MindWell Psychology: Speaking the Mind

Affordable Mental Health Care: How to find free or reduced-fee treatment in your area

2009-01-28T21:24:00.000-05:00

The following is a guide to finding affordable psychological and psychiatric services in your area. Many people call or write me asking how they can find treatment if they do not have insurance or can not pay their deductibles. It is extremely frustrating to need help and not be able to afford it, even if you have insurance. It is sad that many insurance companies do not cover psychological and psychiatric services to the extent that all of their subscribers can access care. Unfortunately, many psychologists can no longer afford to participate with insurance companies or Medicaid/Medicare. The reasons for this include low reimbursement rates, frequency of denied payment for services, and the burden of insurance related paperwork. While the situation is problematic, there is no reason to assume that you can not get the care you need.

On the bright side, if you can take the time and energy to search, you have a good chance of finding someone who can help. First, here are some terms to be familiar with:

Sliding Fee Scale—this means that the clinician will adjust the price of services in accordance with your ability to pay
Community Mental Health Center—a public, non-profit agency that provides mental health treatment
Pro Bono Services—Free services offered to those in need. The ethical code of the American Psychological Association encourages psychologists to do pro-bono work, and most do some form of uncompensated service.

Do not be shy about asking clinicians if they can accommodate your financial situation. If they can not, they should be able to refer you to someone who can provide you less expensive treatment that would meet your needs. You may also find that a psychologist will agree to conduct a short-term, focused treatment on a specific problem. Ask if you can come every other week or monthly. Ask if there is a payment plan. Some psychologists are willing to provide therapy over the phone or through the computer if your work schedule makes it difficult to attend sessions.

Here are some ideas for where you can find free and affordable mental health care:

1. Call your general practitioner. Your physician should have a list of places he or she is comfortable sending you.
2. Contact an advocacy group’s local chapter. Organizations such as the National Alliance on Mental Illness (http://www.nami.org/Template.cfm?section=your_local_NAMI, Alcoholics Anonymous (http://www.aa.org/lang/en/meeting_finder.cfm?origpage=29), or the Association of Retarded Citizens (ARC) in your area will be able to help find treatment for specific needs. Advocacy groups typically maintain lists of local community therapists and respite care providers.
3. Contact your local hospital. Hospitals take insurance, including medical assistance. Call the Behavioral Health or Outpatient Psychology/Psychiatry department. Teaching hospitals (those that train student psychologists and psychiatrists) may be particularly good sources of less expensive care.
4. For urgent matters, try a crisis hotline. Even if you are not in immediate danger of harming yourself, they can still help. The people who answer the phone will have lists of places you can go where you can be seen as quickly as possible, even if you can not pay.
5. Ask your child’s school guidance counselor or school psychologist. Part of that person’s job is to refer students and families to local mental health care services.
6. Contact your local division of social services. You can often find this through your county’s website, or through private social service organizations such as Jewish Social Services (jssa.org).
7. Private ‘find a therapist’ websites such as www.therapists.psychologytoday.com/ will let you search for providers who are willing to offer sliding scale or pro bono care.
8. Local colleges and universities often maintain clinics that provide care to the general public. These clinics can be contacted through the departments of Psychology, Counseling, or Social Work. For example, if you went to the George Washington University Center for Professional Psychology website, you would find a link to the Center Clinic (http://www.gwu.edu/~cclinic/PsydCenterClinicContactUs.html). The Center Clinic is an example of a training clinic staffed by doctoral students who are supervised by licensed psychologists.
9. If you are a member of a religious community, clergy members can often refer you to pastoral counseling or other mental health care providers who have a spiritual orientation to treatment.

Good luck!
posted by MindWell clinician Rebecca Resnik, PsyD

Affordable Mental Health Care: How to find free or reduced-fee treatment in your area

2009-01-28T14:47:00.000-05:00

The Dreaded Power Struggles!

2008-06-29T15:17:00.001-04:00

The Dreaded Power Struggles!

I do not know of any parent who does not dread power struggles. This is one of the most popular things that brings families into therapy. There is nothing like a battle with your own child to cause intense frustration and self-doubt. Not to mention that our kids seem particularly adept at picking times when we are late for work or when your mother in-law is there to see the whole thing.

The only power struggles you truly win are those that you avoid. Once a child has engaged you in a negotiating, arguing, or tantruming battle, everybody loses. From the toddler who throws himself down and screams to the teen who becomes a prosecuting attorney, your best bet is to avoid ever being drawn into battling like an equal. It is very strange to think about it, but power struggles keep undesirable behavior going. Its not that they are pleasant for children, but during a 'battle' with you, your child is actually getting something he wants. When he can engage you, the child gets your full attention, ‘blows off steam’, and sometimes gets you to give in. Even if you are only loosing the occasional power struggle, that rare reinforcement of the unwanted behavior is enough to make it worse over time. Once your child learns that every now and then you will give in, it is just like he’s playing the slots in Vegas. He will keep going with more and more determination until the next big ‘pay off’ comes. Then the pattern becomes very difficult to break.

So the real answer is to keep power struggles from happening as much as humanly possible. First off, you can be proactive. Watch out for situations that make a power struggle more likely. The big triggers include: video games, low blood sugar, fatigue, an anxiety provoking situation, having to share, going to/staying in bed, not enough opportunity to burn off energy, and transitioning from a preferred activity (watching TV) to an unwelcome activity (going to school). We parents can anticipate most of these things coming and plan our strategy in advance by setting up expectations. Give lots of warnings and let the child know explicitly what to expect (“In 2 minutes, it will be time to turn off the TV and put on your coat”). If you are going to a trouble zone like a grocery store candy aisle, tell the child in advance what you will and will not be buying. Set a timer to tell your child when it is time to stop playing computer games. If you are going out, let the child know what behavior you expect to see, and what behaviors will lead to having to leave. Once you set an expectation, make sure to stick to it!

The other two big ways to avoid the power struggle is giving choices and just plain empathizing. I am borrowing here from a terrific book called How to Talk so Kids will Listen and Listen so Kids will Talk, which I can not recommend enough. Your kids will be less likely to battle with you if you give them two things everyone wants, including choices and the feeling that you understand their perspective. While the ‘forced choice’ does not work every time, it can stave off many battles. Give kids lots of little choices whenever you have wiggle room. Choices are great for their sense of independence and for helping them learn to take responsibility for their own decisions. You can offer choices related to when the child will do something (now or in 5 minutes), how it will be done, and what the child would like (which cereal, which shirt, which homework assignment first etc.)

If you can not give your child a choice, such as when its time to leave for school, let him know that you understand how he feels about it. We all feel so much better about unpleasant things when we feel that the important people in our lives care what we are thinking. This is NOT the same thing as giving in to our child’s demands! Empathizing is about helping your child tolerate the frustrations we all face in our day to day lives, not trying to make the frustration go away. We all have to do things like get shots and wait our turn, and kids need to learn to cope. However, we can help kids feel better with such simple statements like: “You wish you could play that game all day instead of going to Grandma’s”, “You’re really disappointed about not being able to have more cake” or “Having to leave your teddy bear feels sad, you miss him when you’re at school.” By empathizing with our children and giving voice to their feelings, we can help them feel that we are on their side, and that we care about their experiences. For an older child or teen, tell them to write you a letter/email describing their grievances. A little empathy goes a long way towards making them feel willing to go along with our directions.

Finally, the important thing in managing power struggles is to diffuse them if you can not prevent them. Keep in mind, it is always better to be proactive in managing behavior than reactive. When you have to be reactive, start by labeling the feeling (“You look frustrated” “I can see you are getting annoyed about this” or “This makes you very grumpy.”), and then state your expectation firmly (“And now we are going to have to leave for school” or “But I expect you touch the dog gently” or “Use words, not fists!”). If the child starts to calm down, you can offer a forced choice at this point (“Now, do you want to wear your coat or your jacket to school?”). If the child escalates with negotiating or a tantrum, it is time to get very firm and direct about what you are going to do (“If you do not choose, I will choose” or “We can discuss it later, right now it is time for school”, “If you need to calm down, I expect you to sit on the steps for two minutes.”). You’re your statements short. Then once you have told the child what you expect, it is time to ignore him until he complies. Some children will become very provocative trying to re-engage you, but ignore all behavior except something that puts your child or someone else in danger. Once the child complies or gets close enough towards acceptable behavior, praise and give attention again.

Across the board, your goal is to give lots of attention, descriptive praise, and affection for desirable behavior, and as little as possible for unwanted behavior. In most families, we tend to pay little attention to the kids when they are doing what we want, and give then our undivided attention when they are being inappropriate. A power struggle is our children’s way of trying to get control over us, so keep in mind that once we are engaged in battling like equals, they have already won. Lastly, it is important to remember that our children do NOT really want to win power struggles. A child who wins power struggles is not a happy child, instead he becomes anxious, angry, and contemptuous (Remember Veruca Salt from Charlie and the Chocolate Factory?). What truly makes a child feel happy and calm is when he knows that his parents are in-control, protecting him even from his own worst impulses.

Dr. Rebecca Resnik

Licensed Clinical Psychologist

Mindworks Clinical Psychology

The Dreaded Power Struggles!

2008-06-20T17:06:00.001-04:00

I do not know of any parent who does not dread power struggles. This is one of the most popular things that brings families into therapy. There is nothing like a battle with your own child to cause intense frustration and self-doubt. Not to mention that our kids seem particularly adept at picking times when we are late for work or when your mother in-law is there to see the whole thing.

The only power struggles you truly win are those that you avoid. Once a child has engaged you in a negotiating, arguing, or tantruming battle, everybody loses. From the toddler who throws himself down and screams to the teen who becomes a prosecuting attorney, your best bet is to avoid ever being drawn into battling like an equal. It is very strange to think about it, but power struggles keep undesirable behavior going. Its not that they are pleasant for children, but during a 'battle' with you, your child is actually getting something he wants. When he can engage you, the child gets your full attention, ‘blows off steam’, and sometimes gets you to give in. Even if you are only loosing the occasional power struggle, that rare reinforcement of the unwanted behavior is enough to make it worse over time. Once your child learns that every now and then you will give in, it is just like he’s playing the slots in Vegas. He will keep going with more and more determination until the next big ‘pay off’ comes. Then the pattern becomes very difficult to break.

So the real answer is to keep power struggles from happening as much as humanly possible. First off, you can be proactive. Watch out for situations that make a power struggle more likely. The big triggers include: video games, low blood sugar, fatigue, an anxiety provoking situation, having to share, going to/staying in bed, not enough opportunity to burn off energy, and transitioning from a preferred activity (watching TV) to an unwelcome activity (going to school). We parents can anticipate most of these things coming and plan our strategy in advance by setting up expectations. Give lots of warnings and let the child know explicitly what to expect (“In 2 minutes, it will be time to turn off the TV and put on your coat”). If you are going to a trouble zone like a grocery store candy aisle, tell the child in advance what you will and will not be buying. Set a timer to tell your child when it is time to stop playing computer games. If you are going out, let the child know what behavior you expect to see, and what behaviors will lead to having to leave. Once you set an expectation, make sure to stick to it!

The other two big ways to avoid the power struggle is giving choices and just plain empathizing. I am borrowing here from a terrific book called How to Talk so Kids will Listen and Listen so Kids will Talk, which I can not recommend enough. Your kids will be less likely to battle with you if you give them two things everyone wants, including choices and the feeling that you understand their perspective. While the ‘forced choice’ does not work every time, it can stave off many battles. Give kids lots of little choices whenever you have wiggle room. Choices are great for their sense of independence and for helping them learn to take responsibility for their own decisions. You can offer choices related to when the child will do something (now or in 5 minutes), how it will be done, and what the child would like (which cereal, which shirt, which homework assignment first etc.)

If you can not give your child a choice, such as when its time to leave for school, let him know that you understand how he feels about it. We all feel so much better about unpleasant things when we feel that the important people in our lives care what we are thinking. This is NOT the same thing as giving in to our child’s demands! Empathizing is about helping your child tolerate the frustrations we all face in our day to day lives, not trying to make the frustration go away. We all have to do things like get shots and wait our turn, and kids need to learn to cope. However, we can help kids feel better with such simple statements like: “You wish you could play that game all day instead of going to Grandma’s”, “You’re really disappointed about not being able to have more cake” or “Having to leave your teddy bear feels sad, you miss him when you’re at school.” By empathizing with our children and giving voice to their feelings, we can help them feel that we are on their side, and that we care about their experiences. For an older child or teen, tell them to write you a letter/email describing their grievances. A little empathy goes a long way towards making them feel willing to go along with our directions.

Finally, the important thing in managing power struggles is to diffuse them if you can not prevent them. Keep in mind, it is always better to be proactive in managing behavior than reactive. When you have to be reactive, start by labeling the feeling (“You look frustrated” “I can see you are getting annoyed about this” or “This makes you very grumpy.”), and then state your expectation firmly (“And now we are going to have to leave for school” or “But I expect you touch the dog gently” or “Use words, not fists!”). If the child starts to calm down, you can offer a forced choice at this point (“Now, do you want to wear your coat or your jacket to school?”). If the child escalates with negotiating or a tantrum, it is time to get very firm and direct about what you are going to do (“If you do not choose, I will choose” or “We can discuss it later, right now it is time for school”, “If you need to calm down, I expect you to sit on the steps for two minutes.”). You’re your statements short. Then once you have told the child what you expect, it is time to ignore him until he complies. Some children will become very provocative trying to re-engage you, but ignore all behavior except something that puts your child or someone else in danger. Once the child complies or gets close enough towards acceptable behavior, praise and give attention again.

Across the board, your goal is to give lots of attention, descriptive praise, and affection for desirable behavior, and as little as possible for unwanted behavior. In most families, we tend to pay little attention to the kids when they are doing what we want, and give then our undivided attention when they are being inappropriate. A power struggle is our children’s way of trying to get control over us, so keep in mind that once we are engaged in battling like equals, they have already won. Lastly, it is important to remember that our children do NOT really want to win power struggles. A child who wins power struggles is not a happy child, instead he becomes anxious, angry, and contemptuous (Remember Veruca Salt from Charlie and the Chocolate Factory?). What truly makes a child feel happy and calm is when he knows that his parents are in-control, protecting him even from his own worst impulses.

Dr. Rebecca Resnik
Licensed Clinical Psychologist
Mindworks Clinical Psychology

Developmental Assessments: Testing for children Five and Under

2008-04-08T14:01:00.004-04:00

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. I have to be ready to be anything from Mr. Rogers to a circus clown to help the child feel comfortable. 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 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

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

2008-02-12T20:15:00.002-05:00

At Mindworks, 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, but just as importantly, I do not want to be wrong in my diagnosis. ADHD is known as a ‘diagnosis of exclusion,’ meaning that you 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.

-Dr. Rebecca Resnik

Licensed Clinical Psychologist

“Too hard to say NO”

2008-02-12T20:15:00.001-05:00

It is too hard to say “no” to your intensely protesting child even though in your heart of hearts you know it is the right answer? Given that a blog on this question is being posted, at least you know that you are not alone with this dilemma. First, children are very good at what they do. Indeed they are wired to be experts in survival. And while we are also wired to be caretakers, the challenge of parenting is much more complex and demanding than being the child. All that having been said, when children are fighting hard against their mother’s and father’s wishes and using every possible strategy they can find, from screaming in the middle of a crowded store to telling you adoringly how much they love you (with a kiss kiss here and a kiss kiss there) to get what they want, you needn’t be fooled. These brilliant young folks are likely testing your strength as the parent and the one in charge as much, if not more than trying to get their way.

It is hard to be a child and so dependent upon others for security. Not surprisingly, these smart little people need to test the limits of their security – when they learn their environment is safe, they can relax and engage more deeply in their environment – a good thing for healthy development. How do they test the limits of their security – by seeing how far they can push you – who is stronger, me or you,

Who is in charge here, how much distress can you tolerate and still prevail?

To test this theory, try refusing your child’s unreasonable requests with this in mind. Hopefully, this discussion will make saying “no” easier. After the initial “storm” do they seem calmer, more at ease, more solicitous of your affection? And how are you doing? Do you feel more “in charge” and self confident? Are you feeling more affectionate towards your child rather than resentful of their victory?

We hope this little experiment is helpful as setting limits effectively with you child not only greatly enhances the quality of your relationship with them, but it is an important component in healthy development, internalized security and respect for others. Another good reason to do this sooner rather than later is that it makes the adolescent years much more enjoyable for all.

Dr. Barbara Mazer

Clinical Psychology Resident and soon to be MindWorks clinician!

Some Thoughts about Behavior Plans

2008-02-12T20:14:00.002-05:00

Behavior plans are one of the most popular approaches for trying to systematically change a child’s behaviors. Decades of research has shown that even an earthworm can respond to a simple behavior plan. So why do so many frustrated parents come to us at Mindworks with the classic lament “We tried that, it didn’t work.”? As with most things in life, it’s because there is almost never a simple answer to a complex problem.

Helping our children develop self-control is one of the most challenging tasks we parents face. One reason behavior plans can fail to make lasting changes is that people understand them as ways of making a child to comply. Getting people to comply is pretty easy. I can get you to do anything I want if I threaten you with a nasty enough consequence. However, once I’m not around or I can’t make good on my threat, you’re going to go right back to doing what you want. While we all need our children to comply with our rules, the true goal of a behavior plan is to teach the child to do something new.

When we take a teaching approach to modifying behavior, we come at the problem differently. Now our goal is to help the child choose a better set of behaviors than whatever behaviors are causing problems. As the psychologist Reginald Lourie noted, we must not eliminate a behavior without giving the child an attractive option for how to handle a stressful situation. If we just focus on stamping out a particular behavior, the child will find another way of dealing with his anger, frustration, boredom or shame (e.g. the child goes from hitting to biting). Remember, the goal is not just short-term compliance, its long-term development of self-control. Behavior plans have many common pitfalls. A major problem is lack of consistency, or using the plan sporadically or for too short a time period. This inconsistency creates a situation like a person gambling at a slot machine. Your child is the gambler, hoping for a pay-off (i.e. you giving in!). Guess who is the slot machine? When the ‘gambler’ never knows when the machine will ‘pay-off’ he is very, very, motivated to keep pushing buttons until it does. Kids are always looking for how to ‘beat the system’ and many parents give up as soon as the child finds a weakness in the plan that he can exploit. Every plan has weaknesses your child will find. That’s a delicate phase in implementation.

A psychologist can help you get through it without having the whole plan go down in flames. It is vital to get help from an expert to make sure your plan is developmentally appropriate! Lots of great plans fail because they are better suited to older children or for those without disabilities. The child must have the maximum chance for success, because there’s nothing harder than trying to implement a second, third, or fourth plan after failed attempts. A psychologist can also help you avoid pitfalls like inappropriate consequences. Too many well meaning people enact consequences that make the situation worse for everybody. For example, some people take recess from a child who desperately needs to let off steam, cancel birthday parties, or put a withdrawn, avoidant child into time-out.

Keep in mind that changing troublesome behavior does not happen overnight, and can be incredibly discouraging. The good news is that when behavior plans are proactive, fair and a good match for the child, they can and do help children change!

-Dr. Rebecca Resnik

Of note, Dr. Resnik was just interviewed with the Voice of America to present a televised series of parenting tips in Urdu speaking Pakistan. It's a reminder that behavioral problems and parenting challenges are universal!

Me First and the Gimmie Gimmies*

2008-02-12T20:14:00.001-05:00

The holidays are supposed to bring out the best in all of us, but it can bring out the worst in our children and in us as parents. The winter holidays is a time of stress and high expectations, and both are hard for children to handle. Pretty much all humans, except for Gandhi or Mother Theresa, are insatiable beings. We all have limitless wants and wishes. Our desires can lead us to great things and achievements, and they can also lead us towards greed and envy. Children have those same feelings, but unlike adults, they don’t understand why all of their wants can’t (and shouldn’t) be granted.

This time of year, children are bombarded with toys, Santa, treats, and commercials. We really can’t blame them for craving all the terrific things they see, especially when so many of them believe that Santa will bring whatever they want. While we would love to curb their greed, the usual methods reasonable parents try don’t work very well against the holiday hype. We try to explain to children about limited budgets, how we need to save for college, and how it’s impossible for grandma to know exactly what Barbie is the perfect one. But kids don’t understand, not really. You can talk yourself blue in the face to a four-year-old who wants a toy NOW, and he’s not going to understand anything beyond what his experience tells him. He knows that you could buy whatever it is he wants (you’re his parent, you can do anything right?), but you won’t until he convinces you that he really, really needs it. We parents all know that this becomes a cycle. First the child demands, then the parent refuses. The child gets more upset, and the parent starts feeling guilty, then frustrated, then angry. The child escalates until the parent punishes, leaving both people feeling terrible. Another awful situation arises when you give a child a beautiful gift, only to have him cry that he doesn’t like it. The holiday combination of stressed-out parents, too much excitement, and unrealistic expectations sets our kids up for meltdowns.

So here are some ideas for the holidays that might help take the edge off a bit:

Avoid the danger zones. Try not to take your child to the toy store, the mall, and turn-off the Saturday morning cartoon line-up (where all of the toy commercials are). The stores are overwhelming and crowded this time of year. All those toys are just too tempting for a child to ignore gracefully. If you must take your child shopping, let her know at the outset what you will and will not be purchasing. Be ready to leave the store if your child is not cooperative.
Focus on the giving. Keep your child’s attention directed towards all of the things he is going to give to others. Take him to the craft store and get lots of supplies for making ornaments, menorahs, scrapbooks, paintable coffee cups and cards (get lots of glitter). Help your child buy gifts online so you won’t have to go to the stores. Shoot for having your child have a gift or card for everyone who will be giving him a gift. Teach your child about giving to charities. A child can pick out a Toys-For-Tots (just have him pick out one for a child of a different age or gender so he can part with the toy without tears) or help choose items for a care package to a solider in Iraq (www.anysoldier.com). Don’t forget your child’s teacher!
Limit the Loot. Limit yourself and your relatives in the gift giving department. Keep it to one or two gifts at any one occasion, and put a cap on the amount people will spend. Don’t let a young child see a gift that he can not open and play with immediately (such as one that takes hours to assemble), otherwise you are sure to provoke tears.
Practice how to accept gifts. Role play how to accept a gift, even if you don’t like it or already have it. Teach the child to say a warm ‘thank you’ and to write or color thank-you notes.
Empathize. Children sometimes do get disappointed at the holidays; we can’t ever get them every wonderful, expensive gift they desire. Part of our job as a parent is helping our children deal with disappointment. Resist the urge to lecture or call your child ungrateful. Instead, find that part of yourself that can relate to being a sad little kid who didn’t get what she wished for Christmas morning (I never did get a pony). Give a hug, give some cocoa, and then gently help steer your child’s focus back on all the things to be grateful for. Empathy is one of our best gifts we can give a struggling child.

Dr. Rebecca Resnik, mom and psychologist, and fellow Target goer.

* Title inspired by the rock band by that name

New Assessment Measures

2008-02-12T20:13:00.001-05:00

At MindWorks, we are dedicated to keeping our assessment tools up to date to keep up with research regarding how to measure a child's strengths and weaknesses, whether it be in academics, sensory issues, or social skills. We have recently acquired the NEPSY-2 (Neuropsychological Test of Development for Children), K-CPT (Kiddie Continuous Performance Test), and the PALS-Version 2 (Process Assessment of the Learner) in Reading, Writing, and Math. These tests are vital pieces of our assessment battery because it allows us to work with children as young as three. We can now detect precursor reading, writing, and math problems in very young children, allowing for earlier prevention. The NEPSY-2 has integrated more subtests that measure for social perspective and inhibition problems. The K-CPT is one computerized test that we use to evaluate for attention and vigilance in children as young as age 4.

These three new tests add to our 50+ meausres that we choose from when we create an individualized battery for your child.

When you are deciding who should work with your child, be sure to ask if the clinic, agency, school, or individual psychologist is using the most updated, emperically validated measures and is not just limited to a cookbook assessment battery.

At MindWorks, we only have doctoral level licensed clinical psychologists (PhD or PsyD) and thus our entire practice is dedicated to excellence in testing and therapy practice, rather than spreading ourselves thin in too many directions.

If you would like more information about the new NEPSY-2, CPT-2, or PALS-2, please give me a call.

-Rachna Varia, PhD, Director of Testing

A feedback letter from a client

2008-02-12T20:12:00.000-05:00

I received an e-mail from a family I worked with earlier this year. With her permission, she is allowing me to post it on this blog (alias used for her son's name)

Dear Dr. Varia,

I thought I'd write and update you on Michael's status since we met with you in August. I am SO grateful for your testing and advice. It gave us the information we needed to understand Michael's struggle with school, and to get him the help he clearly needs.

Michael was determined "Eligible" for help with his "Specific Learning Disability". An IEP was created on October 23. He had been placed in an 8th grade team of students that had special ed teachers already in the primary course classrooms on the second day of school, "just in case" he qualified for help. I am quite sure that just having those extra teachers available to help, for they help all of the kids, not just the ones assigned to them, helped him accomplish all A's and B's on his first quarter interims!

Michael has expressed relief in knowing that there is an explanation for his school difficulties, and that he is not alone moving forward. He's been very receptive to the help of his new teaching team, and continues to work hard at home.

I am so glad we were referred to you, and for the work you did with Michael. I just wish we'd caught it sooner. I know that if Michael had been identified sooner, it would have saved him, and me, much anguish. The silver lining is that it has been caught, and his future will be enhanced. I am so grateful for your work with Michael. Sure, we paid for the evaluation, but knowing it was done by a highly educated professional that specializes in this sort of assessment, and who prepared reports that were detailed and specific to him made it clearly worth the investment. His future was at stake, and has been brightened by your help.

A Call for Routine Psychological Check Ups for Children

2008-02-12T20:11:00.003-05:00

The tragedy at Virginia Tech last spring precipitated a long needed debate about the interaction of mental health services, courts, law enforcement and other social systems. Hopefully, risk assessment procedures and community responses will continue to improve for at-risk youth. As a child psychologist, I must articulate the value that could be gained by instituting standard psychological check ups.

There is inadequate attention given to the mental health needs of children. While there are uniformly accepted schedules for immunizations and annual physicals, we lack a similar strategy to track and treat our children’s emotional and behavioral health. Mental health check ups should be as widely accepted as dental check ups. This is a simple idea that has been discussed in the mental health community for some time; however, it hasnot received adequate attention among the public at large.

Five, twelve and seventeen.

When children start kindergarten, enter puberty and launch into adulthood they are prone to significant social and emotional upheaval. These transitions are widely believed to be critical time-windows in child development. Thus, at these three intervals, every child
would benefit from a standard psychological check up. This service would be affordable and simple to conduct. In one hour, a clinician could conduct a parent interview, a child interview and score a brief psychological test completed by the parent within 15 minutes.

We currently have remarkably useful, scientifically validated tools at our disposal which differentiate normal developmental struggles from clinical symptoms. Commonly used behavior rating scales compare a parent’s ratings about their child to thousands of other parent ratings. This provides the psychologist with data about how extreme a particular problem may be. For instance, a psychologist can quickly let a family know if their ratings about, say, aggression or thought problems were at the 50th, 75th or 90th percentile compared to other children the same age.

Symptoms that can be assessed in this manner include social problems, attention problems, mood problems, anxiety, adaptability and the like. Check ups could yield three simple outcomes. Parents could be told if a child appears to be growing up normally, is at-risk, or requires formal assessment and treatment. This would not, as some people fear, lead to an overwhelming trend of labeling or pathologizing healthy children.
Psychologists are well trained to appreciate the signs of adaptability and health in children and families. Well-trained clinicians recognize that children and families thrive when their competencies are validated and praised.

Preventative psychological care makes good sense. If recognized early, many moderate “warps” in a child’s personality can be improved with simple interventions. I have seen children overcome school phobias, cease aggressive behavior, pull up failing grades and begin using respectful language at home after only a few therapy visits. Problems such as
these can often be treated quickly, protecting children from unnecessary suffering. We must also recognize that there are children facing severe and chronic mental health conditions requiring intensive and long-term treatments. Even children in this category need systems in place to reassess their progress at critical ages. Child psychologists, who are trained in a scientist-practitioner model, can use validated measures to assess if clients are maintaining a healthy developmental trajectory.

The coordination of psychological care and medical care must become routinized. A significant number of pediatric office visits pertain to psychological issues. Children are frequently brought in to see their pediatrician or family doctor because of symptoms such as mood changes, phobias, temper problems, tics, sleep difficulties, learning problems, or attention problems. Unfortunately, it is rare for families to be granted a full-hour to discuss these matters and it is even less common for families to receive a multi-modal assessment that combines interview, play observation and psychological testing. When
the expertise of physicians and psychologists are combined, children and families are far better served.

Five, twelve and seventeen.

This simple schedule should remind us of the new standard in mental health care for children.

Lisa Bennett, Ph.D.; Licensed Clinical Psychologist, Certified School Psychologist

When should my child be tested?

2008-02-12T20:11:00.001-05:00

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 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

Why should I have a private psychological assessment?

2008-02-12T20:10:00.003-05:00

I recently spoke with a very happy father. He told me that he was cancelling our appointment for psychological testing because his insurance company was going to arrange for him to have his child tested for only $15. And as I wished him well and hung up the phone, I understood why he sounded so excited. Fifteen dollars compared to the cost of a private assessment, well who wouldn’t be thrilled? And if you get an assessment though the school system its free. Free sounds awfully good compared to expensive private testing, but the problem is that like with many things in life, if it sounds too good to be true to be, it probably is.

So what are you paying for when you invest in a private assessment? You are paying for time, expertise, and information you can trust. One of the first considerations is time. There’s no getting around the amount of time that a psychologist spends producing a quality report, and ideally it is the psychologist’s time. Some psychologists do not do their own testing, instead they pass you off to a technician or a student after the initial interview. The test administration, consulting, scoring and writing is very labor intensive, and it should be. No one wants to be treated by someone who is in a rush or taking short-cuts. Its worth paying for someone to make your case a priority. A private psychological evaluation should be custom designed around what you want to determine, as well as your child’s strengths and weaknesses. Tests and procedures should be thoughtfully selected, not simply used because they are the only ones you have. It is crucial to find a psychologist who has many tools at his or her disposal and the expertise to know how to use them.

It is unlikely that a psychologist will make useful recommendations unless he or she takes the time to study how an individual solves a variety of problems in the form of tests, tasks and even play. When you walk out of a psychologist’s office, you should have a large document in your hand that gives you insight into how your mind (or your child’s mind) works and lays out a plan for what steps to take next. A comprehensive assessment should lead to specific, concrete recommendations that address educational interventions, therapy, strategies for home, parenting advice, and information to inform medical treatments as appropriate.

When I do a psychological evaluation, I begin by budgeting six hours of ‘face to face’ time with the individual and his/her family. This is as much as three times the amount of time many people spend doing a psychological evaluation. My psychological evaluations resemble the neuropsychological assessments that I learned to do as in intern at a pediatric hospital in Baltimore. I study the person’s functioning exhaustively until I’m satisfied that I understand the problem, both what it is and what I can safely determine that it is not. After those six hours, I start calling everyone I have permission to consult with (physicians, teachers, tutors, even relatives) to get a complete picture of how the person is doing across home, school, and work. I review old testing reports and work samples. Then I set up to work writing your evaluation that takes me hours upon hours. I do not fill your name into a template. I do not dictate my reports to a transcription service. I do not cut and paste ‘cookie cutter’ recommendations into the report. Finally, the family and I sit down and have a feedback session, where we talk about the findings in detail and spend time problem solving. People who come to see me generally complete the entire process in a month or less.

Rebecca Resnik, PsyD - Licensed Clinical Psychologist

If your car is making a screeching noise, do you only want the battery checked?

2008-02-12T20:10:00.001-05:00

We often get requests for "ADHD testing."

I understand that there is a lot of media attention (excuse the pun) on ADD, ADHD, impulsivity, inattention. However, symptoms of inattention or restlessness are common in many learning and emotional problems such as learning disabilities, anxiety, moodiness, and motivational issues.

So if I go to the car mechanic and ask him or her to check only my battery because of the screeching noise, I would be remiss in not also having the whole car looked at. The engine, brakes, and all that other car stuff that I know very little about but may in fact be part of the problem. Thus, I have to trust that the mechanic should look at the whole car so he can ultimately not only fix the screeching sound but also make the car run more smoothly.

After years of doing different types of testing, we have now made it a MindWorks policy not to do "just ADHD testing." If you really want to find out why your child is having certain symptoms that may be affecting him or her at school and at home, we need to understand how the child learns, processes information, rule/out learning disabilities, and make sure that anxiety or depression is not creating these symptoms.

In the past, when we have only done "ADHD testing" (an IQ test, a checklist for attention symptoms, and a computerized test for viglilance and reaction time), we are often left with unanswered questions about why the child is struggling to read or is not doing well in geometry.

Like everyone, I am always a little suspicious when the car mechanic needs to check the entire car and am afriad that he is going to tell me that I am going to have spend money on x, y, and z, when I was only expected x. However, our testing comes from a health based perspective, so that we are identifying the strengths in your child to help overcome and compensate for the possible relative weaknesses.

So, next time you call ask for ADHD testing, expect me (or one of the other clinicians) to talk about why we feel it is important to take a whole child approach and not just focus on the battery. : )

-Rachna Varia, PhD; Director of Testing

Our Mission Statement and Philosophy

2008-02-12T20:08:00.000-05:00

MindWorks Philosophy and Mission Statement
What Makes MindWorks Work.

MindWorks, Clinical Psychology is committed to providing the highest-quality therapy, consultation, and assessment services by having specific standards for its:

Clinical Services
Staff
Environment

1) Clinical Services. MindWorks believes in a family systems model of therapy where children are not treated in isolation, but parents are made active participants in creating change. Assessments are based on creating a roadmap for clinical concerns and are individualized and thorough. MindWorks believes in communication with other parties and a collaborative model of care.

2) Staff. MindWorks believes that high quality services can be provided to clients by having excellent clinical staff. Staff is carefully selected to have a combination of professional acumen, personal warmth, sincerity, and approachability. MindWorks offers contractors a flexible schedule, steady stream of clients, and the ability to focus on clinical work instead of administrative and insurance tasks. MindWorks’ contractors are encouraged to create niche clinical services for professional and business satisfaction and growth. In addition, MindWorks is dedicated to a family friendly work environment where personal needs are prioritized (time off, child-care, pregnancy, professional development).

3) Environment. MindWorks provides a client-friendly office atmosphere where both adults and children feel comfortable. MindWorks strives to create an environment where clients are not anxious about receiving services and rather experience the clinic as a secure place. This Environment is created through clinician warmth, speedy communication and coordination, and a décor that is inviting and colorful.