September 14, 2018

My stepdaughter begins Speech Therapy treatment this week. I was wondering what we need to bring. We planned on bringing the ARK Therapeutic tools to be properly trained, but what else is necessary?

Expert's Answer:

This is a common question from parents as they prepare for their first appointment! Here is what we suggest bringing:

  • If it is for feeding therapy, we suggest bringing some preferred and non-preferred foods along with the ARK tools they have.
  • If it is for speech and language therapy, all you will need to bring with you to the appointment is the ARK tools. Please dress your child in comfortable clothes and have socks in case they go in the gym.

For additional information and commonly asked questions, see our Speech Therapy: What to Expect guide.


May 30, 2018

I have a 17 year old daughter with CRPS/AMPS and I am looking for an inpatient location to help her walk again. Do you take kids age 17? Thank you.

Expert's Answer:

Yes, Children’s Specialized Hospital is one of the few facilities in the country that offers a comprehensive, inpatient Chronic Pain Management Program for children 11-21 with chronic pain. During our 4 week program, our multidisciplinary team works with our patients to increase function, and promote coping skills to help her achieve her personalized goals.

For more information about the inpatient program or to schedule an evaluation with our team, please click here.

by Katherine Bentley, MD


April 04, 2018

I am in the process of getting state insurance for my children and wanted to know how insurance works if I do not have any at the moment?

Expert's Answer:

We suggest you see if you qualify for the Children's Specialized Hospital Benefit Fund until you are fully insured. This program helps make up the financial difference between the rehabilitation a child needs, and what his or her family’s insurance will cover. If eligible, the Children's Specialized Hospital Benefit Fund program can assist with high deductibles, coinsurances, and even copays.


January 23, 2018

My son is now 6 months old, and was born extremely prematurely at 23 weeks. He has been home from the NICU, now for 7 weeks. I want to get my child assessed to see if he needs PT/OT for developmental delays or if they would resolve in due course themselves - can it be done at this center?

Expert's Answer:

Yes, you’ve come to the right place! We have the most Developmental and Behavioral pediatricians in the country and offer PT/OT at 12 sites throughout NJ. You can easily schedule an appointment at www.childrens-specialized.org/request-an-appointment or call 800-244-5373 to have your son evaluated by one of our specialists.

Another very helpful option I would suggest is an Early Intervention Program. This is a resource for in-home evaluation to determine your child’s therapy needs. Early Intervention supports many children who were born prematurely, and can help you understand what additional services may be needed for your child. You can learn more about Children's Specialized Hospital's Early Intervention Program by calling 1-888-653-4463 .

by Malia Beckwith, MD


January 04, 2018

I have a three year old child and I was wondering what age are they supposed to speak clearly and start to form sentences and how do I know if he has a learning disability or if I need to take him to see someone. I see that he has a very short attention span its really hard for me to get him to stay still and learn his name and abc's and 123's.

Expert's Answer:

At 36 months of age, we don't expect 100% intelligibility of speech, but unfamiliar adults should be able to understand at least 75% of a child's speech. The child should also be using 3-4 word sentences. This is a general guideline, however, and much growth happens between 36 and 47 months (I don not know the child's exact age).

It sounds like there may be a combination of language and behavioral concerns in this case. If there is even a mild delay in language, attention and learnings can be adversely effected. I would suggest making an appointment for a Speech and Language evaluation and to see a Developmental and Behavioral Pediatrician. These providers can determine if there are truly any areas of concern, and help formulate a plan of treatment.

by Malia Beckwith, MD


December 26, 2017

What’s test are given for ADHD testing and when does child need medication?

Expert's Answer:

An ADHD diagnosis is made when the child is found to meet DSM-5 criteria, which include features of inattention and/or hyperactivity. There are a variety of tools that can assist in making a diagnosis, but ultimately DSM-5 criteria must be met.

To make a diagnosis, the provider usually needs information about the child’s function in multiple settings. If truly ADHD, for example, we generally should see symptoms and dysfunction in both the home and school settings. Before initial evaluation appointments, we ask parents to request completion of the Vanderbilt Assessment Scale by the child’s teacher. This gives the examiner a sense of what is happening beyond the home setting.

The decision about medication should be made after careful discussion between a child’s parent/ guardian and their medical provider. Every case is different, as some children are better able to compensate and use in school accommodations to be successful despite their ADHD. However, if dysfunction is causing significant distress in the home and school settings, leaving the ADHD untreated may result in profound long term consequences to a child’s self esteem.

If questioning the diagnosis of ADHD, the best first step is to discuss with your child’s primary care provider. The provider will help to determine if a specialist is needed to help with diagnosis of treatment. You can then schedule an evaluation with one of Children's Specialized Hospital's Developmental and Behavioral specialists at www.childrens-specialized.org/request-an-appointment.

by Malia Beckwith, MD


December 20, 2017

My daughter is 10 and sometimes has trouble controlling her emotions. Sometimes these meltdowns have apparent reasons (e.g. she worried about a school assignment) but other times they seem without reason and she can't express why she's upset. I've learned that the best thing I can do is remove her from the situation and give her time to calm down. She does well in school and seems to, for the most part, be better able to control herself in that setting. Should I be concerned?

Expert's Answer:

It sounds like your daughter may be struggling with anxiety. Anxiety can manifest differently in children than it does in adults. They may have meltdowns or can be more irritable, and unable to verbalize feelings or worry or fear. It sounds like she is focused on her achievement and wants to do well. I am very happy these meltdowns are not happening at school, but think that she could benefit from working with a psychologist on her anxiety and emotional regulation through cognitive behavior therapy.

It will empower her to be able to verbalize her emotions more effectively, before she reaches the point of a meltdown. This skill is something we all need. I do not think that you should be "concerned" but this is an opportunity to help her learn a valuable skill for the future.

by Malia Beckwith, MD


November 20, 2017

Do you have bilingual counselors (Spanish/English) for individual and group therapy? Also, do you have a sliding scales or take insurance?

Expert's Answer:

Thank you for contacting us regarding psychology services. Yes, we do have limited bilingual therapists available and we do take many forms of insurance. For additional questions regarding bilingual services or payment options within psychology, please contact our Mental Health Access Coordinator at 888-CHILDREN ext. 8878.

by Richard Leit, PhD


November 09, 2017

Hi My Son is 2 year's 3 months old. He is having speech delay and he is getting therapy from Early intervention. We recently noticing that he is getting upset easily and throwing the objects he has around him etc. Its hard manage him during the phase some times he fighting with person who is trying to calm him down. We are worried about this behavioral change.. any suggestions on this much appreciated.

Expert's Answer:

What you are experiencing is not an unusual problem for children with speech/language disorders. As the child is growing, and may be progressing with receptive language skills (what they understand), they may become more frustrated that they are not able to verbally express themselves resulting in tantrums. Sometimes providing an alternative means of communication (sign, picture communication) can help decrease this frustration, and allows you to continue to work on verbal skill acquisition. I would, however, recommend an evaluation by a Developmental Behavioral Pediatrician to help you with behavior management strategies, and to make sure all of your child’s needs are being addressed. I would also recommend discussing behavioral concerns with your Early Intervention Case Manager. Through Early Intervention, sometimes a behavioral intervention, Applied Behavior Analysis (ABA), can be implemented to help teach more appropriate behaviors which promote participation and learning.

by Malia Beckwith, MD


November 08, 2017

When my son started kindergarten he started to show some behavioral problems, he was then referred to the child study team, evaluated and diagnosed with ADHD. At the time he was moved to a behavioral class, each year he has met his goals and slowly integrated into general education classes. He was started on Methylphenidate last year and it has improved his concentration, impulse control, motivation among many other things. My son is 10 y/o now, in 5th grade and he just started his first year, in a new school district, in Gen Ed full time with in-class support. The first couple months went well but some problematic behaviors are starting to appear. At that time his special education teacher recommended going back to a behavioral class. After speaking with the child study team she has since changed her mind. When the behaviors started to emerge a couple weeks ago, I started looking at some of his old assessments from kindergarten. His academic achievements have all been on or near grade level, at times both above and below. As part of his Psycho-Educational Eval he took the WPPSI-III, He scored Verbal 112 Performance 100 Processing 102 FSIQ 103 In his sub-tests I noticed that, Matrix Reasoning he got a scaled score of 7 /16th percentile and his Coding he got a scaled score of 8 /25th percentile. 1) Are these results reliable since the test was taken when he was 5yrs 11mo and potentially in a poor mental state? a) If they are reliable, are these two low scores something that should be further evaluated or reevaluated? 2) Are these subtests related to working memory, and fine motor skills? When asked about some of the current problems he complains that he finds it difficult to write down his ideas, states that he has thoughts but when he attempts to write, they disappear. As well as he has trouble writing legibly at the same pace as his peers. When the are no time restrictions he is capable of neat handwriting but, with poor pencil grip, hand cramping, broken pencil tips and burns through erasers correcting errors. He says there's more to his struggles and frustration, but he is unable to explain and gets frustrated and emotional when trying to. He often says he is, or feels like a failure because he puts in maximal efforts but still cant achieve what his peers around him can. For example when prompted to write 3 paragraphs, he can only neatly write 3 sentences in the time allotted. If he rushes, he states that his handwriting is illegible and he doesn't write complete sentences or thought. 1) If the scores are correct, will the deficits provide an explanation for some of his complaints and struggles? a )To my understanding IQ doesn't vary much, so if these deficits are accurate, How much can be changed with motivation and effort? i) Would it be best to try to find ways to utilize areas of strengths to compensate for the weaker areas? Thank you in advance, I truly appreciate all the help I can get. Everyone who meets my son sees great potential, yet very few have been able to tap into it. We have an appointment with his CPNP to reevaluate his medication and discuss relevant topics, followed by an emergency Child Study Team meeting at the end of this month/beginning of next. In the past, small behaviors appeared then grew exponentially, bridges were burned and relationships were irreparable. In addition, this year's CST is less equipped and experienced than all previous years. I feel like we have climbed out of the valley and we are teetering on a cliff, a month is a long time to wait. My son is afraid his is going to accidentally have a melt down and be sent back to despite his best efforts and other achievements. This means the leg work is on me, so again I thank you very much for time and expertise. I look forward to your response.

Expert's Answer:

My first recommendation would be completion of a full CST re-evaluation, including psychological (cognitive) and educational re-evaluations. I think it is really hard to comment on the meaning of the scores provided, as testing was completed so long ago. Generally the CST will do a full re-evaluation every 3 years, so he is more than due. IQ scores do not change typically over time, but the accuracy of scores obtained at young ages can be somewhat questionable. We have to make sure there is not a specific learning disability that is further impacting his function.

I agree with meeting with his medication provider to determine if a tweak in dose may be helpful, but would also encourage you to speak with the school about having a Board Certified Behavior Analyst (BCBA) conduct an evaluation (a Functional Behavior Assessment or FBA) of your child in his current classroom setting, to better understand contributors to or functions of maladaptive behavior. This information can be used to create a more effective behavior management plan, that may allow him to stay in the current setting, rather than moving back to a more restrictive environment.

by Malia Beckwith, MD

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