Who We Help

ADD & ADHD
ADHD is a problem with inattentiveness, over-activity, impulsivity, or a combination. For these problems to be diagnosed as ADHD, they must be out of the normal range for a child’s age and development.

Causes, incidence, and risk factors
Imaging studies suggest that the brains of children with ADHD are different from those of other children.  These children produce and/or handle neurotransmitters (including dopamine, serotonin, and adrenaline) differently from their peers, resulting in abnormal communication or integration.  ADHD may run in families and is set in motion early in life as the brain is developing. Depression, lack of sleep, learning disabilities, tic disorders, and behavior problems may be present with ADHD, or may be complicating factors.  Every child suspected of having ADHD should have a careful evaluation to determine what is contributing to the behaviors that are causing concern.

ADHD is the most commonly diagnosed behavioral disorder of childhood. It affects about 3 – 5% of school aged children.  ADHD is diagnosed much more often in boys than in girls.

Most children with ADHD also have at least one other developmental or behavioral problem.  They may also have another psychiatric problem, such as depression or bipolar disorder.

Symptoms
The symptoms of ADHD are divided into inattentiveness, and hyperactivity and impulsivity. Some children with ADHD primarily have the inattentive type, some the hyperactive-impulsive type, and some the combined type.  Those with the inattentive type are less disruptive and are more likely to miss being diagnosed with ADHD.

Inattention symptoms:
1. Fails to give close attention to details or makes careless mistakes in schoolwork
2. Has difficulty sustaining attention in tasks or play
3. Does not seem to listen when spoken to directly
4. Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
5. Has difficulty organizing tasks and activities
6. Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
7. Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
8. Is easily distracted
9. Is often forgetful in daily activities

Hyperactivity symptoms:
1. Fidgets with hands or feet or squirms in seat
2. Leaves seat when remaining seated is expected
3. Runs about or climbs in inappropriate situations
4. Has difficulty playing quietly
5. Is often “on the go,” acts as if “driven by a motor,” talks excessively

Impulsivity symptoms:
1. Blurts out answers before questions have been completed
2. Has difficulty awaiting turn
3. Interrupts or intrudes on others (butts into conversations or games)

The diagnosis is based on very specific symptoms, which must be present in more than one setting.
• Children should have at least 6 attention symptoms or 6 hyperactivity/impulsivity symptoms, with some symptoms present before age 7.
• The symptoms must be present for at least 6 months, seen in two or more settings, and not caused by another problem.
• The symptoms must be severe enough to cause significant difficulties in many settings, including home, school, and in relationships with peers.

 


OCD & Tourette’s Syndrome and Tics

Tourette syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who in 1885 first described the condition in an 86-year-old French noblewoman.

The early symptoms of TS are almost always noticed first in childhood, with the average onset between the ages of 7 and 10 years. TS occurs in people from all ethnic groups; males are affected about three to four times more often than females. It is estimated that 200,000 Americans have the most severe form of TS, and as many as one in 100 exhibit milder and less complex symptoms such as chronic motor or vocal tics or transient tics of childhood. Although TS can be a chronic condition with symptoms lasting a lifetime, most people with the condition experience their worst symptoms in their early teens, with improvement occurring in the late teens and continuing into adulthood.

What are the symptoms?
Tics are classified as either simple or complex. Simple motor tics are sudden, brief, repetitive movements that involve a limited number of muscle groups. Some of the more common simple tics include eye blinking and other vision irregularities, facial grimacing, shoulder shrugging, and head or shoulder jerking. Simple vocalizations might include repetitive throat-clearing, sniffing, or grunting sounds. Complex tics are distinct, coordinated patterns of movements involving several muscle groups. Complex motor tics might include facial grimacing combined with a head twist and a shoulder shrug. Other complex motor tics may actually appear purposeful, including sniffing or touching objects, hopping, jumping, bending, or twisting. Simple vocal tics may include throat-clearing, sniffing/snorting, grunting, or barking. More complex vocal tics include words or phrases. Perhaps the most dramatic and disabling tics include motor movements that result in self-harm such as punching oneself in the face or vocal tics including coprolalia (uttering swear words) or echolalia (repeating the words or phrases of others). Some tics are preceded by an urge or sensation in the affected muscle group, commonly called a premonitory urge. Some with TS will describe a need to complete a tic in a certain way or a certain number of times in order to relieve the urge or decrease the sensation.
Tics are often worse with excitement or anxiety and better during calm, focused activities. Certain physical experiences can trigger or worsen tics, for example tight collars may trigger neck tics, or hearing another person sniff or throat-clear may trigger similar sounds. Tics do not go away during sleep but are often significantly diminished.

What is the course of TS?
Tics come and go over time, varying in type, frequency, location, and severity. The first symptoms usually occur in the head and neck area and may progress to include muscles of the trunk and extremities. Motor tics generally precede the development of vocal tics and simple tics often precede complex tics. Most students experience peak tic severity before the mid-teen years with improvement for the majority of students in the late teen years and early adulthood. Approximately 10 percent of those affected have a progressive or disabling course that lasts into adulthood.

Can people with TS control their tics?
Although the symptoms of TS are involuntary, some people can sometimes suppress, camouflage, or otherwise manage their tics in an effort to minimize their impact on functioning. However, people with TS often report a substantial buildup in tension when suppressing their tics to the point where they feel that the tic must be expressed. Tics in response to an environmental trigger can appear to be voluntary or purposeful but are not.

What causes TS?
Although the cause of TS is unknown, current research points to abnormalities in certain brain regions (including the basal ganglia, frontal lobes, and cortex), the circuits that interconnect these regions, and the neurotransmitters (dopamine, serotonin, and norepinephrine) responsible for communication among nerve cells.

What disorders are associated with TS?
Many with TS experience additional neurobehavioral problems including inattention; hyperactivity and impulsivity (attention deficit hyperactivity disorder—ADHD) and related problems with reading, writing, and arithmetic; and obsessive-compulsive symptoms such as intrusive thoughts/worries and repetitive behaviors. For example, worries about dirt and germs may be associated with repetitive hand-washing, and concerns about bad things happening may be associated with ritualistic behaviors such as counting, repeating, or ordering and arranging. People with TS have also reported problems with depression or anxiety disorders, as well as other difficulties with living, that may or may not be directly related to TS. Given the range of potential complications, people with TS are best served by receiving medical care that provides a comprehensive treatment plan.

How is TS diagnosed?
TS is a diagnosis that doctors make after verifying that the student has had both motor and vocal tics for at least 1 year. The existence of other neurological or psychiatric condition can also help doctors arrive at a diagnosis. Common tics are not often misdiagnosed by knowledgeable clinicians. But atypical symptoms or atypical presentation (for example, onset of symptoms in adulthood) may require specific specialty expertise for diagnosis. There are no blood or laboratory tests needed for diagnosis, but neuroimaging studies, such as magnetic resonance imaging (MRI), computerized tomography (CT), and electroencephalogram (EEG) scans, or certain blood tests may be used to rule out other conditions that might be confused with TS.

It is not uncommon for students to obtain a formal diagnosis of TS only after symptoms have been present for some time. The reasons for this are many. For families and physicians unfamiliar with TS, mild and even moderate tic symptoms may be considered inconsequential, part of a developmental phase, or the result of another condition. For example, parents may think that eye blinking is related to vision problems or that sniffing is related to seasonal allergies. Many students are self-diagnosed after they, their parents, other relatives, or friends read or hear about TS from others.

 


Autism
Autism is a developmental disorder that appears in the first 3 years of life, and affects the brain’s normal development of social and communication skills.

Causes, incidence, and risk factors
Autism is a physical condition linked to abnormal biology and chemistry in the brain. The exact causes of these abnormalities remain unknown, but this is a very active area of research. There are probably a combination of factors that lead to autism.
Genetic factors seem to be important. For example, identical twins are much more likely than fraternal twins or siblings to both have autism. Similarly, language abnormalities are more common in relatives of autistic children. Chromosomal abnormalities and other nervous system (neurological) problems are also more common in families with autism.

A number of other possible causes have been suspected, but not proven. They involve:
• Diet
• Digestive tract changes
• Mercury poisoning
• The body’s inability to properly use vitamins and minerals
• Vaccine sensitivity

How many children have autism?
The exact number of children with autism is not known. A report released by the U.S. Centers for Disease Control and Prevention (CDC) suggests that autism and related disorders are more common than previously thought. It is unclear whether this is due to an increasing rate of the illness or an increased ability to diagnose the illness.

Autism affects boys 3 – 4 times more often than girls. Family income, education, and lifestyle do not seem to affect the risk of autism.

Some doctors believe the increased incidence in autism is due to newer definitions of autism. The term “autism” now includes a wider spectrum of children. For example, a child who is diagnosed with high-functioning autism today may have been thought to simply be odd or strange 30 years ago.

Symptoms
Most parents of autistic children suspect that something is wrong by the time the child is 18 months old and seek help by the time the child is age 2. Children with autism typically have difficulties in:
• Pretend play
• Social interactions
• Verbal and nonverbal communication
Some children with autism appear normal before age 1 or 2 and then suddenly “regress” and lose language or social skills they had previously gained. This is called the regressive type of autism.

People with autism may:
• Be overly sensitive in sight, hearing, touch, smell, or taste (for example, they may refuse to wear “itchy” clothes and become distressed if they are forced to wear the clothes)
• Have unusual distress when routines are changed
• Perform repeated body movements
• Show unusual attachments to objects

The symptoms may vary from moderate to severe.

Communication problems may include:
• Cannot start or maintain a social conversation
• Communicates with gestures instead of words
• Develops language slowly or not at all
• Does not adjust gaze to look at objects that others are looking at
• Does not refer to self correctly (for example, says “you want water” when the child means “I want water”)
• Does not point to direct others’ attention to objects (occurs in the first 14 months of life)
• Repeats words or memorized passages, such as commercials
• Uses nonsense rhyming

Social interaction:
• Does not make friends
• Does not play interactive games
• Is withdrawn
• May not respond to eye contact or smiles, or may avoid eye contact
• May treat others as if they are objects
• Prefers to spend time alone, rather than with others
• Shows a lack of empathy

Response to sensory information:
• Does not startle at loud noises
• Has heightened or low senses of sight, hearing, touch, smell, or taste
• May find normal noises painful and hold hands over ears
• May withdraw from physical contact because it is over-stimulating or overwhelming
• Rubs surfaces, mouths or licks objects
• Seems to have a heightened or low response to pain

Play:
• Doesn’t imitate the actions of others
• Prefers solitary or ritualistic play
• Shows little pretend or imaginative play

Behaviors:
• “Acts up” with intense tantrums
• Gets stuck on a single topic or task (perseveration)
• Has a short attention span
• Has very narrow interests
• Is overactive or very passive
• Shows aggression to others or self
• Shows a strong need for sameness
• Uses repetitive body movements

Signs and tests
All children should have routine developmental exams done by their pediatrician. Further testing may be needed if the doctor or parents are concerned. This is particularly true if a child fails to meet any of the following language milestones:
• Babbling by 12 months
• Gesturing (pointing, waving bye-bye) by 12 months
• Saying single words by 16 months
• Saying two-word spontaneous phrases by 24 months (not just echoing)
• Losing any language or social skills at any age

These children might receive a hearing evaluation, blood lead test, and screening test for autism (such as the Checklist for Autism in Toddlers [CHAT] or the Autism Screening Questionnaire).

A health care provider experienced in diagnosing and treating autism is usually needed to make the actual diagnosis. Because there is no biological test for autism, the diagnosis will often be based on very specific criteria from a book called the Diagnostic and Statistical Manual IV.

An evaluation of autism will often include a complete physical and nervous system (neurologic) examination. It may also include a specific screening tool, such as:
• Autism Diagnostic Interview – Revised (ADI-R)
• Autism Diagnostic Observation Schedule (ADOS)
• Childhood Autism rating Scale (CARS)
• Gilliam Autism Rating Scale
• Pervasive Developmental Disorders Screening Test – Stage 3

Children with known or suspected autism will often have genetic testing (looking for chromosome abnormalities) and may have metabolic testing.

Autism includes a broad spectrum of symptoms. Therefore, a single, brief evaluation cannot predict a child’s true abilities. Ideally, a team of different specialists will evaluate the child. They might evaluate:
• Communication
• Language
• Motor skills
• Speech
• Success at school
• Thinking abilities

Sometimes people are reluctant to have a child diagnosed because of concerns about labeling the child. However, without a diagnosis the child may not get the necessary treatment and services.

 


Asperger’s Syndrome & Social Processing Disorders

Asperger syndrome is often considered a high functioning form of autism. People with this syndrome have difficulty interacting socially, repeat behaviors, and often are clumsy. Motor milestones may be delayed.

Causes, incidence, and risk factors
Hans Asperger labeled this disorder “autistic psychopathy” in 1944. The exact cause is unknown. More than likely, an abnormality in the brain is the cause of Asperger syndrome.

There is a possible link to autism, and genetic factors may play a role. The disorder tends to run in families. A specific gene has not been identified.

The condition appears to be more common in boys than in girls.

Although people with Asperger syndrome often have difficulty socially, many have above-average intelligence. They may excel in fields such as computer programming and science. There is no delay in their cognitive development, ability to take care of themselves, or curiosity about their environment.

Symptoms
People with Asperger syndrome become over-focused or obsessed on a single object or topic, ignoring all others. They want to know everything about this topic, and often talk about little else.
• Children with Asperger syndrome will present many facts about their subject of interest, but there will seem to be no point or conclusion.
• They often do not recognize that the other person has lost interest in the topic.
• Areas of interest may be quite narrow, such as an obsession with train schedules, phone books, a vacuum cleaner, or collections of objects.

People with Asperger do not withdraw from the world in the way that people with autism withdraw. They will often approach other people. However, their problems with speech and language in a social setting often lead to isolation.
• Their body language may be off.
• They may speak in a monotone, and may not respond to other people’s comments or emotions.
• They may not understand sarcasm or humor, or they may take a figure of speech literally.
• They do not recognize the need to change the volume of their voice in different settings.
• They have problems with eye contact, facial expressions, body postures, or gestures (nonverbal communication).
• They may be singled out by other children as “weird” or “strange.”

People with Asperger syndrome have trouble forming relationships with children their own age or other adults, because they:
• Are unable to respond emotionally in normal social interactions
• Are not flexible about routines or rituals
• Have difficulty showing, bringing, or pointing out objects of interest to other people
• Do not express pleasure at other people’s happiness

Children with Asperger syndrome may show delays in motor development, and unusual physical behaviors, such as:
• Delays in being able to ride a bicycle, catch a ball, or climb play equipment
• Clumsiness when walking or doing other activities
• Repetitive behaviors, in which they sometimes injure themselves
• Repetitive finger flapping, twisting, or whole body movements

Many children with Asperger syndrome are very active, and may also be diagnosed with attention deficit hyperactivity disorder (ADHD). Anxiety or depression may develop during adolescence and young adulthood. Symptoms of obsessive-compulsive disorder and a tic disorder such as Tourette syndrome may be seen.

Signs and tests
There is not a standardized (used and accepted by almost everyone) test used to diagnose Asperger syndrome. Most diagnosis are based on neurophysiological and psychological symptoms secondary to changes in brain integration.

Most doctors look for a core group of behaviors to help them diagnose Asperger syndrome. These behaviors include:
• Abnormal eye contact
• Aloofness
• Failure to turn when called by name
• Failure to use gestures to point or show
• Lack of interactive play
• Lack of interest in peers

Symptoms may be noticeable in the first few months of life. Problems should be obvious by age 3 years. Physical, emotional, and mental tests are done to rule out other causes and look more closely for signs of this syndrome.

• PDD-NOS
• Learning difficulties

 

 


Dyslexia
Developmental reading disorder, also called dyslexia, is a reading disability that occurs when the brain does not properly recognize and process certain symbols.

Children

Causes, incidence, and risk factors
Developmental reading disorder (DRD), or dyslexia, occurs when there is a problem in areas of the  brain that help interpret language. It is not caused by vision problems. The disorder is a specific  information processing problem that does not interfere with one’s ability to think or to understand  complex ideas. Most people with DRD have normal intelligence, and many have above-average  intelligence.

DRD may appear in combination with developmental writing disorder and developmental arithmetic  disorder. All of these involve using symbols to convey information. These conditions may appear  alone or in any combination. DRD often runs in families.

 Symptoms
A person with DRD may have trouble rhyming and separating sounds that make up spoken words.
These abilities appear to be critical in the process of learning to read. A child’s initial reading skills are based on word recognition, which involves being able to separate out the sounds in words and match them with letters and groups of letters. Because people with DRD have difficulty connecting the sounds of language to the letters of words, they may have difficulty understanding sentences. True dyslexia is much broader than simply confusing or transposing letters, for example mistaking ”b” and “d.”.

In general, symptoms of DRD may include:
• Difficulty determining the meaning (idea content) of a simple sentence
• Difficulty learning to recognize written words
• Difficulty rhyming
DRD may occur in combination with writing or math learning problems.

Signs and tests
Other causes of learning disability and, in particular, reading disability, must be ruled out before a diagnosis of DRD can be made. Emotional disorders, mental retardation, diseases of the brain, and certain cultural and education factors can cause learning disabilities.

Before diagnosing DRD, the health care provider will:
• Perform a complete neurological exam
• Ask questions about the person’s developmental, social, and school performance
• Ask if anyone else in the family has had dyslexia
• Psychoeducational testing and psychological assessment may be done.

Complications
DRD may lead to:
• Problems in school, including behavior problems
• Loss of self-esteem
• Reading problems that persist into adulthood, which may affect job performance, particularly if the problem was not addressed early in life.


Traumatic Brain Injury (TBI) and Concussions (mTBI)

Traumatic Brain Injury (TBI) is a serious public health problem in the United States. Each year, Traumatic Brain Injuries contribute to a substantial number of deaths and cases of permanent disability. Recent data shows that, on average, approximately 1.7 million people sustain a Traumatic Brain Injury annually.

 

A TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. Not all blows or jolts to the head result in a TBI. The severity of a TBI may range from “mild,” i.e., a brief change in mental status or consciousness, to “severe,” i.e., an extended period of unconsciousness or amnesia after the injury. The majority of TBIs that occur each year are concussions or other forms of mild TBI. The CDC’s research and programs work to prevent TBI and help people better recognize, respond and recover if a TBI occurs.

Each year, an estimated 1.7 million TBI-related deaths, hospitalizations, and emergency department visits occur in the U.S. This data translates to 52,000 deaths and 275,000 hospitalizations. In addition, nearly 80%, or 1.365 million people, are treated and released from an Emergency Department. The majority of TBIs that occur each year are diagnosed as mild TBIs (MTBI). In fact, a study found that about 75% of TBIs that occur each year are concussions or other forms of MTBI. While an MTBI is usually not life-threatening, this injury can have serious and long-term impact on a person’s cognitive, physical and psychological function.

What is a Concussion?
A concussion is a type of Traumatic Brain Injury (TBI), caused by a bump, blow or jolt to the head that can change the way your brain normally works. Concussions can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the head can be serious.

Doctors may describe a concussion as a “mild” brain injury because concussions are usually not life-threatening. Even so, their effects can be serious.
• A concussion is a brain injury and all are serious
• Most concussions occur without loss of consciousness
• Recognition and proper response to concussions when they first occur can help prevent further injury or even death
Concussions can occur in any sport or recreation activity. All coaches, parents and athletes need to learn concussion signs and symptoms and what to do if a concussion occurs.

What are the Signs and Symptoms of Concussion?
Most people with a concussion recover quickly and fully. But for some people, symptoms can last for days, weeks or longer. In general, recovery may be slower among older adults, young children, and teens. Those who have had a concussion in the past are also at risk of having additional concussion and may find that it takes longer to recover if another one occurs.

 Thinking/Remembering  Physical  Emotional/Mood  Sleep
 Difficulty thinking clearly  Headache
Fuzzy or blurry vision
 Irritability  Sleeping more than usual
 Feeling slowed down  Nausea or vomiting
early on Dizziness
 Sadness  Sleep less than usual
 Difficulty concentrating  Sensitivity to noise or light Balance problems  More emotional  Trouble falling asleep
 Difficulty remembering new information  Feeling tired, having no energy  Nervous or anxiety

Some of these symptoms may appear right away, while others may not be noticed for days or months after the injury, or until the person starts resuming their everyday life and more demands are placed upon them. Sometimes, people do not recognize or admit that they are having problems. Others may not understand why they are having problems and what their problems really are, which can make them nervous and upset.

The signs and symptoms of a concussion can be difficult to sort out. Early on, problems may be missed by the person with the concussion, family members or doctors. People may look “fine,” even though they are acting or feeling differently.

Danger Signs in Adults
In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowds the brain against the skull. Consult the professionals at MIND if you experience any of the following danger signs after a bump, blow or jolt to the head or body:
• Headache that gets worse and does not go away
• Double vision, light/noise sensitivity, or diminished smell or taste
• Psychological changes:
• Irritability, anxiety, depression, fatigue, sleep disturbances, personality changes
• Cognitive impairment:
• Inattention, impaired concentration or focus
• Slowing of information processing speed
• Slowing of reaction time
• Memory dysfunction, amnesia
• Decreased appetite
• Motor Impairment:
• Slowing of reaction times
• Weakness
• Numbness
• Dizziness

The people checking on you should take you to an emergency department right away if you:
• Look very drowsy or cannot be awakened
• Have one pupil (the black part in the middle of the eye) larger than the other
• Have convulsions or seizures
• Cannot recognize people or places
• Are getting more and more confused, restless, or agitated
• Have unusual behavior
• Lose consciousness (even a brief loss of consciousness should be taken seriously and the person should be carefully monitored)

Danger Signs in Children
Take your child to the Emergency Department immediately if he/she received a bump, blow, or jolt to the head or body, and:
• Has any of the danger signs for adults listed above
• Will not stop crying and cannot be consoled
• Will not nurse or eat

Clinicians play a key role in helping to identify, diagnose and manage Traumatic Brain Injuries (TBIs), along with helping to improve patient outcomes.

What are the Potential Long-Term Outcomes of TBI?
The specially-trained providers at the Midwest Institute for Neurological Development (MIND) can play a key role in helping to identify, diagnose and manage Traumatic Brain Injuries (TBIs). They can also help improve patient outcomes when a TBI is suspected or diagnosed by implementing early management, or making appropriate referrals.

The severity of a TBI may range from “mild,” i.e., a brief change in mental status or consciousness, to “severe,” i.e., an extended period of unconsciousness or amnesia after the injury.

TBI can cause a wide range of functional short- or long-term changes affecting thinking, sensation, language or emotions.
• Thinking (i.e., memory and reasoning)
• Sensation (i.e., touch, taste, and smell)
• Language (i.e., communication, expression, and understanding)
• Emotion (i.e., depression, anxiety, personality changes, aggression, acting out, and social inappropriateness)

TBI can also cause epilepsy and increase the risk for conditions such as Alzheimer’s disease, Parkinson’s disease and other brain disorders that become more prevalent with age. Approximately 75% of TBIs that occur each year are concussions or other forms of mild TBI. Repeated mild TBIs occurring over an extended period of time (i.e., months, years) can result in cumulative neurological and cognitive deficits. Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal.