O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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How is dyslexia diagnosed?

A diagnosis of dyslexia is best made by an experienced psychologist who has carefully reviewed the child’s developmental, educational and medical history.  Assessment must comprehensively evaluate the child’s health and development. Causes of reading problems other than dyslexia must be ruled out. For example, emotional disorders, mental retardation, diseases of the brain, ADHD and certain cultural and education factors can cause learning problems, but they are not dyslexia.

Neuropsychological and educational testing can provide a detailed understanding of how the child processes information and create a picture of the child’s strengths and weakness.  It can objectively measure the child’s skills in reading accuracy, reading fluency and reading comprehension and compare the child to typical children of the same age and grade level.  Moreover, the assessment can pinpoint the child’s skills in those particular cognitive processes that underlie reading—phonemic awareness, verbal fluency, verbal memory, oral comprehension and auditory attention, for example.  To place these skills in context, it is also important to understand the child’s broader abilities in reasoning and conceptual thinking, so intelligence testing (IQ) is part of the assessment.

I have made many changes over the years in my method of assessment to keep up with new discoveries in the field, and I keep refining my approach as I learn more about the things that matter most to parents, kids and teachers. Always, my goal is to understand as best I can what the main problems are—from everyone’s perspective—and then to answer questions clearly and directly so everyone has a better idea of what is going on and what specific actions will result in real improvement.

I begin with an interview of the parents (without the child). The goals here are to define the main concerns, review the child’s developmental history, review educational history, and learn about the family.  We discuss what has been tried so far, with what results.  I carefully examine all school records, including report cards and previous assessments, and I ask current teachers to complete questionnaires. Then, I usually meet with the child for two sessions of one-to-one testing, each session lasting 2-3 hours.  Finally, I meet with the parents again to discuss all the results and recommendations.  Typically, this whole assessment takes place over two weeks or so.

What do we achieve through this process?  We know if the child has dyslexia or some different kind of learning disorder. We have a good fix on the child’s current skills in reading fluency, reading accuracy, and reading comprehension, as well as writing and math.  We are able to rule in or rule out ADHD and other conditions that might affect reading. And we know about the child’s abilities in important areas of cognitive development—how well the child is able to focus, remember new information, express ideas in words, grasp new concepts, plan and stay organized.  We also have a good sense of how the child is feeling about school and his or her own learning experience.  All of this information is useful for designing the best program of instruction to meet the child’s educational needs.

Continue to my next post to learn about how a neuropsychological assessment is different from a school district assessment.

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Understanding Dyslexia

What exactly is dyslexia?  How is dyslexia diagnosed?  Is it something your child’s teacher can recognize?  Does it require some kind of special evaluation?  What is the school supposed to do to assess the problem?

If your child is struggling to read, it’s going to make you worry.  You see all of his classmates making progress, reading chapter books, glowing with excitement at their newest discovery, while your child lags behind.  He strains to sound out the most basic words, laboring, every sentence like plodding through mud.  Progress comes only by inches.  Meanwhile, frustration­––­for both of you–grows bigger every day.

Maybe you’ve heard some things about dyslexia but you’re not sure what to believe. Maybe you’ve heard that it means kids reverse letters, like d and b, or write backwards.  Maybe you feel sure your child is bright, so it doesn’t make sense that reading should be such a struggle. Or, maybe you struggled to learn to read yourself, and you wonder what a family history of reading problems might mean for your child.  Maybe your child is already receiving special education services, but you still feel confused about what exactly the problem is, and what needs to be done to help.

Dyslexia Defined.  Dyslexia is a reading disability that occurs when the brain does not properly recognize and process the symbols of written language. The disorder occurs when the brain has trouble making links, or associations, between what letters look like and what spoken words sound like.  The result is that the child does not learn the skills of reading at a rate expected for the child’s age.  Dyslexia occurs in children who are of average intelligence, in children who are of superior intelligence, and in children who are slow learners.

What causes dyslexia?  The disorder is a specific information processing problem that does not interfere with one’s ability to think or to understand complex ideas. The disorder affects how the brain processes the sounds of language, such as separating out the sounds that make up words, or properly sequencing sounds in order.  Very often, the child has related problems that involve weakness in verbal fluency, listening attentiveness, verbal memory, and vocabulary.  Commonly, there is also weakness in the “mental scratchpad” referred to as working memory—what we use when we hold information in mind briefly, long enough to complete a mental operation or very short task. Sometimes the child only shows delays in reading and all other aspects of cognitive development are normal, but sometimes the child has problems affecting many kinds of learning.

Research shows that the particular problem of dyslexia arises as a result of problems in language processing.  It is not primarily a visual problem or a kinesthetic problem.  In other words, the problem is not how the child sees or moves.  And it is much more complicated than just reversing letters like d and b.

How common is dyslexia?  Reading difficulties are very common. Exactly how common depends on the particular definition of dyslexia. For example, results of the 2005 National Assessment of Educational Progress indicate 27% of high school seniors are reading below the most basic levels (minimum level at which a student can demonstrate an understanding of what he or she has read). Primary grade students are even more frequently affected—36% of fourth grade children are reading below basic levels.

What happens as children get older?  Unfortunately, reading difficulties are persistent and do not get better just with age.  Children don’t simply outgrow the problem or catch up on their own.  A student who fails to read adequately in 1st grade has a 90% probability of reading poorly in 4th grade and a 75% probability of reading poorly in high school. Moreover, as students get older, they must shift from learning to read to reading to learn, and so poor readers remain at a big disadvantage in their education.

Brain basis of dyslexia. In the past 20 years, neuroscience has created an explosion in our understanding of dyslexia. Scientists now speak of the neural signature of dyslexia, making a previously a hidden disability now visible. Research indicates that a particular part of the brain is usually involved in the problem (the left temporo-parietal cortex), but several other networks also play a role.  Very recent research has studied dyslexia in languages other than English. One fascinating finding is that the phonological deficit—not being able to break up words into their separate components—and the lack of ability to automatize (reading quickly and effortlessly), appears to be universal among those with reading disability, regardless of the specific language. And neuroimaging studies have revealed actual brain changes after effective intervention for dyslexia.

Is dyslexia inherited?  The short answer is that genetics plays a big role. Dyslexia is strongly heritable, occurring in up to 68% of identical twins and 50% of individuals who have a parent or sibling with dyslexia. The latest research has even identified specific genes linked with reading disabilities. Dyslexia also is associated with various medical conditions that affect brain development but are not inherited, such as premature birth, epilepsy, and drug exposure during pregnancy.

But dyslexia can also occur in children who have no family history of learning disorder, and no history of medical problems.  In fact, in most cases, no specific cause is ever identified.  But one implication of this research is that if a child has a parent or sibling who is dyslexic, that child should be considered at risk and be observed carefully for signs of a reading difficulty so extra help can be offered earlier. One good reason to hope is that accurate diagnosis, especially when the child is young, can lead to early intervention that gets the child on the path to reading.

Continue to my next post to learn how dyslexia is diagnosed.

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Preventing infidelity: Open the sliding door to love

 Dr. John Gottman recently sent me a complimentary copy of his latest book, What Makes Love Last? I read it with great interest. Couples often come to my office struggling with trust and betrayal. While infidelity is a common reason couples seek counseling, it does not have to portend the end of the marriage. Before an affair strikes, women and men adamantly proclaim that they would divorce their partner if they caught them cheating. The discovery of an affair has been described as ”waking up to one’s worst nightmare.“ There is no doubt that this fundamental betrayal produces cataclysmic changes in the relationship. But what comes as a surprise, after the initial shock, is that couples often fight for their marriage, not so quick to divorce as they assumed.

How to Prevent Affairs

In What Makes Love Last?: How to Build Trust and Avoid Betrayal by John Gottman and Nan Silver (Simon & Schuster, 2012), Dr. Gottman makes the case that trust is a powerful protective antidote in keeping marriages healthy and affair-resistant. This seems obvious. But there are clear ways to encourage trust within a marriage. How does trust develop? What keeps it alive? And how do you rebuild it once it has been damaged? In this blog post and the next, I’ll address these questions.

Developing Trust is Central

Central in developing trust is how individuals in a relationship react to what Dr. Gottman refers to as “sliding-door moments.” where “one partner expresses a need for connection [and] the other’s response is either to slide open a door and walk through or keep it shut and turn away” (32). These expressions, or “bids for contact” in Gottman’s phrase, happen all the time as partners ask each other in words and deeds for support and understanding. A small bid would be something like, “Hey, isn’t that a lovely flower?” or as intimate as “I need you” after a difficult day. Each one offers a chance to step through the door.

All committed relationships have an abundance of sliding-door moments, and of course, partners will not always be able or want to step through. They could be busy, preoccupied, angry, or just not paying attention. What puts a relationship in trouble is when most of these moments end poorly. If over time, bids are ignored without the benefit of discussion, one or both partners may begin to wonder if they matter in the marriage. Compounded, these lost opportunities for connection will lead to feeling unloved and unappreciated.

Feeling that way creates fertile ground for an affair. For example, a co-worker shows interest and understanding during a time when a partner is absorbed in their own life stressors. What starts as an innocent work friendship can lead to betraying the marriage as the unmanaged conflict between a couple chisels away mutual trust and struggles become set in stone.

Negative Sentiment Override

Research shows that we are more likely to remember things that are unfinished—such as an argument that never gets resolved or discussions that end poorly with misunderstanding and hurt. The memory of the event leads to an increase in negative attitudes about the marriage. This is referred to as negative sentiment override (NSO). The friendship couples once felt is diminished and they see each other in an increasingly negative light. This NSO leads to one partner feeling threatened—perhaps her partner is involved with someone else?

When Joe and Lisa came to therapy for the first session, she was convinced he was having an affair. While his outside relationship had not become sexual, the risk was high that it could do so if they didn’t attend to their relationship. Many years of poorly managed communication about the division of labor conflicts led to feelings of being unappreciated and unloved by both Lisa and Joe. The more Lisa complained the more Joe pulled back—which served to make Lisa more insecure. During one session they described a recent tussle. After a particularly exhausting week, Lisa spent all Saturday cleaning and grocery shopping. She prepared Joe’s favorite dinner. But Joe was frustrated with Lisa because earlier in the day, when he needed her help getting their daughter ready for swim lessons, Lisa continued to Skype with her sister, ignoring him. By the time they sat down to eat, Joe was steaming, Joe has trouble expressing his feelings when he feels them. In this case, he stewed for most of the day. By the time they sat down to dinner, Joe was boiling mad. He didn’t realize that Lisa was trying to create a sliding door moment for them to connect at dinner. She didn’t know that Joe felt ignored.

Loss of Emotional Intimacy

This dynamic is not uncommon when couples start therapy. The loss of emotional intimacy is usually preceded by years of a subtle weakening of the friendship system in the marriage. Couples stop sharing their intimate feelings. Criticisms, gripes, and defensiveness erode fondness and admiration. Rather than thinking loving thoughts about each other, their thoughts are dominated by what therapists call “distress-maintaining thinking” In other words, the more you see your partner and your marriage in a negative light, the more distress you feel. In turn, the negative thinking gains traction, leaving little space for thoughts and behaviors that would increase expression of fondness and appreciation. If Lisa doesn’t express appreciation to Joe for the time he spends with their daughter, and Joe can’t express what he feels, both the loving and difficult feelings, they will grow apart. The door will shut tight. When sliding door moments are repeatedly missed, negative thoughts about the marriage will slip in, squeezing out affection and love.

The good news is that you can take definite steps to build back trust and protect your marriage from betrayal. Couples therapy is often the first step toward building back the foundation of your relationship. Stay tuned for the next post to see how you can protect your relationship.

 

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The fullest experience of the adventure of life: Eleanor Roosevelt, Blogging, and Mindfulness

I just returned from Rhinebeck, NY, where I took an intensive professional training course in Mindfulness-Based Cognitive Therapy (MBCT) for the Prevention of Depression Relapse. The five-day course was developed for health-care professionals who already have experience with mindfulness-based approaches.

Many years ago, I studied Mindfulness-Based Stress Reduction with its developer, Dr. Jon Kabat-Zinn. Since that time, research has continued to demonstrate the effectiveness of mindfulness training in treating many forms of emotional difficulties. Offspring treatments that involve mindfulness as a major component to their treatment protocol include Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and Mindfulness-Based Cognitive Therapy (MBCT).

Taking a course in MBCT  gave me the opportunity to study with one of the major researchers and writers in the field. It was given by Zindel Segal, PhD, and Susan Wood, MSW, LCSW. Dr. Segal is the author of Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse, 2002, The Guilford Press.

While the course was valuable and added to my skills in teaching this treatment approach, the highlight of the trip was my excursion to Val-Kill, the unpretentious, comfortable home of Eleanor Roosevelt. Just down the road in Hyde Park, NY, stands the opulent estate of her husband, Franklin Delano Roosevelt. Ms. Roosevelt created her separate home in a style that reflected her sensibilities, not those of her husband. Set among trees and brooks, the house contains simple furniture and cozy, intimate rooms.

I was fascinated to learn that Eleanor Roosevelt was a kind of pioneering blogger extraordinaire. She wrote a daily letter to Americans that came to be called “My Day,” one of the most popular syndicated columns of the time. She wrote her column six days a week, often dictated in any free moment she found. She published over five hundred words per column, at least six days a week for 26 years from 1936-1962. Personal as well as socially relevant, her work communicated her thoughts, joys, and intimate concerns.

As a beginning blogger, I have wondered about my urge to write. In a previous post, I talked about how this form of writing allows me to take my many years as a psychologist and put words to this experience that can go beyond the confines of my confidential private office. Social media has provided a means for anyone to make his or her thoughts and opinions public, taking journaling to a new level—but not an unprecedented one, as I saw by Eleanor’s example.

Pleasant and Unpleasant Events Calendar

I often suggest that my clients journal. Collecting thoughts and feelings by observing them and taking the extra step to write them down allows insights to emerge. In MBCT, one of the first homework exercises is to write a daily note about a pleasant and an unpleasant experience that occurred during the day. By noting the thoughts, feelings, and sensations associated with such experiences, we bring mindful awareness to daily life. This can allow us to experience and appreciate the moment simply as it is, without adding further elaboration in the form of wishing, dreading, or judging. It is often our mental elaboration that triggers rumination, a common symptom in depression. We can begin to realize that even unpleasant events can be tolerated. Bringing awareness to each situation, whether we label it good or bad, is an important step in learning to relate differently to them. This takes practice. And curiosity.

The Fullest Experience of the Adventure of Life

As Eleanor Roosevelt writes in You Learn by Living: Eleven Keys For a More Fulfilling Life, “There is no experience from which you can’t learn something. When you stop learning you stop living in any vital and meaningful sense. And the purpose of life, after all, is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experience. . . . The experience can have meaning only if you understand it. You can understand it only if you have arrived at some knowledge of yourself, a knowledge based on a deliberately and usually painfully acquired self-discipline, which teaches you to cast out fear and frees you for the fullest experience of the adventure of life.”

Being attentive to thoughts and writing them down takes discipline. When keeping a journal (or a thought record of daily events, or writing a blog) our life experience is enlarged and enriched. For people struggling with depression, being able to notice even slightly positive things during the day allows them to see that such events are already there for them. For some, it may be noticing the song of a bird, or the stars on a clear night—these simple experiences are always within reach, but for someone who struggles with depression, they go unattended. Writing is a vehicle of self-expression.

References:

Roosevelt, E. (2001). My Day: The best of Eleanor Roosevelt’s acclaimed newspaper columns, 1936-1962. D. Emblidge (Ed.) Cambridge, MA: Da Capo Press.

Roosevelt, E. (2011). You learn by living: Eleven keys for a more fulfilling life. New York: Harper Perennial.

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford.

 

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The College Transition: Things to Talk About

 College is a rite of passage, a transition into adulthood. It’s a transition for parents, too, who can no longer sleep in the room down the hall with ears half-cocked and one eye open. It’s all the more important, then, for parents to have conversations with their kids about how to deal with the common, normal changes and stresses likely to arise in these early years of living away from home.

As high-school friendships shift and fade, college students must forge new social connections or risk social isolation. Kids who have poor coping and social skills before starting college might seek unhealthy solutions, like partying, playing computer games, or holing up in their dorm rooms with their laptops

If these solutions, healthy or unhealthy, don’t work, college kids often isolate, deny, pretend, and find all sorts of other ways to conceal their loneliness. To be lonely is shameful. Instead, many tend to brood over stressful experiences and feelings, a process called rumination. The lonely, anxious person ruminates on negative thoughts: reliving past injuries, flubs, or missed opportunities; feeling apprehension about social events, and anticipating distressing outcomes.

Anxiety, Rumination, and Depression in College

Rumination and anxiety create a cycle where each promotes and prolongs the other. The effect of this is that a stressful experience (such as, say, being snubbed at a party) does not end when the stressful situation ends, but can continue on in one’s thoughts and moods. So it is not only the exposure to the initial stress but also exposure to the recurring representation of that event in the mind that results in a depressed mood. Over time, this anxious rumination leads to negative self-esteem and depression.

Apart from such dangers, loneliness doesn’t just feel bad; lonely people are at greater risk for poor health. Social support mediates health: It is well known that when someone has close family and friends, they will be encouraged to seek medical attention when needed, and they will take better care of themselves in general.

One simple thing to look at when considering college students, loneliness, anxiety, and stress is the role of sleep. Good sleep is the cornerstone of mental health. Most of the clients I see—college students or otherwise—suffer from some form of sleep disturbance. Difficulties getting to sleep or staying asleep are common in both depression and anxiety. (Oversleeping, too, can be a problem when it’s used to avoid situations that may provoke difficult feelings.)

In the recent issue of Health Psychology, researchers examined the mechanisms that underlie the relationship found between depressed mood and poor sleep quality in college students. They found that found that rumination and anxiety are strongly connected to loneliness and depressed mood as well as poor sleep quality.  The authors conclude that psychotherapists and college counselors need to assess loneliness in kids at school.  It is not enough to look at depression and anxiety.  Parents, teachers, college counselors need to look at sleep quality and social isolation, in addition to symptoms of anxiety and depression.

(Zawadzki, M. J., Graham, J. E., & Gerin, W. (2012, July 23). Rumination and Anxiety Mediate the Effect of Loneliness on Depressed Mood and Sleep Quality in College Students. Health Psychology. )

Of course, the image of a college student pulling an all-nighter, or partying until dawn, is a common one, and it’s true that college-aged kids need less sleep than adults. For vulnerable kids, however, poor sleep can lead to severe psychological problems. And as we’ve seen, college can be a vulnerable experience in itself. Add to this that students trying to solve their sleep problems don’t always choose healthy options. Some college kids I’ve worked with use combinations of stimulants and caffeine to stay awake, and anti-anxiety medications to sleep. This leads to drug dependence, and in vulnerable kids, will cause emotional problems ranging from depression to delusional thinking.

Whether problems are caused by too much social media, partying, or are the result of depression and anxiety, we need to pay attention to how these activities are affecting emotional well-being.  Find time to talk with your college-bound kid about some of these issues.  Enjoy the fun of shopping for dorm room stuff, but don’t neglect the crucial conversations about what to expect during this first year away from home. Some basic topics to discuss could include: how to deal with being lonely, how to contact the college counseling center if they feel anxious or depressed, limiting social media, how to get sleep when distractions inevitably occur, and of course, “call us when you feel down.”

Originally published here.