521840?1348844371
Rebecca Resnik, PsyD  
Female
Bethesda, MD

Specialties: ADHD, dyslexia, developmental delays

Interests: Developmental Disabilities
MindWell Clinical Psychology
Bethesda Office
301-581-1120
Bethesda, MD
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When should my child have a psychological assessment?

Jun 17, 2008 - 12 comments
Tags:

Psycholgical Testing

,

ADHD

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Learning Disabilities




When should my child be tested?

Parents often ask us when is the right time for a child to receive testing or therapy services. They may have heard people tell them to wait until third grade, or until a child is 7, or even “Don’t worry, he’ll grow out of it.” There is no magic age for testing and therapy, and if your instinct as a parent is telling you that something is not right, its time to act. Time is one of our most valuable assets in helping children. Most problems that took a while to develop take a while to improve, and when better to make changes than at a time in life when the brain is most adaptable? Early intervention is vital if you have concerns about a very young child (under 5) or if things have been getting steadily worse and worse for your child over time.

For children with ADHD and learning disabilities (as many as half of all children with ADHD also have learning disabilities), testing is critical as soon as problems are noted at school and home. Children with average intelligence can usually cope with the demands of the first grade curriculum, at least for the first part of the year. First grade is a time when the basic skills are introduced. Each task is short, involving only a few steps to complete. First grade work is highly structured, and most things the child reads will have helpful pictures. Homework can usually be completed in a half-hour. If your child is having learning problems in kindergarten or first grade, this can mean that the problems are particularly important to address. If the first year of school is unsuccessful, children may become convinced that they will never be able to do well. Feelings of frustration can lead to school avoidance or disruptive behaviors. As a former special education teacher, I have observed that some children quickly get a reputation among teachers for being 'trouble.' Once it sticks, the label is one that follows the child from year to year. It is much harder to develop a working partnership with school staff when everyone in the school has decided that your child is a 'problem.'

Many of the children I see come during the third grade. The reason for this is simple if you are aware of the scope and sequence of the elementary school curriculum. Third grade is when academic tasks require sustained attention to detail. Almost everything takes more time to complete and involves more steps. Instead of taking five seconds to complete a math problem, it can now take a few minutes to complete each problem (e.g. borrowing and carrying operations). Instead of writing a single word or sentence, the child must do a book report. Children with reading comprehension problems have an exceedingly difficult time understanding chapter books and text books. The helpful pictures they depended on are gone. Projects can take a week or more of planning, which is the downfall of a child with executive functioning impairment. These changes in the curriculum can cause child's academic progress to stall. Children who can not sustain attention or understand most of what they read fall behind their classmates very quickly. This can be a disheartening event for the child. Some develop anxious fears that they are not smart enough to learn. Many cope by convincing themselves that they don't care anyway, that school is stupid or that all teachers are against them. This state of affairs should be a thing of the past now that we have so many treatments and educational interventions, yet I still see children who have gone for years without receiving the help they need.

When deciding whether or not to test, it is important to understand that troubling symptoms can happen for a lot of different reasons. Symptoms like irritability can indicate conditions such as ADHD, depression, anxiety, obsessive compulsive disorder, sensory integration disorder, or even a medical problem like a sleep or elimination disorder. Children are complex beings who, unfortunately, do not often know how to tell us what is wrong. When we ask a child questions like "Why aren't you doing your work?" or "Why can't you sit still?" we get answers like "I don't know." Testing can give us the answers the children can not. I have yet to meet a child who is unsuccessful because he chooses to be. I believe that all children want very badly to make their parents and teachers proud. Research has shown that when children can not meet adult expectations at school and home, they are at-risk for secondary mental health problems like depression or anxiety. Children with undiagnosed disabilities often feel terrible. When kids feel terrible they may become disruptive, avoidant, or even aggressive. It makes sense if you think about it from the child's perspective, who can be happy spending six hours a day feeling like a failure or getting punished? As adults, we would quit a job like that, but kids don't have that option. Children are stuck with school, whether it goes well or not. Children who feel chronically frustrated, irritated, stupid or disliked need help before they become so discouraged that they give up school, or worse, on themselves.

Rebecca Resnik, PsyD, Licensed Clinical Psychologist and Former Special Education Teacher

Diagnosis of ADHD

Jun 17, 2008 - 1 comments
Tags:

ADHD




Attention Deficit Hyperactivity Disorder (ADHD): Accurate Diagnosis is the Key to Effective Interventions

At Mindworks (our private clinic), we frequently receive inquires from parents concerned about ADHD. In this article, I will try to present some general information to help parents become a bit more familiar with this relatively common disability. One of the first things we all associate with ADHD is hyperactivity—the kid you see running around like he’s wearing a jetpack with a frantic mother chasing him. While hyperactivity does occur in many children with ADHD, the fact that your child is very active does not necessarily warrant a diagnosis. The Diagnostic and Statistical Manual of the American Psychiatric Association contains three subtypes of ADHD, including Hyperactive, Inattentive, and Combined. ADHD is a constellation of symptoms and behaviors that cannot be explained by any other cause (such as anxiety, learning disability, or a thyroid disorder). Contrary to what many people assume, ADHD is not just having a short attention span. Many parents are confused by the fact that their child can happily spend two hours playing a video game, yet can not complete a short homework worksheet. ADHD is a neurological disorder that has a significant, pervasive impact on learning and behavior.

As Dr. Larry B. Silver has noted, ADHD is a ‘life disability.’ It is not just problems at school. Children with ADHD experience difficulties across settings, meaning that these children have problems with tasks that require sustained attention to detail wherever they go, from the Cub Scout meeting to the homework table. There are two major characteristics of children with ADHD that make life harder for them and the people who love them. One is a weakness with ‘Executive Functioning.’ Executive functioning is our ability to work efficiently, strategically, and to execute our plans mindfully. For example, writing and reading comprehension tend to be the downfall of many children with ADHD, because successful reading and writing depend on executive functioning. Another problematic symptom is difficulty with impulse control (also known as behavioral disinhibition). The child with ADHD has little ability to control his or her impulses, and may routinely violate rules, irritate other people, make careless mistakes, or complete tasks in a haphazard manner.

When talking to parents about testing for ADHD, I recommend investing in at least one very through, comprehensive psychological evaluation. One of the reasons for this is that I want to be able to recommend the most effective academic and behavioral interventions that will match the child’s particular pattern of strengths and weaknesses. Just as importantly, I do not want to be wrong in my diagnosis. ADHD is known as a ‘diagnosis of exclusion,’ meaning that the person making the diagnosis must make sure that nothing else could be causing the symptoms. Doing a quick parent interview or a couple of symptom checklists is not adequate. Additionally, it is currently estimated that as many as 50% of children with ADHD also have specific learning disabilities. Not only are these children at risk for school problems, they are far more likely than peers to have significant levels of anxiety, depression, or behavioral problems. Researcher Dr. Russell Barkley has described children with ADHD as being several years less emotionally mature than typical peers. This means that both parents and child are likely to need additional support. Once you have an accurate diagnosis, your medical, psychological and educational team can be most effective in helping your child achieve his potential.

-Dr. Rebecca Resnik

Licensed Clinical Psychologist

Psychological Assessments for Young Children

Jun 17, 2008 - 4 comments

Developmental Assessments: Testing for children Five and Under

A psychologist conducts a developmental assessment to evaluate your child’s progress in meeting important milestones of early childhood. Important ‘milestones’ occur in the areas of language, visual motor integration, self-regulation, motor skills, and emotional development. While every child is unique, and develops on his or her own timeline, sometimes there is cause for concern. The American Academy of Pediatrics recently recommended that pediatricians conduct more formal screenings of early childhood development. This is easier said than done. Most pediatricians have to compress their exploration of your little one’s progress into a 15 minute appointment, while also conducting a physical and giving shots, all while the child is crying or running around the room. Its more difficult for pediatricians in a practice where the child sees a different physician every time. Pediatricians refer patients to other professionals such as psychologists, developmental pediatricians, and speech-language pathologists when they suspect that something about the child’s development is either delayed or atypical.

When I use the words ‘delayed’ and ‘atypical’ to describe early childhood development, I mean that some children develop skills more slowly than others (a developmental delay), while other children’s development does not follow the expected course. Atypical development (also misleadingly referred to as a ‘developmental delay’) may mean that a child has an autistic spectrum disorder, suffers the effects of living in an orphanage, or has a genetic difference. For example, children with autistic spectrum disorders may acquire and then ‘lose’ some ability to communicate, while a child with a speech-language delay reaches the typical language milestones (one word, two words, phrases, sentences), just later than his peers.

Parents often want to know what I do during an early childhood evaluation. My job is to study several areas of development, including: social relatedness, intellectual functioning, receptive and expressive language, attention, memory, information processing, adaptive functioning, visual motor integration, behavior (especially play), and sometimes I look at how well they are mastering pre-academic goals like learning their numbers and letters. The trick is to do all of this with the most reliable, child friendly assessment tools I have in the brief time window when I can access the child’s best performance. After data collection, I want to consult with as many of the child’s teachers, doctors and related service providers as I can to get the full picture and to help me interpret what I have observed.

Sometimes when a pediatrician refers a child, the nervous parent will ask me if all this is really necessary, if perhaps their child will just ‘grow out of it’. I am a parent too, and I understand that fear that something is wrong with your child, and how much you hope it will just go away. When a parent calls, here are the ‘red flags’ I am listening for: the child’s expressive or receptive language are well behind schedule, the child is having trouble relating to other people, the child is having temper tantrums that are causing problems at home/school/daycare, the child is having trouble learning at school, the child is exhibiting behaviors that are unusual or severe as compared to same aged peers. Testing gives us answers that we need to address our concerns effectively and with compassion. Testing helps answer what I call the “can’t versus ‘won’t” question. The test data help us make a plan to develop what the child can’t do and guide him toward what he won’t do. The last thing you ever want to do is punish a child for something that is beyond his control.

Sometimes people ask me if I do in-home testing. I strongly prefer to see a child in my office. Generally, home is a very accommodating environment. The child knows all the routines, where everything is, and what every object is called. However, life is not about staying home and functioning in that soft nest of familiarity, it is about transitioning to school, the playground and developing relationships with people outside of your family. I need to see how your child copes with being in a room with a new person, strange toys and unfamiliar tasks. I also need to be more objective than a parent or grandparent, and that includes following standardized testing procedures. Since becoming a parent, I know how hard it is to be objective about your own child, especially when you’re afraid something could be wrong. Using standardized tests and making careful observations allows me to systematically measure your child’s strengths and weaknesses as compared to same aged peers.

Finally, parents come to Mindworks (our private clinic) wanting a diagnosis. As psychologists, we do diagnose. This is different from the school system, where the goal is to determine eligibility for special education services (typically under the catch-all early childhood label ‘Developmental Delay’). I believe obtaining a diagnosis is valuable beyond that it helps you access special education services (speech-language therapy, occupational therapy, self-contained pre-school, physical therapy, applied behavior analysis etc.). A diagnosis helps you to empathize with your child, advocate for him, meet his needs, and most importantly to plan for the future.

Unless a child was born with a congenital condition, there is often very little time in between when a delay is identified and when that child will go to school। Early intervention therapies take time. The earlier they begin the more effective they are likely to be. Each family only has so much time, money and energy, and you want to devote those resources to interventions that will matter most. Early childhood services are critical in helping ensure that the transition to elementary school goes a smoothly as possible for a child with a delay or disability. At the end of the day, the reason to do testing is to answer those nagging questions, and to let each family go forth with confidence that they are making the best choices for their child.

-Rebecca Resnik, PsyD
Licensed Clinical Psychologist