INSIDE THIS ISSUE:
> Treating children, adolescents and adults with ADHD
> Subtle Long-term effects of Mild Traumatic Brain Injury
> The importance of cognitive activity in old age
> New Service! Memory Education and Training
> Neuropsychological Deficit and Pediatric Sleep Apnea
> Learn about our new website: www.brichel.com
Brichel's Focus:
Working together for optimal development across the lifespan
The directors and clinicians at the Brichel Center for Neurodevelopment share a keen interest in helping their clients function well at every developmental stage in all areas of their lives.
Clinical excellence is our overarching goal, and to that end we have gathered clinicians from a variety of disciplines, each with a uniquely important perspective and each with a commitment to collaborative practice.
Clinicians at Brichel are also committed to effective collaboration with the medical, mental health and educational professionals involved in our clients' lives. Our assessments and evaluations value the input of collaborating professionals and our referral sources are fully informed when a client is seen at our offices.
It has been our pleasure to meet with many of you since the Brichel Center was founded in 2004 and we'd like to maintain that dialogue.
We'll be sending you our newsletter a couple of times a year to keep you informed of our activities at Brichel, and hope these brief articles on the most recent research related to our areas of service will be of interest to you. We'd like to keep up to date with your activities, programs, and services as well, so we hope you'll keep us informed!
We continue to accept new patients of all ages for psychiatric evaluation and treatment. Please feel free to call us at (603)334-3311 if you have any questions or you'd like to learn more.
Memory Clinic is local site for National Memory Screening Day
Again this year, clinicians at the Brichel Center's Memory Clinic will volunteer their time to participate in the National Memory Screening Day on Tuesday, November 15, 2005.
National Memory Screening Day was organized by the Alzheimer's Association to promote the early detection of Alzheimer's Disease.
Brief screening tests can be scheduled in advance by calling the Brichel Center Memory Clinic at 603-334-3311. Walk-ins are welcome between 9 a.m. and 5 p.m., and will be screened on a first-come, first-served basis.
Tips from the Memory Clinic:
• Using your non-dominant hand for routine activities like eating or brushing your teeth, is good for you brain!
• Certain over-the-counter sleep medications can contribute to memory problems.
• "Visualize" what you want to remember, and exaggerate the image as much as possible!
• Paraphrase what you read to help you remember it.
• Rhythmic rhymes are easier to remember (remember how you learned your ABC's?) Turn your errand list into a song or poem!
Treating ADHD Across the Lifespan
Undiagnosed or ineffectively treated Attention Deficit Disorders can have serious consequences for individuals, families and communities. Children with ADD/ADHD may underachieve or fail in school, develop poor self esteem, or struggle socially. Adolescents with ADD/ADHD are more prone to depression and substance abuse. Adults with ADD/ADHD are almost twice as likely to be separated or divorced, and six times more likely to have a suspended driver's license. Nicotine dependence is far more common in individuals with ADD/ADHD, and with that dependence comes well-known health burdens.
In the last decade, our understanding of ADD/ADHD has grown tremendously. Book stores devote entire shelves to the subject, and the professional literature frequently highlights current research.
Brichel offers comprehensive diagnostic and treatment approaches for children, adolescents, and adults with ADD/ADHD. Diagnostic evaluations include a clinical interview which considers relevant past history and genetic predisposition as well as collateral information gathered from others familiar with the patient's functioning. Computerized assessment provides additional information.
Brichel's experienced clinicians understand that other psychological conditions or issues may co-exist with ADD/ADHD, and we are uniquely capable of offering multifaceted treatments, including behavioral management, parental guidance, coaching for adolescents and adults, and medication management.
Our goal is to find the safest and most effective treatment for each of our clients, helping them manage symptoms that hinder their success and when possible, learn to use their symptoms to their advantage.
Evaluating the long-term effects of mild traumatic brain injury
There is general consensus that the brief loss of alteration of conscientiousness that defines Mild Traumatic Brain Injury (MBTI) is most often followed by complete recovery within three months.
Research also confirms that a certain number (various studies reporting between 7-33%) of MTBI cases will experience some post-trauma cognitive effects, typically in the areas of attention and concentration.
According to a recent article in the Journal of International Neuropsychological Society "when specific and sensitive measures of complex attention and working memory were utilized, subtle problems were identified in the MTBI group". (JINS, 2005, 11, 228-236)
Neuropsychologists at the Brichel Center keep this kind of research clearly in mind when they evaluate a client with a definite or possible history of MTBI.
"MBTI can have adverse long-term neuropsychological outcomes on subtle aspects of complex attention and working memory." (JINS, 2005, 11, 228-236)
For elders, current cognitive activity matters most
Well-educated elders have often found comfort in research suggesting that their earlier brain activity might reduce their risk of developing dementia. The theory was that those who used their brains in their early years developed a sort of "neural reserve", or layer of protection, against the ravages of dementia.
More recent research is focusing on how long our early cognitive talents will continue to benefit us. According to a study by Wilson, Barnes, et al (JINS, 2005, 11, 400-407), "…past cognitive ability contributes to current cognition
principally through its associations with cognitive activity in old age."
Elders who have always enjoyed an intellectually rich life are more likely to continue to do so in their older years, and will be statistically less likely to develop dementia. But this research suggests that whatever your prior academic achievements, intellectual interest or "cognitive activities" have been, it is important to
continue to use your brain in your older years. And it is never too late to start challenging your brain!
New! Memory education and training at Brichel's Memory Clinic
"Personal Training" for your brain is now available at the Brichel Center Memory Clinic. In response to client requests, clinicians at the Memory Clinic have developed services to help clients with age-related cognitive decline or mile cognitive impairment maintain and improve their memory functions.
Memory Clinic clients may now follow up on memory consultations, assessments, and diagnostic evaluations with a series of private and confidential meetings with our clinical social worker.
Over the course of four to six meetings, clients receive detailed information about factors that influence memory functions and personalized strategies for memory maintenance and enhancement.
Clients receive a reference workbook to help them identify and prioritize life-style changes, clarify their goals, learn appropriate strategies for improved memory functioning, and formulate a realistic and useful personal memory plan.
"What works are practical tools that are designed to address specific problems you are encountering in your daily life. " Improving Memory
Harvard Health Publications, 2005.
Pediatric sleep apnea and neuropsychological deficit
The most significant effects of Obstructive Sleep Apnea (OSA) are neuropsychological. In several studies, snoring, (a primary symptom of OSA) has been associated with poor academic performance, inattentiveness, aggression, hyperactivity, and other nonspecific behavioral problems.
Adenotonsillectomy appeared to result in academic, behavioral and intellectual improvement, but a long-term study (Gozal and Pope, 2001) found poorer academic performance among adolescents who snored as children, even if they were treated, than among adolescents who have never snored as children.
Brichel's Child and Adolescent Neuropsychologists are aware that parents often hold vital pieces of information in a complicated diagnostic puzzle. When neuropsychological impairment results from Pediatric Sleep Apnea, information from parents can be particularly important.
"Mental health and educational professionals should make detailed inquiries into the nocturnal functioning of children who are struggling during the day." (JINS 2004, 10, 962-967)
Visit our Website!
We invite you to browse our website, launched in May of this year, to learn more about our services and staff.
We will be continuing to expand and develop our website with additional information about our areas of service and helpful links to national websites and local services.
If you'd like to add your service, agency, or program to our resource list, please email our office manager at
mtappan@brichel.com. There is no charge to be added to our Resource List.
ONE DAY Comprehensive Psychiatric/Neuropsychological Evaluation for children and adolescents avoids delayed diagnosis and treatment
"Amy" thrived in elementary school, but seemed disinterested in academics when she started junior high and stopped calling her old friends…
"Jon" needed a lot of help to get by academically in a highly structured 5th grade classroom last year, and was already doing very poorly in the first few weeks of 6th grade …
"Sam" was struggling in High School, unable to get to class on time, forgetting books and papers at home, and falling behind, for the first time, in his accelerated honors classes …
These are common scenarios, but parents and teachers may not be fully aware of problems until parent-teacher conferences are held almost three months in to the school year. When psychiatric evaluation and neuropsychological testing are recommended, it may be several additional months before both of those appointments can be scheduled, attended, and detailed reports and recommendations received. Even then, it can be difficult for parents and educational professionals to piece together a workable plan of action based on assessments and recommendations from several sources. When a plan is finally in place, it is often very difficult for a child to "catch-up" academically and a child's self-esteem and peer relationships have already been affected by the social, emotional or behavioral problems of the preceding weeks and months.
Doctors Gear and Mautz developed their one-day evaluation service with several goals in mind:
• Prevent short and long term social, academic, and behavioral problems with a timely assessment that includes comprehensive psychiatric and neuropsychological evaluations.
• Provide recommendations and intervention strategies informed by both psychiatric and neuropsychological perspectives.
• Provide an evaluation schedule that disrupts the child or adolescent's schedule and routines as little as possible.
• Respect parents' schedules and commitments while allowing for their important involvement in the evaluation process.
• Provide parent, teachers, and mental health professionals with a comprehensive evaluation and coordinated intervention recommendations.