Have you wondered how we go about diagnosing ADHD? How do we determine mild from severe cases, and how does the severity level impact treatment options? Well, this eBook explains all that, and then some. You’ll also learn about the standard of care for ADHD to help your child meet his or her fullest potential.
You can read the interactive eBook on my Substack!
For more resources about ADHD, or to set an appointment, check out the rest of HelpForYourChild.com. Please feel free to reach out to me with any questions at DrCarosso@aol.com.
Dr. John Carosso's ebook - How We Treat Series: Depression and Anxiety, Autism, ADHD, and Emotional Outbursts.
Dr. Carosso’s eBook: The Most Common Discipline Methods Don’t Work: Here’s Why and How to Make them Work
Dr. John Carosso's ebook: ABA in a Parent-Friendly Format.
Dr. John Carosso's ebook: The Steps to Improving Your Child's Behavior
Have you ever wondered why the discipline approaches you’ve been using, such as taking away the video games or putting your child in a timeout, don’t work so well? This eBook gives the answer and, even better, explains in a detailed fashion why and what to do about it.
EBook Summary:
Read my expanded content eBook on Substack!
There is a lot of useful information at HelpForYourChild.com. Please feel free to reach out to me with any questions at DrCarosso@aol.com.
Dr. Carosso’s eBook: The ADHD Diagnosis, Severity Level, and Treatment Options
Dr. John Carosso's ebook: ABA in a Parent-Friendly Format.
Dr. John Carosso's ebook: The Steps to Improving Your Child's Behavior
Dr. John Carosso's ebook - How We Treat Series: Depression and Anxiety, Autism, ADHD, and Emotional Outbursts.
Reading issues are frustrating for both children and parents. If your child is struggling and you have concerns about dyslexia, this post covers signs of dyslexia and effective treatment options.
I am often asked by parents to assess their child for dyslexia. This process usually leads to a discussion about the nature of dyslexia and how a parent can help.
Dyslexia (disorder of reading) and Dysgraphia (disorder of writing) are two conditions that are often labeled by school districts, more generally as a “Specific Learning Disability”. In fact, over 90% of students classified as having a ‘Specific Learning Disability’ (and given an IEP) are classified as such because they have dyslexia.
Dyslexia is almost always inherited; if a child has dyslexia, there is about a 50/50 chance at least one parent has the issue as well.
Dyslexia is, essentially, a problem decoding words. Think of reading as a process of sounding out letters that are arranged in a particular order; like deciphering a code. Children with dyslexia have a weakness in that ability. However, these kiddo’s are, at the same time, quite intelligent and capable, but struggle with that specific task of sounding out words. Interestingly, dyslexia, more broadly, is also a problem with the processing of language; kids have difficulty processing the sequence of sounds that comprise spoken words. Consequently, you get words like “psghetti” and “amninal.” These kiddos sometimes genuinely don’t ‘hear’ themselves saying the words incorrectly so it’s difficult for them to self-correct. Moreover, they also struggle with visually processing specific sounds. Consequently, they may read “gut” for “glut” and so on.
All of the effective strategies are based on a ‘multi-sensory’ approach that incorporates, in the learning process, visual, auditory, tactile, and kinesthetic senses. In that respect, a child may be shown the word, asked to say the word, hear it spoken by the teacher, write the word on paper, and write the word or letter (using his finger) on a rough surface. Consequently, the child is receiving varied feedback (visual, auditory, tactile, and kinesthetic) regarding how that word looks, sounds, feels, and is written. The Orton-Gillingham approach is commonly used and incorporates this multi-sensory approach.
Moreover, a productive practice-strategy is to read a selected book to your child, then ask your child to read to you. Use your index or pointer finger to track each word from left to right as you read. Pause for punctuation so your child will learn prosody, and to allow your child to catch their breath before beginning the next sentence. As reading skills improve, ask your child to read aloud to you, reminding them to use their index finger and pause for punctuation.
Check-out our online tutoring program at the Dyslexia Diagnostic and Treatment Center. We have Reading Specialists who are Certified in the treatment of dyslexia, and knowledgeable in Orton-Gillingham approaches. Our sessions are available online and are very reasonably priced at $30.00 a session. Our goal is to also offer you guidance and strategies to help your child throughout the week.
I trust you found this helpful - don't hesitate to ask any questions at jcarosso@dyslexiatreaters.com.
Quite simply, it’s a difficulty with the processing of auditory information. Usually, APD is diagnosed by an audiologist.
Here are some of the specific symptoms of APD:
There is considerable controversy in this respect. Some say yes, it is valid, while others say it’s not. Keep in mind that a condition is considered a “disorder” when it has a distinct set of features or symptoms that can be clearly differentiated from any other condition.
Note that APD is not a formal behavioral health diagnosis; it does not exist in the DSM-V. However, clearly, a lot of well-established clinicians, particularly audiologists, seem to think it’s a valid disorder, so who am I to say otherwise?
I tend to fall into the camp that it’s not so valid. In that respect, over the past 35 years of practice, I’ve had lots of parents indicating their child has been diagnosed with APD or the parent has concerns their child may have an APD. However, invariably, I have found a better explanation for the problem rather than anything having to do with a specific disorder of auditory processing.
Problems with:
Can you contemplate some other condition(s) that can cause those problems? In that respect, I tend to find children, for whom there is a concern of having an APD, instead tend to struggle, more generally, with attention problems (ADD or ADHD), academic problems (dyslexia), developmental issues (autism), or with language issues (problems with expressive and receptive language).
A child who struggles to pay attention is going to have difficulty following instructions. They fully understand the words, and process the information just fine, but get distracted too easily to follow-through. A child who was a late talker, has continued to need speech and language therapy, is not yet talking at an age-commensurate level, and has issues with enunciation is likely also going to have receptive language issues that, by definition, is interfering with the processing of auditory information. Lastly, dyslexia can often extend to a broader language-based disorder resulting in difficulty ascertaining phonemics, or the sounds associated with letters and words. Again, this is an aspect of a language-based issue and does not appear to be purely an element of poor auditory processing.
There is so much overlap between APD and these other conditions, and much of the treatment interventions also overlap, that to some extent it’s a distinction without a difference. However, I would contend that a deficiency in auditory processing is a symptom of another condition (ADD, autism, dyslexia, language issues…), not a distinct disorder all by itself.
We treat the underlying condition. If the child is struggling with attention-deficit, we keep the environment structured, quiet, organized, distraction-free, speak in clear and simple terms, ask to repeat instructions, utilize extra prompting, reduce background noise, and utilize a sticker chart for task completion. If the child has a language disorder, we do all the above along with speech/language therapy. If dyslexia, we implement all the above (albeit not necessarily S/L therapy) along with a multi-sensory reading instruction approach.
If you’re seeking more information on the matter, check out my new book, Managing the Five Most Challenging Child Behavioral Health Conditions of Our Day, on sale at Amazon. Additionally, there is a lot of useful information at HelpForYourChild.com. Please feel free to reach out with any questions at DrCarosso@aol.com.
We’re all familiar with the theory that children have their own learning styles, whether visual, auditory, or kinesthetic. So, one child may learn better by ‘seeing’ the material, another by hearing the information, and another through movement.
Well, yes and no. It’s clear that children have learning preferences. Some may, in fact, prefer to ‘see’ the material while others listen to lectures. However, our brains are too complex to be that simple. So, ultimately, no, the theory is not valid. There is abundant evidence in that respect including from the journal, Psychological Science in the Public Interest (20018).
The research clearly indicates that catering to individual learning styles doesn’t seem to make a difference in terms of actually learning the material. A person may think they are a ‘visual learner’, or a teacher may have been told a particular student is an ‘auditory learner’, but when taught in that particular mode, as opposed to another, research clearly has shown that it doesn’t make a difference in the child’s ability to actually learn the material. A ‘visual learner’, taught in a visual manner, won’t learn any better than if taught in an auditory manner. Go figure – the human brain just doesn’t work that way and is far too complex, multi-integrated, redundant, and God-inspiringly wonderous to function in such a simplistic and straightforward manner.
We have been told so many times, for so long, that every child has their own learning style, that we must discover that individual learning style, and teach to that learning style, that it may seem unfathomable to hear otherwise. However, if we’re genuinely going to ‘follow the science’ then that’s where the science has led us.
How a subject matter is taught (or learned) depends on the material being taught. In that respect, some material is more conducive to the visual (geography, math formulas, geometry…), while others are more suited to auditory (music, languages, history…). However, we all know that ultimately the best teaching-style is multi-sensory; it includes more than one modality. The best teachers have always known this fact and have incorporated this concept into their daily teaching. So, a student is lectured about the revolutionary war (auditory), shown pictures of battles from the war and diagrams of supply lines and strategy (visual), and maybe even role-play some decisive scenes (kinesthetic). We do the same at home.
Another example: when teaching children with dyslexia how to read, we instruct them to write the letter or word (visual and kinesthetic), express the corresponding sound (auditory), hear the sound from the teacher (auditory), move their body in the shape of the letter (kinesthetic), and trace the letters in sand (kinesthetic and tactile).
Yes, there is more to it than that. In addition to this multi-sensory approach, we also need to be disciplined in our approach. This means carrying-out daily and rigorous instruction, having a consistent routine, sticking to a game-plan, keeping the environment organized and distraction-free, giving breaks as needed, and promoting motivation through tons of reinforcement and making it fun. Will all of those elements always be successfully carried-out by any given teacher or parent? No, they won’t; but we do the best we can and try to keep the bar high.
Just a friendly reminder that we offer online supportive tutoring from our wonderful, Dyslexia-Certified Reading Specialists. We offer a free introductory session, then follow-up sessions, if you so choose, at only $30.00 a session and we’ll give you daily exercises to carry-out with your kiddo. ? See more at DyslexiaTreaters.com.
My goal is to help your child learn to his or her fullest potential and to help you in that process. I hope this post helped to clarify and streamline your approach. Of course, as always, if you have any questions, please email me at DrCarosso@aol.com and check us out at DyslexiaTreaters.com and HelpForYourChild.com.
Children, teens, and young adults with Autism are eligible for in-home or in-school services through IBHS (formerly known as BHRS or wraparound services). We offer this service through our Community Psychiatric Center’s (CPC) offices; however, these services end at 21 years of age. So, what are the options thereafter? In that respect, in this post I’ll describe four primary options that help individuals with special needs remain as independent and as productive as possible.
Working with a therapist in a structured, confidential, and comfortable setting can be very productive, especially if sessions are weekly and involve the family. Specific skills can be practiced and refined via role-playing and rehearsal of situations. Counseling also provides an opportunity to connect with somebody outside the direct family and develop coping skills. This service is provided locally including at our Community Psychiatric Centers Licensed Outpatient Mental Health Clinics.
This is a service, through the State of PA, that helps individuals with disabilities prepare for, obtain, or maintain employment. It’s a valuable service that has helped many people remain in the workforce.
This is a home and community-based service (HCBS) Medicaid waiver designed to provide long-term services and supports for community living, tailored to the specific needs of adults with Autism age 21 or older. This too is a valuable service also provided through our CPC offices; find out more about AAW by calling us at Community Psychiatric Centers or emailing at DrCarosso@aol.com.
By the way, a “waiver service” allows states to test and develop ways to deliver Medicaid funded programs that differ from the standard federal program. These waiver programs may have unique eligibility requirements and are designed to maintain independent living outside of long-term care facilities.
This is a managed care program in PA that is fully integrated that includes physical health, behavioral health, social, recreational, transportation, employment, therapeutic, educational, crisis, and in-home support. However, it’s only offered in a few PA counties: Dauphin, Lancaster, Cumberland, and Chester.
There are also, of course, host of private nonprofit services and supports, but the goal of today’s post was to present options paid through Medicaid that are readily accessible and have proven to be beneficial. Feel free to reach-out with any questions at DrCarosso@aol.com.
Intensive Behavioral Health Services (IBHS) is a transition from Behavioral Health Rehabilitative Services (BHRS), or “wraparound” services. IBHS officially began January 17, 2021.
From a parent’s perspective, there is not much difference from BHRS. You’ll have essentially the same staff but with different titles. For example, TSS is now called a BHT (Behavioral Health Technician), Mobile Therapist is still Mobile Therapist, and BSC is now simply “Behavioral Consultant”. A social skills group is now classified under “Group Services”. This staff provides essentially the same services as BHRS. Classifications include “Individual Services” that targets general behavioral health, and “ABA”, which is geared toward children who have more complex issues such as moderate to severe autism. The prescription is also written monthly as opposed to weekly. So, you might see a prescription that reads “Behavioral Consultant (BC-ABA) up to 15 hours per month…” or “Behavioral Health Technician (BHT-Individual Services) up to 30 hours per month in the home and community…”
The primary goal has been to increase the ease with which a parent can procure these services for their child and to increase the extent to which staff can be located to provide the services. In that respect, there are fewer hoops to jump through to get and keep IBHS, and the BHT can have a high school diploma (as opposed to a Bachelor’s Degree) given the proper training.
There are notable changes for the Provider including far more stringent regulations for training, supervision, and credentials, which is a good thing for parents and children in regards to the quality of service.
If you’re really bored and ambitious, here are the actual IBHS regs:
http://www.pacodeandbulletin.gov/Display/pabull?file=/secure/pabulletin/data/vol49/49-42/1554b.html
Hope that helps to explain the basics of IBHS. We are available here at Community Psychiatric Centers to provide this valuable service, as well as our licensed outpatient mental health clinic, and medication management from Dr. Lowenstein.
Feel free to forward any questions to me at DrCarosso@aol.com.
In my latest book, Managing the 5 Most Challenging Childhood Behavioral Health Conditions of Our Day, I write about behavioral challenges and some of the overlapping conditions. In today’s post, I want to share more about the idiosyncrasies of the condition referred to as “Oppositional Defiant Disorder,” or ODD.
Oppositional Defiant Disorder is a disorder that manifests, as the name implies, with significant levels of oppositionality and defiance. Specifically, the child demonstrates an angry and irritable mood, is argumentative and defiant, and prone to being vindictive. In children 5 or younger, these behaviors would need to be observed most days for at least six months; older than 5, at least once per week for six months.
It’s important to note that the symptoms cannot be better explained by a mood disorder such as depression or bipolar disorder.
That is the 64,000 dollar question and, really, it’s a important point. In that respect, I’ve tended to perceive signs of ODD more as symptoms than as a primary diagnosis.
There are times when a child is very strong-willed and seems to have been born with a hard-nosed disposition; everything is a fight, argumentative, and moody. In those situations, in the absence of any other identifiable diagnosis, ODD may fit. Interestingly, that situation is often genetic; invariably I hear how the child is similar to an uncle or some other family member, even if they rarely come in contact with that relative. Also, if a child has experienced very difficult situations, such as family turmoil and strife, but there is simply not enough evidence to diagnose with a mood disorder or trauma, then ODD may fit but there will be a caveat explained in the report.
In most cases, when a child is presenting as argumentative, moody, and defiant, there is an underlying reason. In those cases, ODD is more of a symptom than a diagnosis. I often find that children who have been diagnosed with ODD, upon closer look at the situation, actually do meet criteria for some other primary diagnosis, and it’s that primary diagnosis that is causing the argumentativeness, moodiness, and defiance. This may include a mood disorder or that the child is traumatized; keep in mind that children tend to act the way they feel.
If the child does, in fact, have straight-forward ODD, then the treatment is largely based in counseling and behavior management. In that respect, counseling targets coping skills and helping the child to get his or her needs met without causing mayhem, as well as an opportunity to vent frustrations. The counseling is also for the parent to help with communication and to practice reflective-listening, which is a wonderful approach. If interested in learning about reflective listening, check out the first chapter of the book ‘How to talk so kids will listen, and listen so kids will talk”, Adele and Mazlish. Behavior management is simply, ‘how are we going to manage his behavior’? We want to move toward respectful communication, ‘talking things out to problem-solve’, and a reasonable and logical dialogue in that respect. However, that takes time. So, in the meantime, we want to rely on lots of praise and reinforcement for making good choices, a sticker chart, a consistent routine, and firm but fair limits. We want to avoid our biggest enemy when it comes to parenting; pestering and becoming emotional. Also, check out my earlier post, Why Taking Away Privileges and Time-Out Don’t Work (and how to make them work), which soon will be expanded into an eBook and podcast.
If the ODD is due to an underlying condition, then we treat that underlying condition; this too involves counseling (geared directly toward depression, anxiety, trauma, family harmony) and behavioral management. Hope that helps to explain and clarify the ODD diagnosis. Feel free to send any inquiries my way to jcarosso@cpcwecare.com. May God bless you and your family.
In my new book, Managing the 5 Most Challenging Childhood Behavioral Health Conditions of our Day, there is a chapter on autism explaining the nature of this condition and treatment strategies. However, since DSM-V, a new diagnosis has come into play, Social Pragmatic Communication Disorder (SPCD) that is increasingly being used and becoming recognized as a variant of the autism spectrum. In that respect, SPCD involves:
-Problems using communication (verbal and nonverbal) in social situations
-Challenges adapting communication style to fit the context or the style of people the person communicates with
-Problems following social rules like taking turns during conversations
-Difficulty understanding implied messages
So, clearly, one can see how SPCD has some overlap with ASD, particularly what we formerly called ‘Asperger’s Disorder’ (high functioning autism). In that respect, the primary element of Asperger’s is social awkwardness, obsessiveness, and usually some sensory issues. When we see children at our clinic with those signs of SPCD but who are not obsessive and nor do they demonstrate any overt self-stimulatory behavior (hand-flapping, pacing, lining-up objects, spinning…), then the diagnosis of SPCD is considered. In that respect, a child with SPCD typically meets many or most of the social criteria for ASD but lacks any self-stimulatory behaviors (SSB).
You may recall, years ago, prior to DSM-5, the diagnosis of Pervasive Developmental Disorder NOS (PDDNOS) was commonly used in place of Autistic Disorder (AS). In those days, PDDNOS was considered on the autism spectrum, but a milder case of autism. PDDNOS was likely over-used in its day.
We’ll have to wait and see. The most important factor is whether a child meets the full diagnostic criteria for ASD. If they don’t, it’s often due to a lack of SSB. In such a situation, it is often legitimate to consider a diagnose of SPCD (given the criteria is met).
The primary deficit of SPCD is, as the name implies, ’social’ in terms of difficulty understanding verbal and nonverbal communication. Consequently, treatment entails practicing those skills in terms of rehearsing and role-playing social situations and conversations, maintaining appropriate boundaries, understanding nuances, and carrying out the finer points of social interactions. We also incorporate speech/language therapy to target language skills, namely pragmatic (conversational) speech.
I hope that helps to clarify the difference and nuances between ASD and SPCD. The two have some overlap, and in cases of very mild autism, sometimes making the differentiation can be a challenge. If you have any questions, feel free to email me at jcarosso@cpcwecare.com.
I write about improving self-esteem and academics in my new book, Managing the 5 Most Challenging Childhood Behavioral Health Conditions of Our Day, and clearly we face a particularly difficult situation with our present-day pandemic and school-hybrid/lock-down situation.
I am seeing more kids and teens struggling with their ‘down’ mood, lack of productivity, declining grades, and deflating self-esteem. The teen appears depressed, and parents are alarmed and unsure of how to manage the situation.
The situation in which we find ourselves is, well, quite depressing. It would not be surprising that, as a result, our kids are feeling somewhat down in mood. In that respect, teens are more prone to confine in their room essentially all day, sometimes even stay in bed to complete their classwork, are tempted by a multitude of distractions in their room and home that interfere with assignments and, as a result, their grades are dropping, they don’t see their friends and lack the stimulation of the outside world, and are ultimately faced with bickering parents that results in a stressful family dynamic. In this scenario, nobody wins.
No, it’s not across the board. Some children and parents are doing well and, in that respect, enjoying the lock-down and working from home, which is wonderful for them.
Yes, it seems that teens are more negatively impacted, as well as select children with more notable developmental issues. In that respect, children are more likely, than teens, to be ‘happy little campers’ who tend to engage with their family. However, teens are more inclined to remain in their room, even when there is no pandemic. Consequently, with the current school-hybrid situations, and lockdowns, the teen remains isolated in their room for far longer periods of time. Additionally, children with some developmental issues, including autism, need direct instruction in the classroom with trained teachers, and, in the absence of such, they notably suffer. In fact, from what I see, the damage of this hybrid system, and lock-down, predominately outweigh potential benefits, but that’s just me.
During my discussions with parents and teens, a particular regimen is discussed. The more the teen adheres to this regimen, the better off they will be. The protocol includes:
We are all facing difficult times and hoping this will soon pass. In the meantime, our kids need to be out-of-their room; dressed and groomed; prepared to start the school day in an organized work-space, adhere to a schedule, and active. Of course, you may have more success in some areas than others with your teen, but every bit helps.
God bless you and your family during these times, and God-speed for a return to normalcy.
