BLUE CROSS / BLUE SHIELD
MEDICARE (Part B)
Levi Armstrong, Psy.D., M.S. PsyPharm
Talor Trenchard, M.S., L.P.A.
Psychology Doctoral - Resident
Nicole Stevenson, M.S.
Psychology L.P.A. - Intern
ADHD / ADD
Autism Spectrum Disorder
Learning Disorders (dyslexia, etc.)
Traumatic Brain Injury
Dementia & Mild Cognitive Impairment
Parkinson's Disease / Movement Disorders
Stroke & Anoxic Brain Injuries
Depression / Anxiety / Bipolar / OCD / PTSD
Testing & Therapy For:
3737 Lamar Ave., #100
Paris, TX 75460
Brain Blog #5: 3 Quick Tips for Coping with ADHD
Tip #1.You've got to know your brain before you can fix it.
You cannot fix something until you know what's broken. You probably wouldn't try to fix your car without at least doing some research about the nature of the problem and perhaps reading a few step-by-step instructions. So why would you try to fix your ADHD brain (which is vastly more complicated than a car, by the way) without first learning how it works? This is where ADHD testing and / or psychological testing can help with identifying an accurate diagnosis of ADHD, determine which subtype of ADHD you have, and ultimately give you concrete details for your brain's strengths and weaknesses as it relates to your treatment plan. This disorder is much more complicated than what has been said in the media or pop-psychology websites. Don't waste time guessing what your problems are.....get tested and get to know your brain.
Tip #2. ADHD Medication: Why Zombies are Myths and Science is Fact
Me: "In addition to ADHD counseling, I also think you should consider talking to your child's pediatrician about the ADHD medication treatment options available."
Parent: "But I don't want my kid to be a zombie."
Me: "Have you had a chance to read the research literature on ADHD medication?"
Parent: "Not yet, but I saw a documentary one time and my friend's cousin's nephew got put on some ADHD medication and that just seemed to turn them into a zombie. If that's what ADHD medication does, I don't want my kid on it."
Me: "Well, I totally understand your fear and hesitancy. I'm afraid of zombies too.....especially kid zombies with ADHD. I mean...can you even imagine how terrible that would be?!"
Parent: "......" (no laughter...not even a smile......just silence....)
Me: "...But all jokes aside....if you want to know the truth, ADHD medications can actually change your child's life for the better and the neuroscience research literature is clear that medication for ADHD is the most effective treatment option when there has been an accurate diagnosis made that identifies the subtype of ADHD and when a ADHD specialist prescriber is closely monitoring the patient's response to treatment."
Just the facts...Before my training in psychopharmacology, I was also fearful of ADHD medication. And personally with my own children, I'm always hesitant to give them any medication for any reason. That's just good parenting: to be hesitant and cautious when it comes to the health and safety of your child. But you should also know that the media has really pushed "fake news" about the risks of ADHD medication.
Research conducted by organizations with no relationship to "big pharma" is clear that ADHD medication is actually one of the most effective psychotropic classes for its purpose and is actually quite safe in comparison to most other medications (assuming the patient is a good physical candidate for ADHD medication).
That's not to say that there aren't risks with ADHD medication. All medication has risk (and this includes "natural supplements" and vitamins" by the way). But the actual objective science is clear: ADHD medication may have many more long-term benefits than risks for children and adults with ADHD. For example, ADHD medication reduces a child's risk for substance use/dependencedoes not increase a child's risk for substance abuse or dependence. Actually, it reduces the risk by helping the child learn ways to inhibit their impulses and perhaps decreases their need to self-medicate for their ADHD with illicit drugs.ADHD medication does not make ADHD worse. In fact, it helps the child cope more effectively with their ADHD which in turn helps the child's environment shape the child's brain in a healthier manner.
It is expected that there will be "rebound" ADHD symptoms when the medication wears off (which can also include increased irritability/moodiness), but this is a problem that can be easily addressed by talking to their doctor and implementing a few behavioral strategies to help your child transition off the medication each day. ADHD medication is always recommended but never enough. To get 100% better, you'll need to change behavior and learn how to modify your (or your child's world) to compensate for ADHD-related challenges.
Tip #3: Find an ADHD Counselor to Help Your Brain's "CEO" Learn How to Delegate
The frontal lobe is the "CEO" of the brain: it tells the rest of your brain what to do and when to do it. But ADHD is a disorder of the frontal lobe and therefore the "CEO" just doesn't work like it should. This is called "executive functioning" problems. All frontal lobe disorders like ADHD cause executive functioning problems, which is another way of saying one has problems with: planning, prioritizing, time management, impulse control, mental flexibility, resistance to distraction, controlling thoughts/emotions, and making good use of judgment during decision making.
To effectively cope with executive functioning problems, you'll need to learn how to use a "surrogate" frontal lobe. That is, learning how to utilize smart phones, reminders, to-do lists, environmental prompts/cues, and social support (friends, family, spouses, etc.) to help you compensate will be essential to your coping with ADHD. Professional counselors and psychologists who specialize in ADHD are trained to provide you with the resources, education, and support you'll need to tackle ADHD-related executive dysfunction.
That's it for now! Thanks for reading!
Levi Armstrong, Psy.D., MSCP
Clinical Neuropsychologist & Practice Owner
Brain Blog #4: Chronic Stress & Your Brain
Chronic stress really messes with how you think, feel, and behave. It is the root cause of most mental illnesses and can negatively affect your thinking abilities. Chronic stress causes chemical changes in your brain/body that ultimately results in your ever declining ability to mentally cope with life's challenges. Specifically, chronic stress will:
1. Cause your frontal lobe's functioning to decline and result in mood instability (depression/anxiety), difficulty concentrating, and difficulty solving problems.
2. Wreak havoc on your memory and cause you to struggle to learn new information.
3. Disrupt your sleep and diet and thereby further exacerbate your brain's health.
4. Make your brain more sensitive to physical and emotional pain.
5. Exhaust your brain's ability to effectively re-wire itself when injured.
Chronic stress literally changes how your brain produces/responds to hormones and other chemicals in your brain (especially serotonin, GABA, norepinephrine, and dopamine). There are certain parts of the brain that tend to be more sensitive to chronic stress - e.g., the hippocampus/amygdala and your prefrontal cortex. The hippocampus and amygdala are found in the "middle" of your brain and primarily serve to help you remember information and provide you with the ability to respond to stress effectively. The prefrontal cortex (part of your frontal lobes) essentially acts as a brake/gas pedal and gives you the ability to regulate your emotions/behaviors/thoughts.
Unfortunately, chronic stress degrades the functioning of these areas of your brain and results in anxiety, depression, mood instability, and executive dysfunction (e.g., poor planning, prioritizing, judgment, organizing, problem solving, self-monitoring, etc.).
So what can we do to decrease stress and improve brain health? Here is a list of the "pillars" of brain health and specific recommendations for the treatment of chronic stress:
1. Improve your sleep. One thing is certain: your brain needs good rest in order to repair itself. If you do nothing else, work on improving your ability to sleep by learning about proper sleep hygiene and get tested for sleep disorders (e.g., sleep apnea, restless leg syndrome, etc.).
2. Improve your diet. Your brain cannot repair itself without all the nutrients it needs. Eating healthy is not just for your waistline. More importantly, it gives your brain the proper building blocks to help you think better when coping with stress.
3. Exercise. I know, I know.....we've all heard it but the fact remains that exercise causes your brain and body to handle stress more effectively and can literally "cancel-out" the harmful effects of chronic stress.
4. Talk to your doctor and seek the help of a counselor/psychologist/psychiatrist. Setup an appointment with your doctor to talk about your body's physical functioning and perhaps review your options for medication if needed. Seeking the assistance of a professional counselor is also recommended if you are struggling with emotional difficulties.
For additional reading on this topic, I recommend:
Why Zebras Don't Get Ulcers by Robert Sapolsky
The Stress-Proof Brain: Master Your Emotional Response to Stress Using Mindfulness and Neuroplasticity by Melanie Greenburg, PhD
The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being by Daniel Siegel, MD
Brain Rules & Brain Rules for Babies by John Medina
Until Next Time,
Brain Blog #3:
Dementia: The Role of Neuropsychological Testing & Quick Facts
As a clinical neuropsychologist, doctors and other clinical providers frequently refer patients to me for dementia evaluations. The purpose of this relatively brief blog is to provide a few quick facts about dementia and the purpose of neuropsychological testing:
1. A simple definition of "dementia" is as follows: Dementia is characterized by progressive decline in one's thinking abilities (and sometimes decline of physical abilities), which is usually caused by various disease-related changes occurring in the brain. These diseases usually degrade and/or destroy brain cells over time, which results in decreasing cognitive abilities. There are many causes of dementia (see #4 below).
2. Dementia is not a normal part of aging. Although some cognitive and physical decline is normal as one gets older, the disease process of dementia causes abnormal decline in one's thinking abilities, which can occur either rapidly or at a slow steady pace. Unfortunately at some point, dementia causes "functional decline" in one's ability to independently complete daily tasks (i.e., depending on the cognitive problems that arise). In general, the only reason someone should lose functional independence is because of significant cognitive decline or physical limitations. In other words, not all elderly individuals develop dementia or require placement in assisted living facilities/nursing homes.
3. The vast majority of "young" older adults (i.e., ages 50-60) who notice a decline in their cognitive abilities likely do not have dementia. Clinicians often call these folks the "worried well," meaning that they may notice a decline in their learning abilities, problem solving efficiency, memory, attention, etc., but this decline is likely more related to normal aging and/or other medical conditions/medications. There are in fact many medical conditions and mental health conditions that can mimic dementia as one gets older.
4. There are many different types of dementia. Most people know about the most common type of dementia, which is called Alzheimer's disease. However, there are several other types of dementia that may require different treatment approaches. The most common types of dementia are (in order of most common): Alzheimer's disease, Vascular dementia, Lewy-Body dementia, Fronto-Temporal dementia, and the Parkinson's plus dementias (e.g., corticobasal degeneration, progressive supranuclear palsy, multiple system atrophy, etc.). Other less common types of dementia include Huntington's disease, Primary Progressive Aphasia, Semantic Dementia, Normal Pressure Hydrocephalus, Hepatic Encephalopathy, HIV-related dementia, Korsakoff's dementia, progressive forms of Multiple Sclerosis, long-term nutritional deficiencies (Thiamine) etc.
5. A neuropsychological evaluation can help determine the "type" of dementia to help with treatment planning. A neuropsychological evaluation helps with diagnostic clarification, determining prognosis, and tracking the course of the cognitive decline over time. Thankfully, dementia screening is becoming more routine for family practice physicians and other medical/behavioral health providers. Once a patient is identified as being "at risk" for having a form of dementia, they are often referred to a neurologist for a neurological exam. This exam often includes a general physical exam focusing on the patient's neurological functioning, and the neurologist often orders blood labs and possibly neuroimaging of the brain (e.g., MRI/CT scans). Additionally, neurologists may also refer their patient for a neuropsychological exam. Neuropsychological testing provides an in-depth look at the functioning of the patient's brain, which can help identify specific treatments and/or provide diagnostic clarification.
6. Unfortunately, dementia cannot be cured. However, new research is promising. Although most forms of dementia cannot be cured or "reversed," it can sometimes be "slowed" with various treatment interventions and lifestyle changes. There is promising research published recently that shows some types of dementia may benefit from specific behavioral and pharmacological treatment - such as increased social engagement, exercise, proper nutrition, proper sleep, etc. Just a quick note: there are some "reversible" forms of dementia/cognitive decline such as vitamin D deficiency, depression/anxiety (e.g., pseudo-dementia), sleep disorders, and some forms of medication-induced cognitive problems. Although your neurologist and neuropsychologist will likely help rule these out, it is important to talk to your doctor to make sure these are being considered in the diagnostic and treatment process.
7. Lastly, there are many helpful resources out there for people suffering from dementia and their caregivers. Please visit our resources page to review some of these resources. Also, if you or someone you know is suffering from what you suspect is dementia, talk to your doctor about dementia screening or ask for a referral to a neurologist or neuropsychologist.
Thanks For Listening,
Levi Armstrong, Psy.D., MSCP
Brain Blog #1:
What is ADHD and how is it diagnosed/treated?
These are great questions. Unfortunately, too many people are and continue to get misdiagnosed due to a lack of understanding about the nature and treatment options for ADHD. Many parents are rightly concerned with the typical way that ADHD is diagnosed these days: "well, let's just see how he/she responds to medication." ADHD is a complex disorder that involves many factors that may or may not respond well to medication. Let me unpack that a little more...
ADHD or (attention deficit hyperactivity disorder (formerly known as ADHD or ADD), is a neurodevelopmental disorder that has it's onset sometime during childhood or early adolescence. Now I know there there has been quite an emphasis lately on "adult-onset" ADHD, but we'll get to that in a minute. For now, let me offer a simple definition for this disorder:
ADHD is simply defined as difficulty with all or some of the following: sustaining attention, filtering distractions, initiating/completing tasks, hyperactivity/restlessness, impulse control, and inhibitions. Not all individuals with ADHD will have all of these difficulties nor will all of these difficulties occur at the same time. In fact, there are actually three sub-types of ADHD: inattentive subtype, hyperactive/impulsive subtype, and combined presentation (i.e., both hyperactive/impulsive and inattentive). All of these difficulties theoretically stem from prefrontal/frontal lobe brain dysfunction and involve brain chemicals such as dopamine and norepinephrine. There are other classical signs and symptoms of ADHD, but this is the general definition of the disorder.
With that being said, ADHD is often mimicked by many other mental illnesses, neurological conditions, and/or general medical problems. Certain medications can even cause ADHD symptoms or make ADHD symptoms worse. Some of these "false-ADHD" conditions include: sleep disorders (insomnia, sleep apnea, restless leg syndrome, etc.), nutritional/vitamin deficiencies (e.g., vitamin D, etc.), anemia, depression, anxiety, seizures, dementia, bipolar disorder, schizophrenia, oppositional defiant disorder, chronic pain syndromes, dyslexia/learning disabilities, cerebrovascular disease/stroke, traumatic brain injury/concussion, Parkinson's disease, multiple sclerosis, substance abuse.....and the list goes on and on.
Making matters more complicated, an individual could potentially have any number of these diseases WHILE ALSO HAVING ADHD. In fact, most individuals with ADHD have what is called a "co-morbid" diagnosis, which can include depression, mood instability/bipolar-like symptoms, anxiety, OCD, autism spectrum disorder/Asperger's, Tourette's disorder, learning disorders, intellectual disorders, or other neurological/medical conditions. Research shows that there is also an increased risk for individuals with ADHD to abuse substances, which certainly doesn't help the brain function.
So back to the question of "how is ADHD diagnosed and how can it be treated?" Well, as you can see from the last paragraph, ADHD is actually a rather difficult diagnosis to make. That is why neuropsychological or psychological testing is often recommended to help differentiate ADHD from "everything else."
I typically recommend a full neuropsychological evaluation to diagnose ADHD. Sure, it is much easier to use a few questionnaires for parents, teachers, spouses, etc., but as I've already mentioned, ADHD is not easy to diagnose and ADHD medications are not always the answer. Although questionnaires are helpful, a positive finding on a questionnaire does not necessarily mean that ADHD is causing the attention difficulties, hyperactivity, or behavioral problems. This is where testing is useful: neuropsychological tests actually measure the FUNCTIONING of the brain, which is objectively and completely independent of a patient's reported symptoms. In other words, this keeps everyone in the diagnostic process "honest" and allows for the tests to speak for themselves for the most part.
Our ADHD evaluations measure sustained visual attention, sustained auditory attention, auditory attention span, auditory/visual working memory, selective visual attention, information processing speed, complex divided or alternating attention, and resistance to distractions. Executive functioning tests measure impulse control, inhibitions, judgment, planning, organization skills, self-monitoring, emotional regulation, prioritizing, and age-appropriate complex reasoning.
In addition, we typically measure all of the other brain functioning domains including learning/memory, speech and language abilities, auditory processing, visuospatial functions, academic skills (reading, math, spelling, etc.), sensorimotor functions (motor programming/planning, fine motor dexterity, vision/hearing/sense of touch), and emotional/personality functioning. This is all in addition to a thorough clinical interview during which the patient's developmental history, medical history, psychiatric history, work history, family history, and academic history are all explored in detail (usually with collaborative family members or friends with the patient's consent).
Okay okay okay...we get it. ADHD requires a thorough examination. But how exactly can you treat it? Well, it depends. My first recommendation is and will always be ADHD counseling, parental coaching, and/or modifying one's school/work/home environment (in addition to referring my patient to a collaborating physician who can rule-out all of the aformentioned medical problems).
Many times individuals can learn how to "compensate" so well for their ADHD problems by using specific behavioral and environmental modification strategies without ever needing to explore their options for medication. However, there is conclusive evidence that the right ADHD medication (there are many!) prescribed at an appropriate dosage/dosing schedule, and with an accurate diagnosis, can actually be very beneficial for most people suffering from ADHD. Even more improvement can be seen when the patient also participates in ADHD counseling/coaching while taking their medication as prescribed. This is where psychiatrists, neurologists, adequately trained pediatricians, and/or psychiatric nurse practitioners can be very helpful, especially when dealing with any other medical conditions that often are present with ADHD.
A few quick notes:
1) Some individuals cope with their ADHD so well that the symptoms don't appear until later in life. This is especially true for individuals with high intelligence. This is most likely what causes "adult-onset" ADHD.
2) Treating all of the other mental, medical, and neurological disorders that are present with ADHD is essential for complete remission of ADHD symptoms. This is especially true for patients (including children) with sleep disorders (obstructive sleep apnea).
3) Some people don't respond well to certain ADHD medications and/or need occasional adjustment of their dosage in order for the side effects to be minimized and/or the medication to actually work. This is actually quite common and doesn't necessarily mean that ADHD medication will not be helpful. Close communication with your prescriber will always be very important.
and 4) counseling for ADHD and/or environmental modifications have essentially no side effects and will ALWAYS be useful and recommended as an intervention for ADHD. This last piece of the equation is essential, in my opinion, because gaining control over ADHD requires that the child, adolescent, or adult learn about the diagnosis, learn how to manage it more effectively, and take ownership of their brain functions, emotions, and behaviors over time.
Lastly, I feel like I should make one more note about the fact that ADHD is often coupled with "bipolar-like" symptoms. Many children (and adults for that matter) may be incorrectly diagnosed with bipolar disorder when, in reality, all they have is moderate-to-severe ADHD. The reason that people with ADHD suffer from mood swings is because the frontal lobe (which is not working properly in ADHD) also controls mood regulation. The frontal lobe also deals with mood regulation, emotional reactions, and inhibiting impulses/anger/joy based on social norms. I like to call it "our brake pedal for emotions."
It is true that one can have both bipolar disorder and ADHD, but this is the exception and not the rule. With that said, most folks with ADHD will struggle with emotional regulation and mood stability on occasion, which if left untreated or misdiagnosed, can make all of the ADHD symptoms worse. The good news: research is pouring out of academic/clinical research institutions all the time and new behavioral/pharmacological treatment options are being offered on a consistent basis. You just need to make sure you have the correct diagnosis.
If you or someone you know is suffering from any of these conditions/symptoms, please feel free to call us to schedule an appointment. If we can't help you, we will absolutely provide you with a list of referrals to clinicians we trust. Our motto is that we will only refer you to clinicians to whom we would send our own family. You can always count on that.
Until Next Time,
Clinical Neuropsychologist (Texas #36271) & Owner
Neurobehavioral Consultants, PLLC
Keywords: ADHD, ADD, attention deficit disorder, frontal lobe, executive dysfunction, inattention, difficulty concentrating, learning disabilities