Step One – Comprehensive Diagnostic Evaluation
During the evaluation process, Dr. Stern obtains a full history to understand the goals of therapy, and to evaluate if the presenting symptoms indicate the presence of a disorder. We begin by interviewing (often separately and together) the child and parents, and on based situations, gather information from a variety of other sources including teachers, previous therapists and pediatricians. After the evaluation is completed, Dr. Stern discusses treatment recommendations.
Step Two – Treatment
Cognitive Behavior Therapy (CBT), Exposure and Response Prevention (ERP) therapy, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Dialectical Behavioral Therapy can successfully address a wide variety of problems:
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Parent Management Training (PMT) and Cognitive Behavioral Therapy are effective in addressing behavioral issues in children from age two through adolescence. Parent Management Training (PMT)- skills are taught and modeled by the therapist, and parents are equipped with information and skills to increase confidence and self-sufficiency in setting limits and managing the behavior of their child or teen. Likewise, children gain skill in controlling their own behavior and meeting parents’ expectations. Cognitive Behavioral Therapy (CBT)- As children with attention or behavior difficulties grow, these symptoms can often become intertwined with academic failure, learning problems, organizational skills difficulties, family conflict or other psychiatric issues. Dr. Stern uses cognitive-behavioral and problem-solving interventions to work with younger children, older children and teenagers to increase their awareness of and ability to manage their symptoms, also improving their interactions with parents, peers, and teachers.
Problems in school are common for children and adolescents with ADHD and behavior disorders. Dr. Stern partners with educators to find strategies and tactics that work in the classroom — making the learning environment better for everyone.
Commonly provided school-based interventions include:
- Observation and assessment of behavioral issues in the school setting
- Consultation with school staff regarding implementation of interventions related to behavior, social skills, or anger management
- Workshops with school staff on evidence-based strategies for behavior management and promoting improved academic functioning
- Help with implementation of IEP behavior plans, daily report cards, and other classroom accommodations
- Tailoring of individualized student behavior plans to maximize effectiveness
General Anxiety Disorder/ Social Anxiety/Obsessive-Compulsive Disorder/Phobias/separation anxiety disorder/ panic disorder
One of the most important Cognitive Behavioral techniques for children with anxiety is called exposure and response prevention. During this treatment your child’s clinician will expose her to something that triggers her anxiety in structured, incremental steps, and in a safe setting. As your child becomes accustomed to each of the triggers in turn, his anxiety fades, and he is ready to take on increasingly powerful ones. Exposure and response prevention is well-researched, gentle and effective at treating anxiety disorders. Another core component of CBT is cognitive therapy, which helps kids learn to recognize when their thinking is irrational and then to create more logical versions of those thoughts. If we can change the way kids think, we can help them change the way they feel.
Cognitive Behavioral Therapy (CBT) is the most widely researched form of therapy for mood disorders, including depression and bipolar disorder. With CBT, children, adolescents and young adults learn about the connections among their thoughts, feelings and behaviors. Once these connections are made, patients and therapists actively collaborate to meet specific goals, such as helping patients notice and change their unhelpful thoughts, improving their problem-solving abilities and increasing their involvement in positive activities that promote healthy choices. Treatment may also include Behavioral Activation — planned activities aimed at promoting increased mood and energy level.
TF-CBT is provided to assist the child or adolescent in developing coping strategies for traumatic stress reactions. To reduce symptoms of depression, anxiety, or acting out behaviors which are common in children exposed to trauma. This is a cognitive behavioral, directive approach to counseling: TF-CBT components are necessary but the structure and the activities are flexible. The components include: Psychoeducation: learning about trauma and its effects
Parenting skills: for dealing with behaviors; Relaxation and coping skills; Affect regulation: working to identify and express emotions in a healthy way; Cognitive coping: learning how thoughts, feelings, and behaviors are interrelated; learning how to make healthy choices; Trauma narrative: telling their story to promote healing and growth; In vivo exposure: gradually increasing the ability to cope with anxiety caused by triggers and reminders of the trauma; Conjoint parent-child sessions: working to improve communication and attachment; Enhancing safety: children exposed to one trauma need to learn how to protect themselves from ongoing trauma; Helping the child to recognize dangers and identify ways to keep themselves safe.
In CBT, the therapist helps the client to identify and understand the anger triggers, appraisals, behavioral responses, and outcome. Using an analysis of thoughts, emotions, and behaviors leading up to an anger episode, the client gains insight into the anger response and develops individualized anger-reduction strategies. They will learn to self-monitor: detecting thoughts and arousal that predict anger and recognizing situational cues that can elicit anger. The goals of CBT interventions are to enhance self-awareness and acceptance, reduce avoidance, and identify and challenge maladaptive assumptions and beliefs. Cognitive restructuring and problem-solving interventions are used with relaxation techniques for coping with elevated emotional and physiological arousal. Behavioral interventions identify dysfunctional angry behaviors and train the patient in conflict-management skills, leading to increases in self-efficacy. Meta-analyses have shown that CBT treatment is efficacious in treating anger and has the largest effect of any psychotherapy.
Dr. Stern implements Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) for adolescents and young adults who have difficulty regulating their emotions. Therapy involves learning skills to tolerate distress, manage strong and upsetting emotions, decrease impulsive behaviors, including self-harm, and improve relationships with friends and family.
Individuals with difficulties regulating their emotions are often sensitive to emotional triggers in their environment, react intensely to those triggers, and then have trouble getting back to their baseline emotional state. To further complicate matters, these individuals may also have difficulty accurately identifying their emotions, completing tasks when upset, and tolerating distressful emotions in an effective manner. These difficulties in emotion regulation are sometimes referred to as emotion dysregulation. Treatment focuses on teaching these skills by accurately identifying these emotions as they are happening, learning how to tolerate emotions, learning how to change emotions, and developing the ability to be less vulnerable to emotional cues in the environment.
Dr. Stern helps his clients to develop their social competencies to better connect with others and live happier, more meaningful lives. He create unique treatment frameworks and strategies to help individuals meet their personal social goals. These goals often include sharing space effectively with others, learning to work as part of a team, and developing relationships of all kinds: with family, friends, classmates, and co-workers.