Title: Do children with LD and/or ADHD differ at baseline on a pediatric measure used to assess concussion? Authors: Sarah Friedman, PsyD. Sports Concussion Center of New Jersey, Princeton, NJ Rosemarie Scolaro Moser, PhD. Sports Concussion Center of New Jersey, Princeton, NJ Philip Schatz, PhD. Saint Joseph’s University, Philadelphia, PA Purpose: To examine differences at baseline between children with ADHD and/or LD vs. children with neither ADHD/LD on 1) neurocognitive scores and 2) child- and parent-reported concussion symptoms. Methods: Retrospective data was obtained for 1856 children ages 5-11 who were assessed at baseline using ImPACT Pediatric. Groups were determined based on parent-reported diagnosis of their child at baseline (ADHD and/or LD vs. neither ADHD/LD), and groups were compared on the four factor scores: Sequential Memory, Word Memory, Visual Memory, and Rapid Processing and on parent- and child-reported concussion symptoms using a series of ANOVAs. Results: ANOVAs revealed that children with ADHD/LD performed significantly worse than children without ADHD/LD on Sequential Memory [F(1,1845) = 69.86, p<.001)] and Word Memory [F(1,1853)=10.36, p=.001)]. In contrast, children with ADHD and/or LD performed significantly better on the neurocognitive measures of Visual Memory [(F(1,1845)=4.94, p=.026)] and Rapid Processing [(F(1,1853)=20.35, p<.001). Symptom reporting was significantly greater in the ADHD/LD group for both child (F(1,1853)=30.21, p<.001) and parent (F(1,1853)=34.64, p<.001) reported symptoms. Conclusions: The current study demonstrated differences at baseline in children on neurocognitive performance and concussion symptom reporting based on diagnostic group. Analysis of symptom reporting suggested that children with pre-exiting diagnoses of ADHD and/or LD and their parents may report concussion-like symptoms at baseline, prior to ever experiencing a concussion. This finding reveals clinical implications for interpretation of post-concussion symptoms without a baseline comparison in children with pre-existing diagnoses such as ADHD and/or LD.

Dr. Moser presented research on Gender Differences in Ice Hockey Related Concussions at the ASTM 6th Annual International Symposium on Safety in Ice Hockey in Denver, May 13, 2019.

Raeding Disrodurs: Recognize the Signs We’re Back to School and most parents are happy their lives are returning to a more predictable routine. While homework assignments start to pile up, learning glitches may begin to surface. As students progress through school, reading skills become pivotal to learning new information. Often parents are not aware their child is experiencing a Reading Disorder, sometimes called a Reading Disability. If a child is bright, she or he may be able to compensate or “get by” in the earlier grades by spending extra time studying and working harder than classmates. However, as they get older, the reading demands grow. They can no longer keep up and their grades slip. Parents may think their child is just not working hard enough, or worse yet, is “lazy.” These students can lose interest in school, experience low self-confidence, lack motivation, and dislike reading for “fun.” In 2014, New Jersey adopted the NJ Dyslexia Legislation for the identification and improvement of reading skills in youth, with a specific focus on dyslexia. Dyslexia is a type of reading disorder that can result in difficulties with letter and word reversals, learning sight words, blending letters to make sounds, and sounding out words. In New Jersey schools, dyslexia falls under the category of “Specific Learning Disability,” which allows students to receive reading assistance, such as in the form of a structured literacy program. Such programs include teaching the basic units of sounds called phonemes and learning to join them to form words. Dyslexia may be identified in the early school years when young students experience difficulty with basic reading skills. But, not all students with reading problems experience problems learning to read words. Instead, some students show strengths in basic word reading, sounding out words, and reading aloud. Their difficulties are centered around not understanding what they read and/or being unable to read at a reasonable pace. Their challenges are in reading comprehension, fluency, and speed. Because of their intact basic reading skills, they may not be identified as having reading problems until the later school years. Parents should recognize possible signs of a reading disorder: below average reading level, difficulty recognizing words, avoidance of reading, declining grades, starting, stopping, and pausing frequently when reading aloud, difficulty completing homework and tests, and dislike of school. Early identification of a reading disorder is key to preserving a student’s positive attitude about learning and about herself/himself. If you suspect your child may have a reading problem, notify your child’s teacher and pediatrician, and seek a comprehensive educational evaluation by a qualified licensed or certified professional who specializes in learning and reading disorders. By Rosemarie Scolaro Moser, PhD, ABN, ABPP-RP, neuropsychologist/school psychologist, and director of RSM Psychology Center, LLC in Princeton.

New research authored by Drs. Moser and Schatz will be featured in the journal, Developmental Neuropsychology, entitled: “A Cross-Cultural Examination of Parental Knowledge of Concussion in Sicily, Italy” http://dx.doi.org/10.1080/87565641.2020.1789644.

COVID-19 Brain Effects With over a year of pandemic behind us, medical researchers are recognizing that COVID-19 infection affects the brain and may lead to pathological changes in brain physiology. Health care clinicians are documenting that many “recovered” patients are now complaining of persistent neuropsychological symptoms or “brain fog.” These neuropsychological symptoms fall into two domains: cognitive and emotional. Cognitive symptoms can include problems with attention/concentration, memory, processing speed, and executive functions, such as decision-making, problem-solving, planning, reasoning, inhibiting impulses, and multi-tasking. Emotional symptoms may include anxiety, depression, post-traumatic stress, and paranoia. Recent research has shown a variety of brain abnormalities due to the viral infection.1 Hypoperfusion, or reduced blood flow, has been observed in the frontal region of the brain, which regulates executive functions. Structural abnormalities have been seen in the temporal brain region, which is often referred to as “the seat of memory.” Also, demyelination, or erosion of the fatty coating that covers the nerves, may be the cause of slowed information processing speed. Source: Princeton Magazine. Read More...

Our Staff presented original research at the SNS 2023 Symposium in Denver, entitled “Criteria Determining Clinical Recovery From Concussion.”

Our Staff presented research on Clinical Recovery Decisions in Concussion at the BIANJ Annual Conference 2023.

Dr. Philip Schatz, Director of Research, presented our new research about clinical decision-making in concussion recovery at the Concussion In Sport Group International Conference in Amsterdam in October, 2022.

Established in 2012, the Sports Neuropsychology Society (SNS) is a non-profit organization of professional sports neuropsychologists, allied health care providers, trainees, and other colleagues interested in the brain health of athletes. Our professional membership includes neuropsychologists who are active in concussion management, as well as in how brain function relates to emotional, physical, and cognitive well-being. Our Society promotes evidence-based clinical practice, advances in research, professional training, educational resources, and advocacy for the benefit of amateur and professional athletes. We connect athletes of all ages and the public to sports neuropsychologists.

Established in 2012, the Sports Neuropsychology Society (SNS) is a non-profit organization of professional sports neuropsychologists, allied health care providers, trainees, and other colleagues interested in the brain health of athletes. Our professional membership includes neuropsychologists who are active in concussion management, as well as in how brain function relates to emotional, physical, and cognitive well-being. Our Society promotes evidence-based clinical practice, advances in research, professional training, educational resources, and advocacy for the benefit of amateur and professional athletes. We connect athletes of all ages and the public to sports neuropsychologists. For more information: www.sportsneuropsychologysociety.com

Paying Attention to Attention By Drs. Rosemarie Scolaro Moser, Sarah Friedman & Christina Zebrowski Back to school time, that time of year when both youth and adults must bid a temporary farewell to vacation mode and attend to the business of school and work. For some, the transition is an easy one. For others, problems with rallying our attention make the transition difficult. We all experience occasions when our minds wander, or when we miss the details of conversations because we are preoccupied. At these times, our attention is interrupted by distractions. For some, this distractibility or loss of focus is frequent, persistent, and longstanding since childhood, disrupting normal daily activities. It can hamper our academic achievement and professional performance, place stress on relationships and jobs, and make the back to school transition agonizing both for students and parents. ADHD Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder, or pattern of brain functioning characterized by inattention, distractibility, and, in some cases, hyperactivity. Individuals identified with ADHD typically fall into one of three categories: Inattentive, Hyperactive/ Impulsive, or Combined. Inattentive ADHD is characterized by a failure to give close attention to details, to engage in active listening, or to see a task through to completion. Individuals often have trouble organizing tasks and activities, are forgetful, and are easily distracted. Hyperactive/ Impulsive ADHD is characterized by fidgetiness, chattiness, restlessness, difficulty remaining seated, and risk-taking. Combined ADHD is characterized by symptoms of inattention as well as hyperactivity and impulsivity. It is estimated that ADHD occurs in approximately 5 to 8 percent of the population. It is more frequently diagnosed in males than females, perhaps because males display more of the hyperactive symptoms that are easily identified. ADHD is not a modern disorder. Many believe that historical figures such as Pablo Picasso, Thomas Edison, Albert Einstein, and John F. Kennedy may have coped with ADHD, which has also been associated with creativity, spontaneity, innovation, and energetic qualities. Celebrities and contemporary figures such as Terry Bradshaw, James Carville, Justin Timberlake, Henry Winkler, Jim Carrey, Michael Phelps, and Adam Levine have also been identified with ADHD. ATTENTION BASICS Attention, the first step in capturing new information, is critical to learning and memory. With a lack of attention, new information cannot be stored in memory, and cannot be retrieved as needed. In this case, the problem is not with memory (or storage) per se, but poor initial attention (or encoding). There are also different types of attention depending on which body sense is registering the new information: visual (sight), auditory (hearing/listening), tactile (touch), olfactory (smell), and gustatory (taste). Attention concerns are usually associated with problems in visual and auditory attention. To help improve attention while studying: Remove games, electronics, and non-homework related materials from the desk. Be sure the desk is fully organized with all necessary work materials, before sitting down to study. Use of external organization aids such as calendars, whiteboards, bins, and colored folders may help to support organization. Use a white noise machine, electric fan, or soft classical music in the background to drown out distracting noises, voices, and conversations that may disrupt attention and focus. Noise canceling headphones may also be helpful. Program a timer or alarm to sound every 5 to 10 minutes to minimize daydreaming, check on wandering focus, and provide designated break times to reset focus on the task. Attention is highly influenced by the value of the stimulus. It is far easier to attend to information that is considered to be very important or very interesting. A student who is passionate about video games may be able to focus on them for hours at a time, yet be unable to focus on his or her teacher for five minutes in the classroom when the educational material seems monotonous, repetitious, or uninteresting. ACCURATE DIAGNOSIS AND TREATMENT ARE ESSENTIAL ADHD can often be misdiagnosed. Proper diagnosis is imperative in order to effectively treat and manage the symptoms of ADHD. Symptoms of attention difficulties are found in a wide array of disorders and diseases other than ADHD, which may include but are not limited to: hearing loss, depression, anxiety, stress, behavior disorder, brain impairment, concussion, dementia, autism, seizures, auditory processing difficulties, emotional trauma, learning and memory disorders, chronic sleep deprivation, and even normal aging. As an example of the serious implications of misdiagnosis, a student who appears inattentive, due to an undiagnosed auditory processing disorder, may be incorrectly prescribed ADHD stimulant medications. In order to most accurately diagnose ADHD, a clinical interview and completion of self- report checklists are not enough. It is important to conduct a comprehensive evaluation, which includes a broad range of neuropsychological tests that measure various aspects of attention, and assist in ruling out other potential causes. Based on the findings of testing, a tailored treatment plan can be developed to address the individual’s areas of functioning that are most affected by ADHD. Depending on the age and life stage of the individual, recommendations may include academic accommodations for school and for standardized testing, work accommodations, skill training, coaching, psychotherapy, behavior therapy, and mindfulness training. A medical-psychiatric consultation for possible pharmaceutical therapy may be considered and, in many cases, may be helpful. In addition, an ADHD academic or life coach can be instrumental in teaching compensatory strategies to manage distractibility, motivation, procrastination, and organizational difficulties. Director Rosemarie Scolaro Moser, PhD, right; Sarah Friedman, PsyD, left; and Christina Zebrowski, PsyD provide neuropsychological testing, psychotherapy, and academic coaching services at the RSM Psychology Center in Princeton. Source: https://issuu.com/witherspoonmediagroup/docs/princeton_magazine_september_2019_digital_issue_

The National Register of Health Service Psychologists is proud to present the 2020 Alfred M. Wellner Lifetime Achievement Award for Clinical Excellence to Rosemarie Scolaro Moser, PhD, ABPP-RP, ABN, of the RSM Psychology Center and the Sports Concussion Center of New Jersey. This award is named in honor of the National Register’s first Executive Officer, Alfred M. Wellner, PhD, and is the highest honor bestowed on a Registrant by the National Register to commemorate numerous, significant contributions to psychology during a distinguished career. The National Register’s Awards Committee selected Dr. Moser for the Wellner Award for Clinical Excellence based on her numerous professional accomplishments and pioneering work in the field of sport neuropsychology. Among these many accomplishments, Dr. Moser created one of the premier sport concussion programs for youth in New Jersey. She has authored landmark papers and several widely cited works on concussions and mild traumatic brain sport injuries. Upon receiving the award, Dr. Moser said, “It is such a humbling experience to be recognized by my colleagues and peers and to be chosen by the National Register of Health Service Psychologists for the Alfred M. Wellner, PhD, Lifetime Achievement Award. I am truly grateful to all the patients whom I have served over the years. They have been the source and inspiration for my commitment to a clinical practice embedded in a foundation of original research, public education, and advocacy.” Dr. Moser is the Director of the RSM Psychology Center and the Sports Concussion Center of New Jersey. She received her Ph.D. in Professional Psychology, from the University of Pennsylvania and is a board-certified neuropsychologist and rehabilitation psychologist and certified school psychologist. Her publications have covered the topics of learning and memory disorders, concussion, brain injury, Alzheimer’s Disease, post-traumatic stress, psychotherapy, personality, violence, parenting techniques, alcohol/substance abuse, medical illnesses, and practice ethics. She is internationally recognized for her work in sports concussion and is the author of the highly acclaimed Ahead of the Game: The Parents’ Guide to Youth Sports Concussion (Dartmouth College Press). She has served as a scientific expert and co-author for the U.S. Centers for Disease Control and Prevention's (CDC-P) Pediatric Mild Traumatic Brain Injury Workgroup Guidelines, and as a subject matter expert and systematic review co-author for the 2017 International Consensus Conference in Sport (CIS)-Berlin and for the upcoming 2021 CIS-Paris guidelines. She has been awarded the American Psychological Association Presidential Award for Advocacy in Psychology (Karl Heiser Award), the Sports Neuropsychology Society Distinguished Career Award, and the Brain Injury Alliance of New Jersey Jill Shulman Community Pillar Award. Dr. Moser has also held leadership positions in multiple societies and associations throughout her career, is currently the president-elect of the Sports Neuropsychology Society, and has been featured in popular national media for her work. Dr. Moser has been credentialed by the National Register since 1994. This announcement will also be featured in the National Register’s Journal of Health Service Psychology. About the National Register of Health Service Psychologists The National Register of Health Service Psychologists was established in 1974 and is the largest credentialing organization for psychologists and psychology doctoral students. We are an independent nonprofit organization dedicated to improving healthcare by identifying psychologists who meet specific education and training standards, and by verifying these professionals to consumers, healthcare organizations, and regulatory bodies. The National Register currently credentials 10,000 Health Service Psychologists and has approximately 3,500 psychology doctoral student and postdoctoral trainee members of its Associate Program. For more information, visit www.nationalregister.org. For more information about this announcement, contact the National Register at 202.783.7663.