dyslexia as being a visual problem

“My child can’t read… and the school told me its because he has dyslexia… he reverses his letters and they said that he gets the letters all jumbled. They said that it had something to do with his vision and as a result, he can’t read. Now what? Do we get an eye examination?"

Hmmmm… letters jumbled up meaning that you can’t raed? Are you albe to raed this eeven thugoh the ltteres are all mxied up? Aoccdrnig to rscheearch at Cmabrigde Uinervtisyity, ltteer odre deos not mttaer… the iprmoatnt ptar is taht the frist and lsat ltteer be in the rghit pclae… the rset can be a taotl mses and you can sitll raed it wouthit a porbelm. So… is dyslexia related to letters being jumbled up? Is dyslexia a disturbance of visual configurations of letters?

Research (see Dr. Jack Fletcher) among children reveals that phonetic or speech sounds processing is the most commonly the primary underlying disorder in dyslexia. Other contributing factors to low achievement in reading (or dyslexia which means a disturbance in reading) include low vocabulary and limited experience with reading (ie., few repetitions, insufficient time spent reading, etc.). Need to rule out reduced visual acuity as a contributor to slowed reading, headaches in the afternoon… by all means, please get an eye examination. But, dyslexia as being a visual problem? Hmmmm… maybe not.

So, how do I know if my child has dyslexia”? Well, dyslexia simply indicates a disturbance in reading… Is your child reading significantly below the level of his or her peers? If so, then he or she has dyslexia or a reading disorder. Unfortunately, dyslexia or the formal diagnosis of a reading disorder does not communicate anything beyond the symptom description. The real task is identification of factors that contribute to reading problems. In the past, various models have been employed to classify reading disorders with the discrepancy model holding court for the past 25+ years. The discrepancy model defines a reading disorder in terms of a significant discrepancy between reading achievement (lower) and abilities (higher) with some suggestion or assumption of a significant verbal (lower) vs. perceptual-motor (higher) processing discrepancy.

However, recent reviews of research (see Fletcher, J.M., Francis, D.J., Morris, R.D. and Lyon, G.R.. “Evidence-based assessment of learning disabilities in children and adolescents”, Journal of Clinical Child & Adolescent Psychology, 2005, Vol. 34, No. 3, Pages 506 – 522) indicates that this model has serious psychometric problems (meaning research cannot reliably replicate it). More recent work suggests that, while low reading achievement is the critical element for classification as a reading disorder (by definition), an evidence-based assessment must include an analysis of reading components (ie., see, discriminate letters, associate letters to sounds, put sounds together to make words, put words together to form sentences/ideas, formulation of themes and output) so that interventions are directed towards the weakest link in the chain of reading.

In addition, the work of Fletcher, et. al. (2005) calls for “a stronger underlying classification that takes into account relations with other childhood disorders” including a need for assessment of abilities (hardware), skills (acquired) and coping resources (ie., family support, teachers, educational instruction, etc.).

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Dr. Richard Dowell is a Neuropsychologist located in Pennsylvania. Dr. Dowell evaluates upwards of 400 children and adolescents each year. In addition, Dr. Dowell is recognized as one of the top Forensic Neuropsychological witnesses in the North East.

Dr. Dowell can be contacted at DrDowell@NeuropsychologicalServices.net

For more information on Neuropsychology visit NeuropsychologicalServices.net

Einstein’s Relativity

“I am a foster parent. My (foster) child appears angry with periods of rage and depression along with acting out, aggression… he can’t sleep at night, can’t sit still… and has basically no friends because he plays too rough. His family background is a mess… father is incarcerated, mother has a long drug history with multiple paramours, alcohol abuse, domestic violence. We have been told that he as ADHD, ODD and bi-polar disorder. He has "failed" trials on three different psychostimulants and now is taking some kind of cocktail that includes three medications at one time. Are his problems biological or environmental?” Hmmmm…

… this may take a minute to formulate a theoretical background… but please be patient with me… Einstein’s “Theory of Relativity” boiled down to its child-like essence goes something like this. As a boy, young Einstein would sit along the railroad tracks and watch the trains go by. In his book, Relativity, he recalls wondering what would happen if someone threw a ball up in the air while riding on a moving train. What would it look like? Well, if you were on the moving train the ball would travel in an arc … and one could actually construct a mathematical equation that would define the arc. But, if you were sitting beside the train tracks, the ball would travel straight up and down in a line and you could construct a mathematic equation that would define the line. Both are mathematical truths! So, which is true? Does the ball travel in an arc or line? The answer… it depends on the relative position of the observer.

Hmmmm… what does that have to do with neuropsychology in general or your child, in particular? Is a symptom/problem related to a physiological disorder (mass) or a psychological disorder (energy)? The answer? Yes… it is both… any symptom/problem will have both physiological (brain/body) and psychological (energy/spiritual) components. The implication is that a holistic approach that seeks to understand both physiological and psychological contributions to symptoms is critical… and that interventions must necessarily consider both physiological and psychological factors. The physician who treats only the body is a fool as equally as the psychologist who only treats the psyche… the mind and body are simply two aspects or perspectives of the same person… and treatments must consider both avenues.

What does this have to do with your child? It means that your activities, relationship, home environment, emotional tone, etc. are as critical to your child’s healing as the medication. Oftentimes we look to wizards (ie., physicians, psychologist, etc.) to treat the body and feel powerless or impotent to affect outcomes. Your efforts are central to healing!!!

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Dr. Richard Dowell is a Neuropsychologist located in Pennsylvania. Dr. Dowell evaluates upwards of 400 children and adolescents each year. In addition, Dr. Dowell is recognized as one of the top Forensic Neuropsychological witnesses in the North East.

Dr. Dowell can be contacted at DrDowell@NeuropsychologicalServices.net

For more information on Neuropsychology visit NeuropsychologicalServices.net

M&M’s and a Spray Bottle Part 2

I wish I had asked for more than a week to address your question from the last installation.

You indicated that your four year-old daughter presents with multiple developmental delays along with eating non-food items, self-stimulation, self-abuse, some biting and rocking. The cluster of behaviors that you are describing tend to be classified as being primitive, meaning that the symptoms emerge during the neonatal/infant period and are generally related to limbic system-driven drives (eating/biting) and instincts (fight or flight). Under “normal” conditions of development, these instinctual behaviors are suppressed starting at about age three years. Onset of inhibition of these primitive drives/instincts corresponds with emerging development or maturation of frontal lobe inhibitory processing.

The same frontal lobe mechanisms that inhibit lower level drives/instincts (biting, pica, exploratory behaviors, “fight or flight”) are responsible for inhibition (over-rides) of sphincter reflexes for successful completion of potty training. Prominence of instincts/drives in governing behavior beyond about 3-4 years of age typically indicates a high potential for frontal lobe dysfunction or maldevelopment (which also undermines cognitive, adaptive and social development giving rise to references to “mental retardation”).

The behavioral program you described as being a “failure” in our last installation was an operant conditioning model. The frontal lobes learn via operant conditioning. Taken together, it should not be terribly surprising that a child who shows delays in frontal lobe development should fail to show benefits to an operant conditioning intervention. Development of a software program (operant conditioning intervention) that relied on hardware (frontal lobe) that the child did not possess was doomed to fail and as a result, you and your frontal lobe have been “punished” by the failure with resulting high levels of frustration.

In contrast, the limbic system is 40,000 years old, has not changed appreciably in 40,000 years and I’m guessing that you will not change it with a few M&M’s. Limbic system responses are elicited by unconditioned (no learning necessary) stimuli that are “hard-wired” into the system. However, the limbic system can be modified via classical or Pavlovian conditioning. Remember Pavlov? His work went something like this… present a dog with food (unconditioned stimulus) and it salivates (unconditioned response). No learning necessary. Use the can opener (neutral stimulus), present the food (unconditioned stimulus) and the dog salivates (unconditioned response). Eventually, open the can (conditioned stimulus) and the dog salivates (conditioned response). Limbic system responses are not modified by consequences, but are elicited or controlled by antecedents (triggers).

Hmmmm … and what has this to do with our child? The first strategy is to record the ABC’s (antecedent – behavior – consequence) of unwanted behaviors with an emphasis on identification of those antecedent stimuli or triggers that consistently elicit maladaptive behaviors. Recall (in previous installations) how I preach evaluation and assessment? This time, you get to do my job. Assessment is not a specific set of tests or tools, but a way of thinking and your assessment and recording are central to any program. Antecedent (A) stimulus recording generally includes the date, time and external environmental stimuli (who, what, when, where, etc.) that were present prior to the onset of maladaptive behaviors. Recording is an important part of the entire intervention process since it both sets a baseline against which to judge the effectiveness of any interventions and provides important information regarding potential antecedents. Once specific antecedents are identified, the next step is to avoid antecedents. I love this one (that I hear once a month) “every time we go to K-mart, my child acts out.” Solution, “do not go to K-mart.” The goal is to have low elicitation of limbic system-driven “fight or flight” responses. If one cannot avoid the antecedent (such as a sibling coming home from school), the next step is to “put the frontal lobe in front of the antecedent.” This rule suggests that once specific antecedents are identified, attempts should be made to introduce structured activities (frontal lobe functions) during high risk time frames. Provide your child with a routine task or set of tasks to complete (ie., set the table) when antecedents (ie., sibling coming home from school) are present.

You are probably wondering, “then what?” Hmmm… give me 2-3 weeks (see my frontal lobes are learning).

M&M’s and a Spray Bottle

“Our four year-old daughter has always been slow… slow to sit up, slow to walk (she never really crawled but sort of GI-Joe’d it across the floor), slow to talk (she has only a couple single words that sort of telegraphically communicate her wants)… and potty training?… it seems like it will never happen with no progress during the past year. She was diagnosed with mental retardation.”

“The most recent problems have been eating non-food items, she eats every piece of fuzz on the carpet, self-stimulation, self-abuse, she hits her head on the floor when frustrated, some biting and rocking. When recently seen by a professional (psychologist, physician, therapist, etc.), it was recommended that we initiate a behavior modification (operant conditioning) program in which we reward her with preferred items (attention, M&M’s, touches, etc.) when she displays positive behaviors, ignore her (extinction) when she is engaged in negative behaviors that are not physically injurious and spray her with a water solution (punish her) when she is engaged in self-injurious or aggressive behaviors. After two months, our daughter has shown a dramatic increase in physical aggression and has learned to adeptly avoid sprays to the face while we have felt like total failures as parents while our child appears to fear our presence. What do we do?”

First things first. The diagnostic system adopted by the American Psychiatric Association and utilized by the American Psychological Association is an “axial” system that is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM for short). Numerous versions and revisions have been completed across time that reflect changes in our understanding of various symptom complexes.

The axial system has five axes that include: Axis I (Clinical disorders that may be the focus of clinical attention or treatment), Axis II (Personality disorders and mental retardation including factors that may mediate symptom expression), Axis III (General medical conditions that are potentially relevant to understanding and treating Axis I and II problems), Axis IV (Psychosocial and environmental problems or stressors that may affect symptom/problem severity and Axis V (Global Assessment of Functioning or the clinician’s judgment of the individual’s overall level of functioning).

My take on the process? Axis IV and V are so poorly correlated among observers to be irrelevant or meaningless (this opinion may not be shared by others). Axis I is analogous to the current weather conditions (it is raining, it is snowing, it is a thunderstorm, etc.). Axis II is analogous to the severity of the weather conditions or associated factors (28 degrees, high winds, etc.) and Axis III is analogous to the underlying cause of the current weather conditions (a cold front from Canada merging with a warm front from the Gulf of Mexico) that cause or contribute to the Axis I (thunderstorm) and Axis II (high winds) diagnoses.

For your daughter the Axis I diagnosis is the presenting symptoms/problems or what you are seeking assistance in addressing. Axis I diagnoses may include Pica (eating non-food items) and a Disruptive Behavior Disorder (self-abuse, aggression). To discover that your child has been diagnosed with Pica or a Disruptive Behavior Disorder is not particularly enlightening (particularly since you told the professional what those symptoms were). The Axis II diagnosis of mental retardation is similarly unenlightening, it simply refers to the degree to which your child’s cognitive, behavioral, adaptive living and social development deviates from the average or middle of the bell curve. You said “slow” or “delayed”… the IQ score simply provides an estimate of how much (IQ = 60 = 40% delay relative to peers, IQ = 55 = 45%, got the idea, 100 – IQ = % delay).

To discover that you finished fifth in a race does not provide insight into how to improve your running speed.

In contrast, the Axis III diagnosis refers to biological and/or neurological factors that underlie or are the cause of the Axis I and II diagnoses. Axis III diagnoses could potentially include maldevelopment of myelinated axonal connections from limbic to frontal regions secondary to premature birth, frontal lobe disconnection secondary to perinatal hydrocephalus, stroke involving the left middle cerebral artery, shear strain injury secondary to high force trauma to the head, etc. The Axis III diagnosis is designed to identify the “hardware” (computer analogy) limitations or factors that contribute to, drive or cause the presenting symptoms (Axis I).

Does your daughter have mental retardation? No… she may show a slow (retardation) rate or incomplete development of skills. What do we do?” Hmmm… give me a week to think on that one.

Generic Treatment - Sex Offenders are not all Created Equal

I just finished reading a March 6, 2007 New York Times article on adult sex offenders that indicates dismal outcomes (high recidivism or repeat offending) among individuals who participate in sex offender programs. The article appears to relate this failure (in part) to our failure to complete research on treatment programs and effective interventions (when I thought that the major cause of sex offending was due to the presence of perpetrators). Sometimes I feel like a broken record... but my belief is that one of the major problems in the area of sex offender treatment programs is that the programs tend to treat "sex offenders" using "programs". There is not a thing that is a "sex offender"... only individuals who engage in sexually inappropriate behaviors... and a as a result, any “program” that treats sex offenders is bound to be associated with limited results.

About twenty years ago, I had the wonderful opportunity to experience and be mentored by Dr. Jan van Eys in the Dept. of Pediatrics at M.D. Anderson Hospital and Tumor Institute (who mentored everyone who had the good fortune to be near him). During one of our discussions, he indicated that existing treatments for ALL (acute lymphocytic leukemia) were not 60% effective (which is what I recall the literature stated at that time), but that the existing treatment was probably 100% effective for 60% of the children and 0% effective among 40% of the children. Wow… the thought changed my life. The task in cancer treatment… like ADHD treatment… like sex offender interventions… is to learn to identify those individuals who benefit from specific treatments and to develop alternative interventions among individuals who do not respond to specific treatments. The critical factor to this type of undertaking? …perform evaluations that provide data to allow us to differentiate among responders and non-responders for treatment.

My experience with child & adolescent sex offenders has really been enlightening, maybe 30-40% (I'm making up these numbers... but an estimate) are Asperger's Syndrome / Nonverbal Learning Disabled adolescent males who are unable to engage peers in social (or sexual) relationships and, as a result, tend to drop down to engage with younger children (i.e. the 16 year-old Asperger's male who cannot "get" the 16 year-old girl and drops down to engage with 10-12 year old females and proceeds to act out 16 year old sexual behaviors with a 10-12 year old female); another 20-30% may be low IQ - low frontal lobe processing - very disorganized, poor planning, failure to perceive consequences of actions, failure to identify with the victim or see the world from the perspective of others and violations of social rules/norms in the service of personal needs/wants and as a result act out more primitive drives; maybe 30-40% have a history of early sexual experiences and abuse that results in early sexualization, sort of like they "taste" sexual experiences/pleasures before they are in a position to appropriately channel it, they often attach sexual drives to children (since they were sexualized as a child) and subsequently as they become older repeat the attachment. They also tend to internalize or identify with their perpetrators and act out the sexual abuse they experienced. For another maybe 10%, sexual offending is about dominance, same-sex offending to dominate other males. This group tends to have high scores on the Psychopathy Checklist - YV. Generally "scary" to the community… repeat offenders who will use other means of domination including bullying, aggression, threats, etc. While I recognize that children / adolescents who are sexual predators have a high rate of exposure to sexual abuse, this exposure does not affect each child the same. Some become sexual offenders (maybe if they have other risk factors like Asperger's Syndrome, limited frontal lobe processing, etc.) some do not.

I’m not sure about the percentages (above), but in our practice, we have some prototypes that we tend to see as recurring and the interesting fact is that each group (and each child) is different and requires an equally individualized treatment plan that addresses their specific needs. I don't mean to criticize others for classification of all sex offenders in one group, and then embark on my own classification that simply has several groups, but I thought I would share some of my experiences & perceptions (since if I reviewed each individual child that we have seen, this blog would be even more cumbersome than I already have made it). Anyway, I feel like we embark on interventions, treatments or programs for individual children & adolescents before we have completed the evaluation to identify the cause…and the result?… catch the NY Times article… read your own local papers…

Time: A Marker for Change Part 2

OK… I was not dodging the first part of the last question (even though it may resonate with my life and I would probably feel better dodging it). “My child always did well in elementary school… but since about 5th or 6th grade, his performance has really deteriorated… he is disorganized, does everything at the last minute, makes repeated careless mistakes. I’ve been told that a lot of kids have difficulties at that age due to the transition into middle school along with the hormones kicking in. Is this just a maturity thing? Will it just get better with time?”

The first part… “is this just a maturity thing?”. The answer is most likely “yes”, “no” or “yes and no” (which philosophically-speaking should cover all states of the universe). Helpful? Let me expand. The collection of “coaching” functions including organization, planning, utilization of feedback to adapt responses (along with assumption of an “observer role” to perceive the world through the eyes of others, internalization of social rules and inhibition of lower level emotions), has been related to the frontal lobe. Studies indicate that this frontal lobe or “social” part of each of us shows a trend for progressive development or maturation throughout childhood. Existing social institutions (ala Erik Erikson) have evolved to mirror this maturation process. During the first few years of life, the frontal lobes play a very limited role…ergo the egocentric (“terrible”) under-socialized two year-old tramples social rules in service of self. At about age 3-4, children complete toilet training. Completion of toilet training reflects initiation of frontal lobe processing (and inhibition of lower level behaviors). At about 5-6 years of age, children start kindergarten. Initiation of formal schooling parallels a phase of rapid growth or maturation of the frontal lobes. At about age 12 years, children begin to change classes in school and manage social interactions independently. This time frame corresponds to a phase when the frontal lobe development has progressed beyond 50% development. This frontal lobe development also corresponds with reduced parental input (as the “external hard drive frontal lobes”). At about age 16 years, we (and other drivers) hope that the frontal lobe development has developed to at least about 85% to sustain executive driving skills and by age 21 years of age, frontal lobe processing should approximate the adult level or about 100%.

Children at age 12-13 years show very dramatic differences in rate of growth secondary to hormonally-drive growth spurts. As a result, children in this age range often show dramatic variations in the extent to which the frontal lobes are maturing. Children who are later maturing (with respect to the frontal lobes) often present with features of disorganization (ie., desk, backpack, outlines for writing, study notes, etc.), poor planning (ie., spur of the moment), failure to use feedback to adapt (ie., repeatedly make same mistakes), poor observer functions (ie., difficulties understanding how others may see the world, difficulties with peers, etc.) and limited control of basic emotions with resulting dramatic mood swings, irritability, acting out and rule violations. While “maturity” or growth results in changes, it is the quality of the environment (ie., parenting) that channels the growth into effective processing. Therefore, while maturity may result in positive changes, the positive changes are not a given unless the parents are able to establish and develop a good “frontal” lobe environment that includes: (a) high levels of organization (ie., desk, backpack, room, etc.), (b) high levels of planning (ie., schedule, daily planner, daily study times, etc.) and (c) consistent and predictable feedback (ie., require child to correct tests, study after tests to learn areas of weakness, well-defined rules and consequences, consistent and predictable consequences, etc.). Stability during this stage of instability is critical to positive growth.

A Dennis the Menace Incarnation

Johnny is a six year-old boy who appears to have missed his calling for the leading role in the remake of “Dennis the Menace”. He is blond-haired with two teeth missing. When I introduce myself, he steps behind his mother allowing one eye to remain trained on me. He follows his mother and me into the office, sits quietly while his legs swing rather quickly under his chair. He tells me that he has no idea why he is here today (although mother swears they had a thirty minute talk about the visit on the trip to the office), but later relents to suggest that his mother wanted him to come here because he doesn’t “listen”. Mother subsequently describes a child history of significant inattention at home that includes not following instructions (ie., he may recall only one step in an instructional set), not attending when she calls him name and becoming overwhelmed in high stimulation (noise) conditions. Mother indicates that problems intensified when Johnny entered kindergarten. In addition, the teacher reports an increase in social withdrawal and limited peer interactions on the playground. However, mother suggests and the kindergarten teacher concurs that perhaps symptoms are due to immaturity. Mother reports that the situation deteriorates in first grade. Johnny is off-task when the teacher is talking, he turns and looks at the papers of other children, he cannot answer questions posed by the teacher, he looks puzzled during class sharing/discussions and he constantly draws or plays with small items in his desk. Mother reports that she took Johnny to see the family physician with a handful of checklists in which the Inattention boxes had been checked by the teacher. Do you know him? Classic ADD, right?

Mother reports that Johnny was started on Strattera (since its not a “stimulant”). After a month of no benefits, the medication is discontinued and replaced with a more potent psychostimulant (fill in the brand name). Mother reports that since taking the psychostimulant, Johnny is restless, has trouble falling asleep and appears to be more “fragile”. Mother indicates that the dose of the medication is increased since the physician suggests that perhaps his symptoms are intensifying in the school setting. Johnny reportedly responds with insomnia, crying, agitation and irritability. Johnny is seen by a counselor who discusses issues of low self esteem with mother. Mother reports feeling overwhelmed and anxious… she is failing her child. Which brings us to today’s clinic visit….

…findings of our comprehensive neuropsychological evaluation reveal that Johnny has a receptive language disorder. While statistics on the frequency or base rate of this disorder are unclear, research suggests that perhaps 4-8% of children with “classic ADD” symptoms may have receptive language disorders. For Johnny, the English language is like a second language (recall taking Spanish in high school?). He cannot decode speech sounds at the rate necessary for comprehension and, as result, he cannot follow instructional sets, cannot comprehend the discussion of the teacher and cannot decode the rapid-fire playground speech of his peers (with resulting social withdrawal). Reading, which is dependent upon integrating speech sounds with letters is labored for Johnny (and no fun) and, as a result, he learns words based on the visual configurations (which appears to reflect “impulsive” guessing). On the playground, Johnny retreats since he cannot keep pace with the conversation rate and slang of his peers.

Application of a symptom-based diagnosis (which Johnny fits all ADD criteria) resulted in termination of the search for the underlying cause with resulting delays in introduction of intervention strategies, social isolation, loss of self-confidence, dislike of reading, treatment using medications for a disorder that he did not “have” and counseling sessions after school. . The solution… demand evaluations that search for the underlying cause while ruling out other alternative or possible causes.

Symptom-based diagnostic models

You enter your physician’s office holding your head from a throbbing headache. The nurse cordially smiles at you and takes you to an examining room. Minutes later (hey… this is my dream… I can keep the wait short)… the physician enters the office. You inform him or her that you have a headache. Your physician gives you a long look, sighs then pronounces the diagnosis “You have a headache disorder!” Nonplussed, huh? Thinking that perhaps its not too late to get your co-payment back?

Unfortunately, each day millions of parents take their child into offices of physicians, psychologists, therapists, etc. proclaiming that their child has a deficit in attention and is hyperactive and are told by well-meaning professionals, “Your children has an attention deficit hyperactivity disorder!” Nonplussed? I hope so. Attention deficit hyperactivity disorder is a symptom-based diagnosis much like a “headache disorder” would be a symptom-based diagnosis. The unfortunate aspect of this scenario is that labeling the symptom (ie., “headache disorder”) does not explain the underlying cause or etiology of the symptom. Headaches are non-specific symptoms and may be related to underlying etiologies ranging from muscle tension, cervical neck strain, migraines, cluster headaches, increased intracranial pressure, hemorrhagic strokes to brain to tumors. As a patient-consumer you (and your physician) want to know the underlying cause of the headache so that subsequent treatment may be directed towards the cause, not simply the symptom, of the headache. Similarly, inattention, distractibility, off-task behaviors, restlessness, etc. are non-specific symptoms. A review of the DSM-IV-TR (Diagnostic and Statistical Manual – IV Text Revision) and other diagnostic manuals reveals that this cluster of symptoms is consistent with multiple diagnoses ranging from anxiety, depression, Tourette’s Syndrome, post-traumatic stress disorder, neurologic disorders, pervasive developmental disorders to learning disabilities.

The unfortunate effects of this symptom-based diagnostic model of “ADHD” include: (a) the simplistic labeling of symptoms (ADHD) with resulting termination of the search for an underlying cause, (b) evaluations that are limited to symptom counting, (c) a delay in the development of effective intervention plans among children with more pervasive developmental disorders or other deficits, (d) utilization of the child’s response to medication as a tool for confirming the accuracy of the diagnosis and (e) the “mis-diagnosis” of children with resulting public perceptions that oftentimes effective medications (ie., psychostimulants) are of no value or counter-productive. The solution… hmmm…

See you next week.

Neuropsychological Services

During the past twenty years, Dr. Dowell has completed neuropsychological evaluations among over 5000 patients. Neuropsychological Services currently completes consultations among over 300 – 400 children/adolescents each year presenting with a variety of symptoms/problems including features of attention deficit hyperactivity disorders (ADHD), learning disabilities, behavioral disorders (ie., oppositional defiant disorder, conduct disorder, etc.), pervasive developmental disabilities (ie., autism, Asperger’s Syndrome), post-traumatic stress disorders, neglect/deprivation, reactive attachment disorders and other adjustment disorders. He has served as a forensic neuropsychological witness within the county and federal court systems throughout Pennsylvania and New Jersey and testified in front of the State Department of Education.

Here Dr. Richard Dowell will share insights to common issues seen within the clinical and forensic neuropsychological arenas. At times humorous, other times a bit sarcastic, examples given are taken from real world experience, with the any names being changed to protect the innocent, and the doctor of course. While certain matters may be shown in a lighthearted manor the illnesses and people suffering from any type of mental or physical pain is not taken lightly.

The intent of Inside Neuropsychology is to open a dialogue between patients and their loved ones and the medical staff serving them. It is also a means to uncover some of the lunacy often common in diagnosis and treatment.