Paul Beljan, PsyD, ABPdN, ABN - PowerPoint Presentation

1. Paul Beljan, PsyD, ABPdN, ABN9835 E. Bell Rd., Ste. 140Scottsdale, AZ  85260(602) 957-7600www.beljanpsych.comp.beljan@beljanpsych.comTwitter@BeljanPsychhttp://motorcognition2.com/ 9/21/2019Paul Beljan (602) 957-7600

2. 9/21/2019Paul Beljan (602) 957-7600

3. Bell Curve and IQCharacteristics of GiftedCommon DisordersCommon MisdiagnosesDiscrepancy Model and Learning DisabilityEasy Rule Outs What to do?9/21/2019Paul Beljan (602) 957-7600

4. Distribution of Intelligence Quotients9/21/2019Beljan Psychological Services (602) 957-7600

5. CHARACTERISTICS AND BEHAVIOR PATTERNS OF GIFTED THAT CAN LEAD TO MISDIAGNOSESAsynchronous Development Impatient with other people during periods of intense focus Neglects duties in favor of reading or interestsAdvanced and diverse interests (jumps from one to the next)Narrow interests (could be a lifetime focus ex. Light=Einstein)Reluctant to move to new activities-transitionsMakes jokes or puns at inappropriate times9/21/2019Beljan Psychological Services (602) 957-7600

6. CHARACTERISTICS AND BEHAVIOR PATTERNS OF GIFTED THAT CAN LEAD TO MISDIAGNOSESJudgment/awareness lags behind intellect/insightPoor handwritingLacks interest in details (ex. does math in mind)Turns in messy work (works too fast)Unusual sleep patternsPeer relation problems, unless with like intellectual peers9/21/2019Beljan Psychological Services (602) 957-7600

7. Emotional sensitivity and intensity (“over-excitabilities”)Strong-willed; power strugglesBoredom if educationally misplaced Resists routine/repetitive practiceCreative, non-traditional thinking styleFeeling on equal footing with adults9/21/2019Beljan Psychological Services (602) 957-7600CHARACTERISTICS AND BEHAVIOR PATTERNS OF GIFTED THAT CAN LEAD TO MISDIAGNOSES

8. CHARACTERISTICS AND BEHAVIOR PATTERNS OF GIFTED THAT CAN LEAD TO MISDIAGNOSESChallenging; non-conformist; disrupts status quoRefuses to accept authority; stubbornIdealism/fairnessImpatient with failures/disappointmentSelf-critical; perfectionism; unwillingness to take risksOversensitivity to criticism; may overreactEasily becomes angry or cries when things go wrong 9/21/2019Beljan Psychological Services (602) 957-7600

9. FREQUENT MISDIAGNOSES OF GIFTED CHILDREN Attention Deficit/Hyperactivity Disorder (ADHD)Oppositional Defiant Disorder (ODD)/Conduct DisorderLearning Disabilities (LD)Obsessive-Compulsive Disorder (OCD)Autism Spectrum Disorder (ASD)Major Depressive Disorder (MDD)Bi-polar DisorderDysthymic Disorder Narcissistic Personality DisorderAvoidant Personality DisorderIntermittent Explosive DisorderSchizoid Personality Disorder9/21/2019Beljan Psychological Services (602) 957-7600

10. DISORDERS THAT COMMONLY INVOLVE GIFTEDNESS (2e) Learning Disabilities (LD)Exec Function Based LD (PAC)Attention Deficit/Hyperactivity Disorder (ADHD)Asperger’s Disorder (AD)Allergies (particularly food)Reactive HypoglycemiaObsessive-Compulsive DisorderParent-Child Relationship ProblemsRelational Problems with peersDepression (existential)Sleep Issuesnightmaresleep terrorsleepwalking9/21/2019Beljan Psychological Services (602) 957-7600

11. Diagnosing 101: Rule out the easy stuffShort Term MemoryProcessing SpeedAuditory ProcessingSensory IntegrationOppositional DefiantSpectrum Disorder (Conspiracy)9/21/2019Paul Beljan (602) 957-7600

12. Base RatesClustering symptoms and factoring them against the age, gender, weight, SES, culture, etc., of the patient to quickly reduce many possible diagnoses down to a few likely diagnoses. 9/21/2019Paul Beljan (602) 957-7600

13. Short Term MemoryFirst, consider how significantly impaired a child would be if he/she had a short term memory deficit. Learning would be completely impaired. If a child never suffered had an inutero or birth injury, became asphyxiated, experienced a severe blow to the head, or had any other seizure or disease process involving the brain; then what would be the likelihood of them having a short term memory deficit? The answer is nearly zero. 9/21/2019Paul Beljan (602) 957-7600

14. Short Term MemoryIf children perform well on only one encoding task, they do not have a short term memory deficit; because how could a child do well on any task of encoding if they have a short term memory deficit? They could not.You cannot fake a skill if you do not have it. When this is determined, then I begin to look at what causes a child to seem like they have a short term memory deficit when in fact they do not. 9/21/2019Paul Beljan (602) 957-7600

15. Short Term MemoryOne must pay attention to information meant for encoding in order for that information to be encoded into short term memory.Gifted children are often bored in class or taken with their own entertaining thoughts. If information is not encoded then the result is a child who seems to have a short term memory problem, when the child actually was not listening or was distracted. Problem solved. 9/21/2019Paul Beljan (602) 957-7600

16. Processing Speed David Letterman “Top 10 List” “How do you know you have a dumb dog? There is a long delay between Bow and Wow.” 9/21/2019Paul Beljan (602) 957-7600

17. Processing SpeedThree tests on the Wechsler Intelligence Scale for Children- fourth edition (WISC IV) can rule out a speed deficit. Symbol Search CodingBlock Design9/21/2019Paul Beljan (602) 957-7600

18. Processing SpeedCompare the WISC IV SS and Cd tests to the BD test. Double checking work on SS and Cd causes the child to earn correct responses, but less of them, ultimately rendering a lower score. Gifted children frequently yield fast BD times (under 10 seconds) on the 45 second items and earn bonus points for fast completion on the more difficult 120 second items.Low scores on SS or Cd and high scores on BD rules out a cognitive speed deficit, and vice-versa. **recent TBI dx based on misinterpretation of SS and CD in forensic case9/21/2019Paul Beljan (602) 957-7600

19. Auditory ProcessingAPD is commonly questioned by parents of gifted children.APD has numerous definitions. Most consistently it means the physical elements of the outer and inner ear function, but the child has difficulty processing and making sense of how language sounds in their head. This seems more like a receptive language disorder than an audition issue. Could Be: Engrossed in their thoughts/activity = not listening9/21/2019Paul Beljan (602) 957-7600

20. Auditory ProcessingTrue APD is rare and impairing.I only see it co-morbidly with phonological processing deficit. Get an audiology evaluation in addition to neuro/speech-language evaluation.The child tries to identify a given sound while a competing sound is presented. In my experience, children with attention deficit have the same problem, but no one claims it is an APD. Attention deficit is a disorder of sustaining and prioritizing attention.9/21/2019Paul Beljan (602) 957-7600

21. Sensory IntegrationSensory Integration Disorder (SID):Think Asynchronous DevelopmentSID basically means the child’s sensory system is working well, but their frontal lobe (i.e., cerebellar-thalamocortical-basal ganglial-neostriatal-frontal circuitry) mediation of the sensory stimulus has not developed to the extent that it can be put in the background of experience. In other words, the child cannot yet inhibit/modulate sensory experience; it does not mean the sensory system is impaired (Koziol 2010 & 2011). 9/21/2019Paul Beljan (602) 957-7600

22. Sensory IntegrationWhy does treatment help?The sensory system is working well. Tx feels really good and the response is temporaryTx is external soothingThe px comes back fastThe px resolves with time and higher cortical development (i.e., inhibitory control)Bonus caveat: Ever meet an adult with SI?9/21/2019Paul Beljan (602) 957-7600

23. Oppositional Defiant DisorderODD is made, not born.Parent/Parents/Caretaker; home; food; warm bed; hugs and told, “I love you.”Does the dx exist across environments?School only? Home only? Socially only?9/21/2019Paul Beljan (602) 957-7600

24. Oppositional Defiant DisorderIs the child overly indulged for intellect?Negotiating? Arguing? Tantruming? Defying? “Why” before compliance?Has the child been assisted to develop a full identity that does not stand solely on intellect?They were born on the intellectual 3rd base; they did not hit a triple.Are inappropriate behaviors overlooked and justified as high intellect?Sports figure Narcissism9/21/2019Paul Beljan (602) 957-7600

25. Oppositional Defiant DisorderADHD children who are gifted cannot reliably and consistently express working memory, inhibition, and sustained attention for as long as they want and whenever they want, and their variable expression causes a ‘Swiss cheese’ effect in academic and behavioral performance. These children often are identified as willful or oppositional because when they are experiencing an ‘ADHD moment’ and their working memory, inhibition, and sustained attention is undermined, they cannot execute a previously expressed skills, and that looks willful.9/21/2019Paul Beljan (602) 957-7600

26. AUTISM SPECTRUM CONSPIRACYNo insurance support before 2003ishInsurance has to pay for ASD tx -2004ishWhy? Big pharma & lobbyistsASD tx is often drugsPsychiatry prescribes the drugsPsychiatry writes the DSMThe diagnostic bar is lowered FOLLOW THE MONEY9/21/2019Paul Beljan (602) 957-7600

27. LEARNING DISABILITIESWhy discrepancy model is wrongReading/Spelling (Dyslexia)Math (Dyscalculia)Hand Writing (Dysgraphia)9/21/2019Paul Beljan (602) 957-7600

28. The Discrepancy Model (DM)IQ is 22 points (1.5 standard deviations) above achievement scoresThe child functions two grade levels below placementLed to most children in USA not receiving specialized reading remediation until 3rd grade because you cannot get two grade levels below 1st or 2nd grade.Bush II era replaced PL 94-142 with IDEA, which rang in teaching to the AIMS test 9/21/2019Paul Beljan (602) 957-7600

29. The Precursor: What Must Be Known Before Advocacy Begins9/21/2019Paul Beljan (602) 957-7600

30. How do you know who to see?Ask yourself: What is the origin of the problem?Medical Brain BasedLearning BasedEmotional BasedTrauma Based9/21/2019Paul Beljan (602) 957-7600

31. How do you know who to see?Rule out everything medical firstMany medical disorders mask as psychological issuesThyroidBladder InfectionAllergies/Food SensitivitiesLow vitamin and amino acid levelsGenetic syndromes9/21/2019Paul Beljan (602) 957-7600

32. When the only solution in the toolbox is a hammer, then every problem looks like a nailPsychiatryDevelopmental understanding of children?Arranging carsPouring waterTantrum BxToe walking; flapping; eye contact (shy vs gaze avoidant)DistractibilityHyperkinesis 9/21/2019Paul Beljan (602) 957-7600

33. How do you know who to see?A neuropsychological Assessment accounts for everythingDevelopmentIQAcademic Achievement Attention/Executive FunctionLearning and MemorySpeech/LanguageSensory Motor/Visual SpatialSpectrum – one swallow does not make a summer9/21/2019Paul Beljan (602) 957-7600

34. How do you know who to see?Rule out everything psychological Emotional/Family/Social/TraumaAsynchronous DevelopmentIntensityInnate anxiety/depression/OCDToxic living environmentExperiencing/witnessing a traumatic eventIncongruent fit between intellect and school environmentBullying Undiagnosed giftedness or learning disorder9/21/2019Paul Beljan (602) 957-7600

35. Finding the appropriate professionalWhat is their training/knowledge base in gifted?If they are neuropsych: What was their training in neuro and gifted?APA InternshipAPPIC Post-doc in neuro (at least one full year)If they are medical: Do they acknowledge gifted?9/21/2019Paul Beljan (602) 957-7600

36. Professional CivilityWill they give you 10 min to interview them: free?Will they take a short phone call at times: free?Do they bill you for a fax or a short letter?Are they more about money than your child?Do they call you back within 24 hours?9/21/2019Paul Beljan (602) 957-7600

37. When Disorders are NOT Disorders:A pediatric neuropsychologist looks at all elements of functioning as opposed to individuals who specialize in one area and tend to only look for and find issues within their wheelhouse of knowledge. It takes a whole brain to function, so the whole brain should be evaluated to rule out erroneous diagnoses. 9/21/2019Paul Beljan (602) 957-7600

38. Learning Disabilities are Brain Based DisordersThe neuropsychology of LD it too vast and complex for this discussion; suffice it to say the following:To execute skills and tasks the brain functions in a multimodal manner that is highly interdependent upon the interactions between the micro-systems of neurochemicals and neurons to pathways, and the macro-systems of the limbic system, white matter, grey matter (higher cortical processing), and the cerebellum.135 iq with 100 Achievement scores = LD, but the gifted child will not receive services.9/21/2019Paul Beljan (602) 957-7600

39. When Disorders are NOT Disorders:Katz, J., et al. Handbook of Clinical Audiology Sixth Ed. Lippincott Williams & Wilkins, 2009. Green P., Josey, F. The Use of an Earplug to Increase Speech Comprehension In a Subgroup of Children with Learning Disabilities: An Experimental Treatment. Applied Neuropsychology. 2002, Vol. 9, No. 1, 13–22. Koziol LF, Budding DE, Chidekel D. Sensory Integration, Sensory Processing, and Sensory Modulation Disorders: Putative Functional Neuroanatomic Underpinnings. The Cerebellum 2011 Dec; 10(4):770-92.9/21/2019Paul Beljan (602) 957-7600

40. When Disorders are NOT Disorders:Koziol LF, Budding DE, Chidekel D. Adaptation, Expertise, and Giftedness: Towards an Understanding of Cortical, Subcortical, and Cerebellar Network Contributions. The Cerebellum 2010 Dec; 9(4):499-529.Goldberg, E. The Executive Brain: Frontal Lobes and the Civilized Mind. Oxford Press, 2001.9/21/2019Paul Beljan (602) 957-7600

41. Paul Beljan, PsyD, ABPdN, ABN9835 E. Bell Rd., Ste. 140Scottsdale, AZ  85260(602) 957-7600www.beljanpsych.comp.beljan@beljanpsych.comTwitter@BeljanPsychhttp://motorcognition2.com/ 9/21/2019Paul Beljan (602) 957-7600