure measurable goals and objectives and receive services and accommodations based on your child’s unique needs. Through open lines of communication during the IEP process with the parent, they will be an equal part of the educational team.

  • Educational Consultation / School Collaboration

    • To understand and meet the special needs of a child with a range of disabilities, we will maintain strong communication with teachers, special educators from multiple disciplines, and parents as we observe the child in varying learning or social settings to experience firsthand, authentic interaction with the child’s environment.

  • Educational Consultation for Gifted and Talented students (GATE/SEMINAR program)

    • For students which possess unique intellectual talents that require a different curriculum and more enriching opportunities, we can serve as educational consultants.

  • Student /Parent Coaching

    • To optimize learning strategies and self-advocacy, we can help students with organizational skills, study habits, time-managing strategies, note-taking, and test preparation through student coaching. Through parent coaching we will place the parent in the student’s position and help parents learn strategies that can develop their child’s strengths and mitigate his or her weaknesses.

  • Classroom Observations/ School- Based Therapy and Behavior Support

    • We can work with students in the school setting to better target problem behavior, find appropriate behavioral substitutions, and implement an intervention plan. Furthermore, we can recommend school based occupational therapy.

  • Social Skills Training

    • In order to address and correct presenting difficulties of children, adolescents, and teenagers with relating to others, social skills training is an effective form of behavioral therapy.

  • Advocacy Services

    • We believe that it is vital to advocate for children in their school systems and with other service providers, and we help parents navigate the maze of assessments, services, and professional selection to insure the best treatment for the child. Out goal is to insure a team dynamic between parent and child in order to address his or her disabilities and how it affects his or her educational ability, instead of shifting blame and harboring negativity.

ADHD VS OTHER SIMILAR DISORDERS

WHAT IS EXECUTIVE FUNCTION?

EXECUTIVE FUNCTION ASSESSMENT

Executive Function is an umbrella term that refers to brain functions that activate, organize, integrate and manage other functions. Furthermore, it allows individuals to make real time evaluations of their actions while considering short and long term consequences, planning and modifying their behavior as necessary if outcomes are not desirable. The proper function of this process insures academic and subsequent occupational success, deficits of these skills can result in disorganization, difficulties in getting started and finishing work, remembering homework, memorizing facts, writings essays or reports, solving complex math problems, reading comprehension, long-term products, being on time, controlling emotions, and generally planning for future events. A useful metaphor to understand this concept is by comparing executive function to the role of a conductor in an orchestra, according to an expert in the area of Executive Function, Dr. Tom Brown. Dr. Russell Barkley, a noted authority on ADHD, reported that 89-98 percent of children with ADHD have deficits in executive skills. Dr. Barkley believes that evaluating and understanding a person’s executive function, breaking it down across several domains, is a better predictor of real world functioning than merely reporting they have a deficit.

Executive Function can be broken down into six different clusters:

  1. Activation: Organizing, Prioritizing and Getting Started on Tasks (getting started; paying attention; organizing time, projects, materials, and possessions, finishing work)

  2. Focus: Focusing, Maintaining and Shifting Attention (changing activities, stopping existing activity, stopping and thinking before acting or speaking)

  3. Effort: Regulating Alertness, Sustaining Effort, Processing Speed (complex problem solving).

  4. Emotion: Managing Frustrations and Regulating Emotions (ability to tolerate frustration; thinking before acting or speaking)

  5. Memory: Using Working Memory and Accessing Recall (holding facts in mind while manipulating information; accessing facts stored in long-term memory.)

  6. Action: Monitoring and Self-Regulating Action (self-monitoring and prompting, using “self-talk” to control one’s behavior and direct future actions)

Understanding which area(s) of executive function are impaired allows recommendations for accommodations and support be the most successful in helping an individual in their daily life.

WHAT IS SENSORY PROCESSING DISORDER?

 

SENSORY PROCESSING ASSESSMENT

Sensory processing (SP), sometimes called sensory integration (SI), is a concept that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Everything we do, from exercising, eating, to reasoning, requires processing sensation or sensory integration. A Sensory Processing Disorder (SPD) is a neurological condition in which sensory information is received but isn’t organized into appropriate responses then what is typically expected.

A useful metaphor coined by pioneering occupational therapist and neuroscientist A. Jean Ayres, PhD, compares SPD to a neurological “traffic jam.” This jam of signals prevents certain parts of the brain from receiving the signals needed in order to interpret the sensory data accurately. A person who struggles with SPD can find it difficult to process and act upon information received by the senses, creating countless, seemingly simple everyday tasks more difficult.

Signs of SPD may include:

• difficulty planning and organizing

• carrying out self care skills and activities of daily living

• completing school work or job tasks

• avoiding activities

• frequent distress or agitation

• fear of trying new things.

This disorder can affect people in a single sense, for example just sight, or in multiple senses, giving the impression that there is too much or too little sensory input. For example, a person whose SPD leads to over-stimulus may find clothing, physical contact, food, sound, light, etc. to be unbearable. Some who suffer from under-stimulus may show little to no reaction to stimulus, even pain or extreme temperatures. An impairment of sensory processing of the muscles and joints can further negatively affect posture and other motor skills. Children who develop an appetite for perpetually increased sensations are sometimes misdiagnosed with Attention Deficit Hyperactivity Disorder (ADHD).

SENSORY PROCESSING DISORDER AND ADHD

ADHD and SPD have several striking similarities, and one can easily be confused for the other. Both disorders lead children to display issues and behaviors with hyperactivity, lack of focus, fidgeting, and impulsivity. Children may run or skip through the halls to class, struggle to focus on reading assignments, and fidget by repeatedly touching a toy or moving their seat. Both SPD and ADHD can cause difficulties with learning, pear relationships, and the ability to comply and complete activities.

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ADHD VS AUTISM

Attention Deficit Hyperactivity Disorder (ADHD) and Autism have a tendency to share many similar symptoms. Both show signs of: problems with focus, inattention, hyperactivity, impulsivity, communication, trouble with school work and with social interactions. However, the two are completely different conditions. Autism is a developmental disorder whereas ADHD impacts the way the brain grows and develops. And possibly, you or your child can have both. According to researchers, roughly two-thirds of kids with ADHD have at least one co-existing condition, and Autism Spectrum Disorders (ASD) are among the conditions that commonly occur with ADHD. Some studies suggest that up to half of kids with ASD also have ADHD.

There are two main differences between the two conditions:

  1. ATTENTION

    While children with Autism will struggle to focus on things that they want to do and fixate on other things, kids with ADHD simply lose interest.

  2. COMMUNICATION

    A child with ADHD may talk nonstop, interrupting or attempt to dominate conversations, while a child with Autism may have a hard time communicating thoughts and feelings.

Our goal is to provide an early diagnosis and set the child on a correct treatment plan in order to insure that both as kids and into adolescence and adulthood he or she can lead a successful, and happy life!

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WHAT ARE THE BENEFITS OF PSYCHOTHERAPY FOR DEPRESSION & ANXIETY?

  • Help you find ways to deal with everyday stressors

  • Can give you new perspective on problems

  • Can encourage you to use your medication and to stick with treatment

  • Testing has proven that combinative treatment of psychotherapy and medication can best alleviate symptoms of depression & anxiety

  • You can learn how to deal with side effects from your medication

  • Learn how to discuss your condition with other people

  • Can help catch early signs if your depression and/or anxiety is getting worse

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SHOULD I CONSIDER MEDICATION?

It can be a challenge for parents to decide if their child would benefit most from ADHD medications. In order to insure that ADHD children reach full potential at school, at home, and with friends, medication can be of great help. Although medication will not cure ADHD, it will allow children, adolescent, or adults to better manage their ADHD and improve overall functioning in school, work, home, and in the community. A combination of treatments (academic, behavioral, psychotherapeutic) with medication can be the most effect method to being able to live full and productive lives with ADHD. With proper prescription, ADHD medication can help with focus and concentration, while reducing hyperactivity and impulsiveness, all while leaving the child’s personality unaffected. In order to find the proper medication and treatment, close collaboration between the doctor, the family, and the therapist is essential. While some children may no longer require treatment as they enter their late teens, many ADHD symptoms persist into adulthood. ADHD symptoms are known to change over time, specifically with decreased hyperactive behaviors in teens and young adults, however inattention and impulsivity can persist into adulthood and negatively affect everyday life. Proper treatment in children reduces their hyperactivity and inattention, insuring better development. Teens and adults with ADHD often notice a significantly greater ability to concentrate on tasks and less inclination to boredom and restlessness. An experienced health-care provider or psychiatrist to prescribe useful medication is essential. Following your evaluation, should medication be a recommended part of your treatment, you may be recommended a list of ADHD experienced Psychiatrists in the community. other providers may be provided upon request should medication be a recommendation of your evaluation.

Children of divorced parents do best when,
1. There is proper co-parenting

2. Good communication between both parties

3. Staying "kid-focused" during conversations

4. Parent's learn to compromise and respect different opinions

5. Giving kids space to adjust to transitions

6. Have an established routine and staying consistent

7. Establish a strong support network for yourself & your child

8. Keep each other involved in the lives and events of both parties (birthdays, special holidays)

9. Legitimize the child's feelings during transition and encourage honesty

10. Heal yourself first

Parents who are divorced should avoid?
1. Venting their negative feelings to their child

2. Using the child as a messenger

3. Exposing children to visible conflict, heated discussions or legal talk

4. Strong disruption to the child's daily routine and personal space

5. Being secretive about what is happening entirely

6. Stopping the other parent from seeing the child (depending on custody or visitation agreements)

7. Ignoring physical and verbal signs of distress from the child

8. Making promises you won't be able to keep

9. Radically changing the family dynamic

10. Using your child as a weapon or turning them against the other parent

Warning Signs Of Childhood Gaming Addiction

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Technology is both a transformative and an unavoidable consequence of our modern day life. As adults we may have learned to manage our impulses with age and maturity, not every flashing advertisement garners our attention, however, children are the most susceptible to marketing schemes and the addictive nature of certain games. Studies have shown that games with a “gambling” system and the development of fixation around playing said game, shares many similarities with real world gambling addictions. A pattern we’ve noticed while treating many patients and parents who struggle with children’s lack of “video game self-control”, games with “In-App” purchases, microtransactions, and “loot boxes” bore the greatest resemblances to the similar serotonin induced thrill of gambling. Our strongest recommendations is for parents to monitor there children’s games and the amount they spend on them (compared to the time they spend outside or doing schoolwork) and steer them to games with a “strategy” or “problem-solving” basis. Multiplayer games can be further beneficial to your child’s social development as he learns team-work when completing tasks.

Below we will go over some points about the warning signs of childhood game addiction and tips to combating it.

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Symptoms and Bad Effects of Video Game Addiction

  • Obsessive behavior

  • Lack of Sleep

  • Lack of physical exercise

  • Other Physical problems

  • Social isolation

  • Having gaming as his only focus in life

  • Neglect of school activities and responsibilities

  • Lack of interest in reading and other hobbies that have educational benefit

  • Escaping life problems instead of confronting them

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How to Address & Treat your Child’s Video Game Addiction

  • Address the issues with your child directly & help put their video game in perspective

  • Determine and agree of a reasonable time for your child to play in moderation

  • Set specific boundaries and be firm about it

  • Create consequences for not following agreed on boundaries

  • Make game time a reward

  • Track your child’s game time & the type of games they play

  • Use tools to set limits for the game time (most electronics have screen time restrictions)

  • Be ready for pushback from your child but remain firm

  • Discourage “gambling” games & encourage “strategy” games

  • Place games in a visible, public space where they can play out in the open in front of you

  • Encourage your child to spend more time with their friends in the real world

  • In a worst case scenario, you may have to make the child quit “cold turkey” and confiscate the games entirely

  • In further extreme cases, bring up this concern to therapists as early and decisive intervention is the best strategy

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RECOMMENDATIONS FOR THE LEARNING ENVIRONMENT

Recharging the “Fuel Tank” of our Attention and Executive Function

Some students and adults must work much harder than others to sustain their attention and employ various executive skills in settings which they find non-stimulating. Today’s researchers believe there is a way to replenish the resources needed to stimulate these tasks on an ongoing basis. These replenishing methods may range from taking more breaks or doing other activities that the individual finds more replenishing for the attentional and executive tasks later. Our specialists can experiment with brief activities throughout the day to see which ones are the most helpful at “fueling the tank.” For example, something that can improve a student’s ability to sustain attention for longer periods of time may be an increase in sensory stimulation such as a fidget object, chewing gum, work while standing up, doing chair push-ups, passing out class materials, running errands, having a chair that allows for motion, or an exercise band around the legs of the chair. Some teachers strategize to allow students to have a sensory break by creating designated zones in their classrooms for refocusing purposes or having a set of physical activities one can do on their way to the bathroom. Other useful methods may include noise cancelling headphones or listening to music to screen out other distractions. Further, visual cues which monitor the individual’s attention, such as a watch which vibrates periodically or post it notes with a code word can help the individual to remain focused.

 

Written directions/checklists

The student may miss important information when screening out distractions (auditory attention), remembering information long enough to write it down (working memory), repeatedly switching attention between listening and writing (cognitive flexibility), and then writing the information down fast (rapid fine motor). A good strategy to combat distractions from tasks is to provide the student with a visual copy of the instructions, listed in order. If there is no time to provide written instructions, auditory directions should be given to the student while maintaining eye contact and minimizing external distractions. The student should be able to repeat back instructions so that the teacher can check that they were accurately comprehended. Directions, both written and auditory, should be short and clear, with one direction (as opposed to multiple) given at a time with supplemental visual aids. Questions should be encouraged, and the student should have access to an additional classroom helper who can further clarify missed directions.

Impulse Control

Behavioral inhibition is a notorious weakness to individuals with this profile. For example, they may blurt out answers without being called on, start tasks without reading the before-hand instructions, and rush through tasks they find non-stimulating to something more interesting. In encourage impulse control, frequent check-ins, visual reminders, and time to pause and check work can be helpful.

Coaching

These individuals may benefit from the help of a coach who can (ideally) meet for a few minutes before school begins and just after school ends a few days per week. This individual will help with planning, organization, and time management functions, by running through a list of daily requirements. This will help the student turn in homework, have a correct list of assignments and the correct books to complete their task. Furthermore, allowing the student to mentor a younger student in some way may give themselves a sense of accomplishment and additional encouragement. There is also a watch available through www.watchminder.com that allows a student to program a series of messages and vibrating alarms, which will provide additional sensory cues to promote their concentration. If a student struggled with remembering to write down their homework for the night, for example, the alarm could remind them every five minutes before the end of the school subject with a message reading “homework”!

Homework modification/reduction

Long and repetitious tasks for students with this learning profile are a known difficulty, especially when it comes to homework assignments. These difficulties can be minimized by allowing the student to demonstrate a mastery on a small number of items, a focus on quality over quantity so to say. A helpful strategy for completing homework would be writing the assignment step by step, skipping a line underneath each task, and filling in a brief reward for themselves following the completion of each assignment. For example, math problems, watching videos for fifteen minutes, reading a chapter, texting a friend for ten minutes). Another helpful strategy is studying in various places, such as in the closet or outside on the trampoline in their early years, and in their later years in places such as a coffee shop, the park, or the beach. Increasing sensory stimulation (listening to music, reading on a treadmill, sitting on a therapy ball) or working with a peer who is focused on the task for short bursts rather than longer periods can also be beneficial. If problems continue to persist, an after-school homework club or a tutor can further decrease stress and insure homework completion. College mentors who can teach study skills and oversee homework are available at Club Xcite (www.exciteway.com).

A home-school behavior plan

For a successful home-school behavior plan, close communication between the teacher and the family is essential. There is a variety of ways this can be structured; however, it is important to note that this plan may not last when the novelty wears off and it will need to be restricted anywhere from three days to a month.

Nonverbal Prompts and Cues

Nonverbal prompts and cues are preferred to auditory ones in order to minimize stigmatizing the student in front of their peers. Simple methods such as moving closer to the student’s desk or putting a hand on his or her shoulder can help them re-focus on the task at hand once more.

Prioritize and Monitor

Parents or other family members can help break down larger tasks into smaller ones, help decide which tasks are of larger priority than others, and monitor that the student is making progress.

Help Develop Routines

Parents and other family members can help the student develop routines which can ensure that tasks are completed on time. For example, having a designated place (preferably visible to the parent) and time for daily homework assignments, where the student can leave all their learning supplies and then successfully pack them up for the next school day. Memory strategies may also aid in memory and organization, such as an acronym and a saying. For example, “Don’t leave the house without your PANTS” where P stands for parent note, A is for assignments, N is for notebook, T is for textbook, and S is for the student themselves.

 

Health and Lifestyle

It is recommended that parents assist in maintaining a child’s healthy lifestyle which includes a balanced diet, regular exercise, and enough sleep, as each of these factors can have a significant impact on the child’s behavior. For example, parents may encourage their child to receive sensory stimulus before the start of the school day, such as through activities like running or surfing, or afterschool to replenish themselves. Regular exercise can help not only the student’s health but also their executive functions and emotional regulations. Furthermore, children with attention and executive function challenges may have a hard time falling asleep, so a consistent bedtime routine is immensely helpful. As sleep deprivation can mimic or worsen the student’s challenges, it is important to consult with a sleep expert if challenges in this area persist. Examples of helpful things to incorporate your child’s nightly routine may include limiting or excluding screen-time after dinner, taking a bath or shower, brushing their teeth, reading quietly, meditating, or listening to soothing music).

Compliances

Individuals in this demographic can struggle with compliance both at home and at school, presenting as what can be called a “difficult child.” Working with a therapist can help both parents and the child work at methods of managing behavior. An additional useful tool is a book by Ross W. Greene which provides a problem-solving approach to challenging children: The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children. Ross W. Greene has further resources on his website (www.livesinthebalance.org).

 

Greene’s work is built around the belief that 1) kids will do well if they can and 2) that behavior is always preferable to misbehaving. This shifts the view that misbehavior is a result of attention-seeking, manipulation, testing, and/or being poorly motivated. In contrast from the standard view, Ross Greene works to show that misbehavior is a result from the demands placed on the child, exceeding the skill that they must respond positively. A few examples of skills a child might be lacking include frustration tolerance, flexibility to shift mindsets, adaptability, acknowledge other’s perspectives, self-soothe, and problem solve. An important goal of the collaborative problem-solving process is to identify which skills a child is lacking and the specific conditions or situations in which a challenging behavior is occurring. These unresolved problems, however, happen to be highly predictable. When struggling to meet the demands and expectations placed upon them, kids can react in a number of fairly common ways: whining, pouting, sulking, withdrawing, crying, screaming, swearing, hitting, spitting, kicking, throwing, breaking, lying, stealing, and so forth. It is vital for you to know why and when your child is reacting in these ways, in order to correct the listed behavior.

 

Luckily, because these challenging behaviors are in response to highly predictable unresolved problems, a collaboration between you and your child can solve them. If adults attempt to tackle these issues without a collaborative spirit, simply by asserting their will, Greene’s Plan A outlines how this will likely increase the number of challenging episodes or prolog them into the future. However, through collaboration, or Plan B, the child will be more inclined to incorporate lasting solutions. Furthermore, the child will learn the skills they were lacking all along over time. Plan B is described in the following way, with three basic ingredients. The first ingredient is called the Empathy Step, which involved gathering information and understanding the child’s concern or perspective, which will allow the child to feel fully heard and understood. The second ingredient, called Defining the Problem, involves bringing the adult’s concern or perspective to the table. The third ingredient, called the Invitation Step, involves a collaboration between the parent and the child as they brainstorm solutions and arrive at a plan that is realistic and mutually satisfactory to both parties.

 

In addition to the Ross Greene’s model for helping behavior management, general strategies such as those listed below can be of further help in reducing noncompliance behaviors.

1.       Daily Positive Attention

It is important for the parent and teacher to connect with the child on an individual level, where he or she is the focus of positive attention. At home it can range from playing games together, reading, chatting, sharing a hobby together, or going on walks. At school it can be the teacher asking the student to help with a special task (such as setting up for a class project), giving them a special job (such as feeding the class pet), or setting up special activities like having hot chocolate or a snack together once a week. A positive experience at the start of the day can create a further positive behavioral momentum.

2.       Notice and Compliment.

Even if it is for the smallest behaviors, reward even the smallest amount of compliance. This will solidify that good behavior is noticed and appreciated.

3.       Offering Two Choices

By allowing the child to choose between two choices, it allows the child to feel a sense of control over the situation. For example, instead of asking “Do you want to get dressed now” you instead phrase the question into “Do you want to wear your blue or your red shirt?” In the end you get the desired result, a dressed child.

4.       Using Grandma’s Rule of Discipline

This strategy uses the When/Then or the If/Then method, framing things as incentives rather than negative consequences. For example, instead of saying “You can’t play video games because your room is messy” you instead say, “You can play video games as soon as your room is clean.” To put it simply, when X is done, then y will occur.

5.       Use Logical Consequences

Whenever possible this outlines a logical consequence to a child’s actions which will make sense to them. For example, if a child is 15 minutes late to school, they must go to bed 15 minutes earlier at night, because they must need more sleep.

Sadness, Friendships, and Bullying

A detailed report on these issues requires the full cooperation of student, parent, and teacher, as the child may not feel fully inclined the occurrence or the extent of these struggles. The parent rating scales allows the parent to express information about this subject, while feedback from the teacher will help the therapist better understand the academic and social setting of the school environment. Recommendations for these challenges will be discussed in later feedback sessions.

 

Malleability, Context, Resilience, and Advocacy

It is well reported that our abilities are malleable rather than fixed, our perception of whether or not we can alter our abilities through a combination of hard work, persistence, and the use of other resources can have a significant impact on our goals. An observation noted by Carol Dweck, a researcher at Stanford, noted that a student’s performance on a given task improves when he or she comes to view their abilities as malleable rather than fixed. Dweck has written a book and created a program that helps improve cognitive abilities and their performance. For more information please visit, www.mindsetonline.com (book) and www.mindsetworks.com (educational program).

 

In addition to the view of abilities as malleable, context for many learning profiles can help a student who was previously struggling in an environment to succeed in it. For example, a greater emphasis on project-based learning rather than through repetition can be of greater benefit. While both methods result in the same information being taught, the method in which the information is being taught and demonstrated can allow one student to thrive and another student to struggle, depending on the particular learning profile of the student. A comfortable fit between a student’s learning style and the context in which they perform their abilities determines their feeling of successfulness as a student which will motivate them to work harder.

Resilience is also an important concept for students with an uneven learning profile. It takes a lot of courage and resilience to overcome constant, frustrating situations in which your strengths and talents may not lead to frequent academic success and instead the few areas of weakness grow large. It is very important that the affected child understands the nature of their learning differences and prevent it from taking a toll on their sense of self, leading them to mistrust their own abilities. It should be emphasized that there are many impressive strengths the child possesses within many intellectual and cognitive areas. Many students with attentional differences suffer from demoralization and discouragement over time, and it is important for parents and teachers to highlight the student’s strength, talents, and good behaviors in order to insure continuous positive momentum for success. A few ways a teacher can foster a sense of mastery in the classroom for the student include giving him or her a special job that he or she already excels at, sending good news cards to the student’s parents of specific weekly accomplishments, and create a mistake jar which can teach a child that mistakes are ok and part of the learning process.

 

Our goal is to ensure that the child learns to be a self-advocate with time, without feeling ashamed or embarrassed of their difference. Individuals with these difficulties have the strengths and talents to be very successful in life, advocacy for their needs can help them realize their own potentials. We must be transparent with the child about all aspects of his or her condition, including insight on the many strengths, the few specific areas of weakness, and the many available strategies and accommodations that can be implemented to mitigate the weaknesses. An excellent resource for parents and teachers is a website known as understood.org which can allow them to better understand how it feels to have ADHD and other learning disabilities. When visiting the website, click on the Parent Toolkit tab and then the “Through Your Child’s Eyes” tab. There you will see opportunities to “try on” ADHD and understand things from your child’s point of view.

 

Other useful resources that have helped in better understanding the condition include:

  • Children and Adults with Attention Deficit Disorder (CH.A.D.D.)

  • Learning Disability Association (LDA)

  • The University of Arizona, SALT Center provides information on what is available at a college level for students with uneven learning profiles. Access the program at

 

Intervention Strategies for Emotion Regulation

Helping Children/Adolescents Tolerate and Regulate Negative Emotions

  • Outline the difficulties they have with negative emotions and build strategies to help them deal with and overcome these vulnerabilities.

  • Discuss the barriers they have toward changing their emotions and develop a plan for overcoming these obstacles.

  • Give them instructions on how to recognize and label emotions; help them identify emotional reactions that are specific to particular contexts.

  • Provide training that enables them to identify the physical effect of emotions. Skills training in deep-breathing exercises and muscle relaxation techniques may help alleviate some of the physical symptoms of negative emotions, especially anxiety.

  • Help them develop strategies to tolerate rather than avoid distress. If they are able to fully experience and develop an awareness of their emotions, they can learn to experience without judgment and then to let go. Avoidance behaviors may make the situation worse and become harmful over time.

  • Teach them the technique for regulating negative emotions of expressing the opposite emotions. For example, if they are feeling sad, they would try to feel a counterintuitive or opposite emotion, such as gratitude or happiness.

  • Provide strategies that will help them to be more aware of and increase the number of positive events in their life. These strategies may include providing techniques on how to avoid giving up, being more mindful of positive events, and building positive relationships with others.

CHILD PSYCHOANALYSIS

WHAT IS CHILD PSYCHOANALYSIS?

Psychoanalysis is a form of psychotherapy conducted 3 or 4 times a week. The goal is the restoration of healthy progressive development so children can achieve their full potential. This approach is not a quick fix, instead, it helps the child or adolescent to overcome troubles and delays while building deep, long-lasting strength and resilience.

WHO IS A CHILD PSYCHOANALYST

Child psychoanalysts are highly trained and experienced professionals, and beyond their initial education and training, psychoanalysts compete additional years of education and training, b anywhere between 5 and 10 years after a doctoral or medical degree. The goal of a child analyst is the modification of psychological roadblocks so children and adolescents can achieve their full potential. In other words my job is to put development back on track.

HOW DO WE DO PSYCHOANALYSIS WITH CHILDREN?

In the analyst’s consulting room, younger children usually play with toys, such as puppets, animals, toy cars and houses, or draw, paint, or model with clay, as they talk. Words, play, and activity are ways children express their inner world.  Children play and adolescents talk.

Whatever activity they choose to express their emotions, the analyst is there to listen and understand, and to share this understanding with the child or adolescent. The latter part is what makes psychoanalysis unique. Psychoanalysts are able to help children and adolescents verbalize problems in a way that they were unable to do on their own. The other very important component to psychoanalysis is that exploring the relationship with the psychoanalysts and its similarity to important family relationships can free the child from acting on his or her feelings and allow more intentional, self-directed action and growth.

WHAT IS THE ROLE OF PARENTS AND OTHER ADULTS

Parents are the most important adults in the lives of children and adolescents, and they also are a very important component during psychoanalytic treatment. I usually say to parents “without you I can’t do my job, I need you in order for me to help you child.”

Other adults are also very important, for example teachers are key. Although I do not discuss content with teachers, the teacher can tell me things that I can’t see for myself. For example, how the child relates to others, is the child focused in school, and if so, what distracts the child from concentrating. And paying attention. The teacher can also help us understands the social life of the child. Is the child shy, does he/she plays with other children, what is the quality of the interaction, and finally, what is the interaction with the authority figures in the child’s lives. I do genuinely believe that every parent wants to be a good parent, but sometimes they need a little help in understanding their children’s emotional life. Sometimes the problems stem from within the child or teen, as we know children and adolescents have complex emotional disturbances, and understanding them is key for a successful navigation of childhood.

 

Historically, child psychoanalysis has been a preferred treatment of choice in Europe, Latin America, and South America. I believe the US is behind in accepting psychoanalysis as a way to treat children. My opinion is that there is a lack of information about the benefits of child psychoanalysis. Also, the treatment can be expensive, because of the duration of treatment, also because it requires a great of emotional investment from the parents. In child psychoanalysis, I need to see the child anyway from 3 to 5 sessions a week. I can see that it can intimidate people, but what they child gets in a psychoanalytic treatment will change the child’s live forever.  Since I can’t disclose any information about my patients, there are many studies that demonstrates the success of child psychoanalysis.  If you would like more information about child psychoanalysis, please visit my website www.drboscan.com, or visit the American Psychoanalytic Association website at www.apsaa.org, the International Psychoanalytic Association (IPA) or the Association for Child Psychoanalysis (ACP) for further information.