A Neuropsychiatric approach should be considered when a child or adolescent has had a series of treatment failures. It can also be considered as a child’s first placement if there are indicators of a possible brain disorder. The following checklist may be helpful in screening for a brain disorder.
Brain Disorder Indicators:
“Neurobehavioral” refers to the type of behavioral problems that are associated with brain disorders. It is a term frequently used to describe the serious behavioral problems often seen after traumatic brain injury. For example, explosive rage behavior, impulse control problems, mood swings and poor judgment are neurobehavioral problems. We also use the term “Neuropsychiatric” to refer to the same behaviors. Both of these terms apply to developmental brain problems that are the result of fetal exposure to drugs or alcohol (e.g., fetal alcohol syndrome, etc.), or other early brain impairments such as anoxia at birth or shaken child syndrome. When these brain impaired children become adolescents, they sometimes display the same neurobehavioral problems seen in traumatic brain injury cases, including violent temper and very poor impulse control. Unfortunately, traditional psychiatric treatment has been ineffective with these neurobehavioral disorders. The brain problem is a barrier to successful counseling, and typical psychiatric medicines are of limited benefit.
First of all, it is based on a thorough assessment of the brain function as well as psychosocial issues. Many of these children have language or memory disorders that prevent verbal psychotherapy from being effective. Some of these children have partial complex seizure disorders and other treatable brain conditions. By treating those correctable brain disorders and then using modified methods of therapy (e.g., non-verbal therapy to bypass language and memory problems), it is possible to more effectively manage the violent behavior and allow for a re-socialization process to take place. If the individual’s actions present a danger to himself/herself and others, or if symptoms are severe, treatment in a Neurobehavioral inpatient unit is recommended. Once stable and manageable, the juvenile is ready for discharge to a structured aftercare plan.
In cases where the patient is impulsively aggressive but not highly dangerous, outpatient assessments are available through Neurobehavioral Systems. Outpatient assessments are possible for children from age 6 and up, and also for adults. Outpatient assessments are also available for attention, learning, language and neurobehavioral disorders. Electrophysiological (EEG and evoked potentials) studies assist in determining appropriate medication to treat the area of the brain affected. This increases the probability of successful treatment on an outpatient basis.
The term “EEG” stands for Electroencephalogram. The EEG is a medical test that measures the electrical activity of the brain and, among other things, is used for the diagnosis of epilepsy. Electrodes are placed on the scalp to pick up the electrical activity that is occurring in the brain. It is a non-invasive test that is used when a doctor suspects that an episodic behavior is being caused by an electrical disorder in the brain. Episodic staring spells, shaking of the body, fainting spells or convulsive seizures are common behaviors that may be symptoms of electrical problems in the brain. However, there are other episodic behaviors that may lead a doctor to order an EEG for a patient. These may include some psychiatric symptoms such as poor emotional control or sudden onset of a loss of impulse control. For example, rapid mood swings or repetitive episodes of explosive aggression (against self, others or property) can sometimes be associated with brain electrical disorders. The doctor may order an EEG test.
We recommend a qEEG (Quantitative EEG) because it includes evoked potentials. The evoked potentials provide the critical information our Pediatric Neurologist uses to determine the source of brain electrical abnormalities.
Two common types of evoked potentials are Auditory Evoked Responses (AER) and Visual Evoked Responses (VER). Evoked response measurement is similar to an EEG, using the same electrodes on the scalp, the same EEG machine, and a similar measurement of the electrical activity of the brain. However, whereas the EEG measures the ongoing electrical activity of the brain, the Evoked Response (as the name implies) measures the electrical response evoked (stimulated) in the brain by either auditory (AER) or visual (VER) stimulation. For example, for the AER, the patient is presented with a “click” from a headphone (many times) and the EEG machine measures the brain’s electrical reaction evoked by that sound. For the VER, a flash of light is used instead of a sound. The advantage of this “evoked” response, for psychiatric conditions, is that it allows the doctor to see if there is any electrical abnormality deep inside the brain. Deep electrical disorders are important because the brain’s systems for controlling both emotions and impulses are located deep in the brain (in the Limbic region). Electrical disorders in this deep region can result in poor emotional control and/or poor impulse control. Abnormal findings indicate that medications to treat the source of the problem behavior can be prescribed.
In our brains there are several primitive structures that give us important abilities that are needed for the survival of the species. The “limbic system” is that group of brain structures devoted to the ability to fight or run away in an emergency. The limbic system also helps us to remember events that caused strong emotions.
Deep within the center of our advanced “thinking brain” (cerebral hemispheres), there is a primitive “emotion brain” (limbic system). The limbic system consists of several structures, including the amygdala (sometimes called the rage center), and the hippocampus (an important part of our memory system).
If someone were to be attacked, the limbic system would first produce fear and then perhaps rage. The fear would energize the body to help you to run away, if possible. If not, your limbic system might trigger a rage, which would prepare the body to fight in a ferocious manner, to protect yourself or your loved ones. Picture a mother bear protecting her cubs from a predator, and you will get the idea.
Since this is our “emotional brain”, it is vulnerable to disorders in brain chemistry and in brain electrical activity. Some disorders run in families and are genetic in origin, while others are acquired by developmental brain damage (e.g.; drugs or alcohol used during pregnancy, or a difficult birth). A disorder in the “emotion brain” can produce emotions that are out-of-control. Extreme acts of violence, suicidal behavior, agitation, and mood swings can be due to disorders of this brain system.
Neurobehavioral Systems specializes in the assessment and treatment of neuropsychiatric brain disorders in children and teens. If you know a young person struggling with impulsive aggression and has had difficulty with treatment in the past, Neurobehavioral Systems may be able to help. Call 800-272-4641 today to inquire about an assessment and treatment.