May 15, 2017

My son, 13, will be starting High School in September. I had to fight the school system to get him an evaluation in 1st grade. They eventually classified him as "specific learning disability". For 7th grade the IEP team recommended he be placed into Reg. Ed. with in class support and accommodations. I was not really comfortable with this and asked that there be a stipulation placed that I could request he be placed back into Resource. It took 5 months of meetings to get them to place him back, and by that time he had failed one subject for the year and almost had to complete summer school because of misplacement. Now the IEP team is again suggesting Reg. Ed with in class supports even though he is barely a C now, so I presented to them a High School for Learning Disabilities that would be out of district. They are fighting me tooth and nail. I want to have a complete evaluation of my son to present that the School District is not equipped nor addressing all his learning disabilities, and that the Out of District HS would be best for him. He was diagnosed at Children's years ago with ADD. I highly suspect Auditory Processing Delay, Dyslexia. He has been having severe anxiety since last year over school. He has a terrible memory and poor fine motor skills as well. Can Children’s Hospital do a complete evaluation for me to present to his school district of his learning issues? Thank you so much!

Expert's Answer:

It sounds like you have gone through a lot in your pursuit of the best services for your child. After hearing this situation, I would suggest a Developmental evaluation so that a Developmental Pediatrician/APN can partner with you to determine how best to help your son.

by Malia Beckwith, MD


April 27, 2017

How do I go about getting a prescription refill for my daughter's ADHD medication?

Expert's Answer:

The easiest way for you to refill your daughter’s prescription is through our Patient and Family Portal! The Patient and Family Portal can be easily accessed on any smartphone, iPad, or laptop at my.childrens-specialized.org/PtAccess. Ask one of our registration representatives for a code at your next visit or email us at PortalHelpDesk@childrens-specialized.org. Once you set up your account you can conveniently request prescription refills, pay your bill, set up your child’s next appointment and much more!

by Malia Beckwith, MD


April 20, 2017

Hi, my daughter was diagnosed with Holoprosencephaly. I was informed it is in the Cerebral Palsy family. What is the life span and outcome of this disorder? She cannot walk or talk. She also has seizures.

Expert's Answer:

Holoprosencephaly is a disorder that results from early abnormal development of the brain where the forebrain does not divide properly into two separate lobes. The severity of the deformity varies significantly from child to child. The life span and outcome of the disorder varies significantly and depends on the severity. In most cases, the babies do not survive to birth. With the least severe cases, the brain may be nearly normal and that individual may have a normal life expectancy.

Many children born with holoprosencephaly will have facial abnormalities involving the eyes, nose, and lip. Evaluation by a craniofacial specialist or team may be helpful. There may also be abnormalities in endocrine function so an evaluation by an endocrinologist may be necessary.

Much of the care for a child with holoprosencephaly involves providing the necessary support to allow her to maximize function and minimize deformity. An evaluation by a pediatric physiatrist would be helpful to thoroughly evaluate the degree of disability, guide therapy services (physical therapy/occupational therapy/speech therapy), and prescribe bracing and equipment to maximize mobility and ease of care, and treat movement disorders and abnormal tone. Optimizing seizure management by a neurologist specializing in epilepsy is also very important for your child’s health and development.

Children with holoprosencephaly will very often times have developmental delays and an evaluation by a neurodevelopmental pediatrician may be helpful in guiding therapy and school services. If your child is under three-years old, therapy services through the Early Intervention Program may be available.

Each child with holoprosencephaly is very unique and a comprehensive team of physicians and therapists can help children with this condition to reach her maximize potential. You can request an appointment online with a specialist here at Children’s Specialized Hospital or call 1-888-CHILDREN (244-5373).

by JenFu Cheng, MD


January 17, 2017

Where can we go or what shall we do to learn about proper holding techniques for a 15 year old with PDD?

Expert's Answer:

It sounds like you are seeking safe handling Applied Behavior Analysis (ABA) intervention. You can consult the Autism NJ website for a list of ABA providers and contact Perform Care (1-877-652-7624) for additional in-home behavioral support.

by Malia Beckwith, MD


January 09, 2017

Hello! My four year old son has been having behavioral issues for quite some time. We thought he would grow out of them, but they seem to be getting worse. He is very defiant against direction, won't listen when we try time outs, has sudden outbursts and will hit. He also won't sleep well- up very early in morning and will NOT go back to bed. We are very frustrated and at our wit's end (add exhausted to the list). I was recommended to reach out to you by his pediatrician. What type of doctor should i call to set up an appointment? I am just not sure if you deal with this? Thank you!

Expert's Answer:

You have come to the right place. I recommend that you obtain a Developmental and Behavioral Pediatrics Evaluation, as certainly more information and analysis is needed to determine the reason for these behaviors, and how to help them. Some common reasons for this kind of behavior include frustration due to limited communication skills (potential history of speech delay), attention seeking (behavior happens when your attention is directed elsewhere), task avoidance (behavior happens when demands are placed on him), or problems with self-regulation due to underlying developmental or behavioral disorder. While awaiting the Developmental Pediatrics Evaluation, I would also suggest seeking an evaluation with a Child Psychologist, who would provide behavioral therapy.

by Malia Beckwith, MD


January 03, 2017

My 7 year old has several "nervous ticks" which include nail-biting, fixing his hair, and leg-shaking. Most recently, he has has several behaviors that fall into the ADD/ADHD symptoms and that seem to be getting worse over time. Most notably, he has increasing difficulty remembering things, distraction, frequent daydreaming, struggle with following directions, trouble understanding consequences, excessive chatter, constant movement, frequent interruptions and he will act or speak without thinking. Notably, he has gotten to be more aggressive towards his brother. I don't want to medicate without a proper evaluation and diagnosis, but am afraid his pediatrician will be going that route to start. Would it make more sense to have my son evaluated by a psychologist, and avoid medications at this time? Would it make more sense to have him evaluated by a psychiatrist or neurologist instead?

Expert's Answer:

As you allude to in your question, obtaining a proper evaluation and diagnosis is essential before embarking on a plan of care. Working with your Pediatrician in obtaining the proper evaluations to rule out any specific medical conditions contributing to your child’s current symptoms and coordinating his ongoing care is important in developing an integrated treatment plan. A good place to start would be to have a psychological evaluation to assess for ADHD and any co-morbid conditions ( such as learning disabilities, anxiety and mood disorders). As part of the evaluation, information about home, school and social functioning (including screening questionnaires, rating scales or more specific testing) will be obtained with specific diagnoses and recommended treatment interventions. Depending on the results of this evaluation, recommendations including psychoeducation, school accommodations, therapy or referral to additional specialists such as Neurology, Psychiatry or a Behavioral Developmental pediatrician for further assessment or treatment may be made.

by Elvira Downs, MD


December 01, 2016

My 6 year old has had motor and some verbal tics for 2 years on and off. He is a very funny, smart, athletic boy who, as he gets older, is becoming more aware of these tics and is exhibiting some anxiety related to doing them in front of others. He has been teased by a classmate as well which has seemingly sparked his most recent verbal tics. We are not sure how to help him.

Expert's Answer:

Tics in fact are quite common in childhood. Tics are a Neuropsychiatric disorder that involves an irresistible urge that must be expressed motorically and/or verbally. While there is some ability to control the tics, urges can be quite persistent. As a first step it would be important to see a medical professional who specializes in tics/movement disorders (Neurologist/Psychiatrist) to obtain a definitive diagnosis and then outline a treatment plan which can include educational and therapeutic interventions and even pharmacological interventions depending on the severity and functional impairment.

Finding a therapist who is familiar with treating children with tic Disorders is important to help both you and your child by providing educational materials and teaching techniques to help the child control tics and/or anxiety which can exacerbate the tics. This would also help him in managing the issues with his peers. There are also educational materials for teachers and schools to use to educate peers in the classroom about the disorder. An important resource would be New Jersey Center for Tourette Syndrome for professional referrals for medical diagnosis, treatment and psychological services. A useful website is the American Academy of Child and Adolescent Psychiatry for additional information.

by Elvira Downs, MD


November 28, 2016

As a loving and concerned Mom of a vibrant 8- year-old boy, I have had my suspicions that he is suffering from ADD. However, for some time, I have tried to suppress this feeling, with hopes that I was wrong. His third grade teacher has expressed some concern that he may be suffering from a learning disability. I truly do not feel that he has a learning disability, but rather a lack of focus and inattentiveness that is hindering him succeeding in some of his studies. The teacher suggested that I have him tested in school to see if there is indeed a learning disability; however, I am hesitant to do this, as he is very conscious of being singled out. I am just looking to get to the root of his issue and help & support him in every way possible – all while NOT letting him know that there may be something wrong, or bringing unnecessary attention to him in school. Should I take him to see his pediatrician for diagnosis, or bring him to a specialist? And secondly, would one of your physicians be able to diagnose him with ADD, as well as determine if there is a learning disability?

Expert's Answer:

Unfortunately 3rd grade seems to be the year when many bright children with ADHD or a learning disability start to suffer academically. There are increasing expectations for self-organization from children during this grade, while the child also encounters increasing academic challenges. Attention deficit hyperactivity disorder- inattentive type (previously known as attention deficit disorder, or ADD) can be diagnosed by the general pediatrician if the pediatrician feels comfortable with their ability to make this diagnosis.

Many pediatricians will make the diagnosis of ADHD, and provide treatment through medication; however, some prefer the child be evaluated by a specialist, such as a developmental and behavioral pediatrician or a child neurologist. The diagnosis generally requires evidence of significant impairment in attention in at least 2 settings (home and school), resulting in performance deficits. I would suggest you start by speaking with your son’s pediatrician to determine next steps. The pediatrician may ask you to complete behavioral rating scales, and ask your son’s teacher to also complete these scales in order to help with the diagnosis.

Learning disabilities are a separate area of challenge, which may accompany ADHD. Examples include specific learning disorders, with deficits isolated to reading, written expression, or mathematics. The diagnosis of a learning disability requires completion of extensive cognitive and academic achievement testing. This type of evaluation is often completed by your School District’s Child Study Team, who will also determine through this process if your child qualifies for any special education services.

As you have long held concerns about the possibility of ADHD-inattentive type for your son, I would start with a medical evaluation to see if this diagnosis is appropriate. I recommend discussing with your pediatrician, to determine if referral to a specialist is needed. If so, our providers through CSH are able to make this diagnosis. If your son continues to struggle, despite his attention challenges being addressed, I would then encourage you to seek a Child Study Team evaluation through the District.

by Malia Beckwith, MD


October 10, 2016

My son was diagnosed with ADHD but I have concerns about him having Autism.

Expert's Answer:

The number of children with ADHD in individuals with autism spectrum disorder (ASD) is estimated to be 30 to 50 percent, depending on the study examined. Clinically, we do often see ADHD symptoms in individuals with ASD, but it is important to remember that the key feature of ASD is social impairment- which may be accompanied by in attention and hyperactivity.

In the situation presented, where there may be co-occurring disorders, I would suggest a multidisciplinary team evaluation. This team consists of a psychologist, developmental pediatrician, and therapy providers who work together to determine the most appropriate diagnosis of the child. This type of evaluation can be scheduled through Children's Specialized Hospital. If you are considering an autism-team evaluation for your son, call 1-888-CHILDREN, extension 2493.

by Malia Beckwith, MD


October 10, 2016

My son is 22 months old. He had an un-diagnosed Arachnoid cyst on his spine which caused loss of movement in his lower body. (C6/7 - T2). The cyst has been successfully removed and now nearly 7 weeks after the operation he is still in hospital in London, United Kingdom, unable to walk or sit up. My family would be extremely grateful if you could provide any information of any programs you may be able to offer us at your facility.

Expert's Answer:

Thank you for contacting us. It sounds as if your son would benefit from our inpatient Spinal Cord rehabilitation program, offered at our inpatient hospital in New Brunswick, NJ. The program at Children’s Specialized Hospital provides intensive and comprehensive rehabilitation services for infants, children, and adolescents with acquired, traumatic, and congenital spinal cord dysfunction. I encourage you to watch the spinal cord video in this video library to learn about our unique program and reach out to your son's current care team about his rehabilitative needs.

There are many challenges of caring for children from different countries. You can find more information about our admission process.

by Michele Fantasia, MD

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