The last issue of the prestigious Journal of Child Psychology and Psychiatry included a study that examined the role of parental age on the risk for autism among two very large nationally representative cohorts in two separate countries (Sweden and the UK). The basic question – whether the parents’ age impact the risk of having a child with autism – is not that exciting or innovative as several studies have shown that older parents, especially dads, are more likely to have children with autism. What was really interesting about this study is that it was conducted with an incredibly large numbers of twins, which can help us understand the association between parental age and the relative environmental vs. genetic contributions to autism. Read More…

I spent most of my Sunday afternoon reviewing and editing reports of child neuropsychological evaluations. Most of them were for children who came to our clinic for a comprehensive ADHD diagnostic evaluation. At the end of these reports we always include a large number of individualized recommendations for home and school accommodations and interventions. Within this list, we often, if not always, encourage parents to consult with their pediatrician or child psychiatrist regarding the appropriateness of medication for the treatment for their child’s ADHD. But such recommendation is only one of more than a dozen. In our approach to treatment, medication is one small component of a multi-pronged strategy. Why? Because medication alone is unlikely to be enough to help the child successfully navigate the multiple obstacles imposed by his/her condition. So I was not surprised when I read the results of one of the largest studies of community-based medication interventions for elementary school children with ADHD. The result? Medication alone works, but not as much as we’d like. Read More…

Last week after writing about the DSM-V “Temper Dysregulation Disorder with Dysphoria,” I received several emails asking my opinion regarding the proposed merger of autism and Asperger’s disorder into a single ‘spectrum’ category.  This change has clearly generated some significant political debate in the media and the blogosphere, with some in favor of the change (see for example Dr. Roy Ginker’s NYT article), while others have expressed reservations about the potential impact that this change may have in the autism and Asperger’s community. So I wanted to keep my contribution to this discussion somewhat removed from the political/social issues associated with the change, and instead focus on the scientific/clinical basis for this specific move.  Thus, my aim with this post is not to take a position for or against the proposed DSM-V changes. Instead, I simply want to provide some background information about some of the research data and clinical issues that may have contributed to the DSM-V committee’s decision to propose the merger of all ASDs into a single category. Read More…

Today the American Psychiatric Association released a draft of the major changes that are expected in the new version of the Diagnostic and Statistical Manual of Mental Disorder – 5th Edition (DSM-V). While most people in the field will be underwhelmed by the relatively minor changes,  there are a few areas where the DSM-V will likely make some drastic changes.  Today most of the news coverage was focused on the proposed changes to the Autism diagnosis, which has raised some heated debate in the autism community. However, there is another major change that has received little, if any, attention: the clarification that a syndrome that in recent years has been labeled childhood bipolar disorder is actually NOT bipolar disorder. Instead, a new disorder category was created: Temper Dysregulation Disorder with Dysphoria (TDD). Read More…

In our neuropsychology practice we see a large number of children with special health care needs (i.e., medical conditions) as well as children with neurodevelopmental or psychiatric conditions (autism, language impaiments, ADHD). Although the main goal of these evaluations is to identify their patterns of cognitive strengths and weaknesses to guide intervention, we always evaluate the current mental health functioning of these children. We do this because we often see that these children have high levels of anxiety and depression, which many times go unnoticed.  Although this is a very common clinical observation, and many studies have shown that specific chronic physical or developmental conditions are associated with internalizing mental health symptoms (depression and anxiety), less is know about the prevalence of mental health symptoms in this population and the factors that increase the risk for experiencing or developing internalizing symptoms. Read More…