Neuropsychological Evaluations

Aug 18, 2017

I recently received an email from a parent about getting a neuropsych. for her daughter. I thought it was important enough to post as a blog entry, not just respond to her directly. So here's my 2 cents...

A comprehensive neuropsychological evaluation is not the only way, and generally not the best way to diagnose ADHD. The "gold standard" for diagnosis of ADHD is an in depth clinical assessment by a qualified MD or PhD. For kids this involves a thorough history, evaluation scales, parent surveys, and often teacher surveys. 

I rarely recommend a neuropsych. for adults. I very often recommend them for kids though, especially in cases where it is important to ascertain whether or not the child is dealing with comorbidities. 80% of ADHDers have at least one co-occurring condition. However, there can be as much as a 30% false negative for attentional issues because the test is delivered one on one in an environment that is designed to be minimally distracting. Also, particularly bright kids will often not fully demonstrate their weaknesses in such on such a test because their intelligence compensates in some ways. And, there always is the issue of whether the test administer/evaluator is adept enough to see more subtle deviations from the norm. Plus they are really expensive and very often not covered by insurance. 

So, if you are primarily concerned with ADHD and there doesn't seem to be any other issues, seeing a competent clinician for an evaluation and (potentially) medication treatment is probably the best place to start. If medication gets complicated, the symptoms aren't adequately addressed, or the clinician thinks there may more going on, that would be the time to seek further testing. Or, if the school system demands it in order to allow accommodations. Though, then you can usually get them to administer and pay for it. But, you have to be careful about how good their people are. 


Standard Disclaimer:  In an effort to foil my own perfectionist tendencies, I do not edit my posts much… if at all. Please excuse and typos, mistakes, grammatical errors, or awkward phrasing. I focus on getting my content down. An imperfect post completed is better than a perfect post that goes unposted.



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Quick Calendar Keeping Trick

Aug 11, 2017

Just a quick note this week. 

I've had many clients recently have scheduling SNAFU's because they put an event on their digital calendar (on their phone) but accidentally put it on the wrong week. The advantages to keeping your calendar digitally are numerous and worthwhile. However, there is a very real hurdle that everything looks exactly the same. Next week looks like next month, which looks like next year. Most apps will reopen the calendar exactly where it was when you closed it. But wherever you are looks just like this week.

For example, I have one doctor who I see for a follow up once a year. So, when I saw her a few weeks ago, I put next year's appointment into my phone calendar. Then I switched out of my calendar app. So next time I opened the app, I was in August of 2018... I have screwed up my calendar because of this in the past. I accidentally kept adding events to the next year. 

My tip is to get in the habit of always hitting the "Today" button on your calendar app to bring you back to this week before flipping to whenever you want to make a new appointment.
Quick Calendar Keeping Trick

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Mise en Place - (Food Prep #4)

Aug 4, 2017

My career as a professional chef and my education at the Culinary Institute of America was crucial to my achieving the level of organization that I have now. In fact there is a single phrase that encompases the all facets of organization in the kitchen that I thought it was worth sharing while doing this summer series about kitchen organization and food prep. 

That phase is Mise en Place. Roughly, it translates from French as "everything in it's place." Believe it or not, this is actually the motto of my alma mater. That's how important it is to the method and madness of a good chef. Practically, it means that you need to have everything set up and planned before you start cooking. Otherwise chaos (more than is necessary) likely will ensue. 

Of course as a trained chef I can sometimes overlap preparation with production. I can start sauteing the veggies while I prepare the meat for a stew. But, the reality is that the ability to do that effectively has come from years of practice and mastering the timing of cooking and of my own prep speed... and I still don't always get it right.

Personally, I find Mise en Place most applicable in the kitchen for me in regards to baking. I'm a good baker. I trained for a time with Joanne Chang of Flour and Meyers + Change. However I am a very careful baker. It doesn't not come easily or naturally the way cooking does at this point. I am slow, methodical, and detailed. Because otherwise I will make a mistake....

...timer just went off to check my Blueberry Buckle...
...the Buckle needs 5 more minutes...

...As you can see from the picture, I go into pastry battle fully prepped. My oven is preheated, my pans are greased, I've read the recipe FULLY to make sure I'm not missing something, and everything is measured out precisely. Otherwise I promise you I will screw something up. 

Now, you may be thinking that I'm spending an awful lot of time yammering on about baking, which is not something that everyone does and certainly most people don't do that often. True. However, the concept of Mise en Place is an outstanding method or template to approach life with ADHD. It is an almost sure fire way to defeat executive dysfunction. If you plan well and thoroughly, and you have all your "ducks in a row" whether they are fresh whole Long Island Ducklings, or metaphorical ducks, you will set yourself up for your best shot at success.


Mise en Place - (Food Prep #4)

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Food Prep #3 - Brussel Sprouts

Jul 28, 2017

First of all, let's talk about how awesome Brussel Sprouts are... Very awesome! They are one of the things that I never liked but forced myself to keep trying when I was a chef. And, it really didn't take too long to start liking them and then really liking them.

How to buy: Pick sprouts that are medium sized, not much bigger than a quarter in circumference. The bigger they are the tougher and less flavorful they are. Small ones are delicious, but they take more time to prep. Also try to pick ones that are all roughly the same size. That way they will cook evenly. If you don't like Brussel Sprouts I think there is a good chance you've only had them either overcooked or undercooked. If they are radically different sizes, you might get both in the same plate. 

How to cook them: There are many ways to cook Brussel Sprouts. I had an amazing bowl of Buffalo-style Sprouts at the East Coast Grill many years ago. But my go to on a Tuesday night is...
1. (When prepping) Cut the bottom off and cut in half lengthwise. 
2. (Optional.) I like to toss them in a bowl with just enough oil to coat and season with salt and pepper. I think you get a nice even seasoning that way.
3. Sear them, flat side down in a hot pan with olive oil until golden brown on the flat side.
4. Add a small handful of Craisins. (Golden raisins would work too and if you wanted to get crazy throw some pignoli (pine nuts) in too.)
5. Toss, add a little bit of water, maybe 3 T if you're working with a 14" pan, then cover with a lid. (or the bowl you tossed the Sprouts in.) The goal is to have enough water to steam them for about two minutes until they are "al dente" but not have any water left over in the pan. 
6. Serve and enjoy. I even like them cold the next day as a sort of antipasti. 

If prepped as discussed and pictured, fresh Sprouts should last at least a week in the fridge. And even if they get a bit oxidized, they'll still cook up fine.


Food Prep #3 - Brussel Sprouts
Food Prep #3 - Brussel Sprouts
Food Prep #3 - Brussel Sprouts

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Six Pane Window Picture Frame

Jul 21, 2017

Quick break from the kitchen storage and food prep series to talk about something that happened, or should I say finished happening today. I don't bring this up to toot my own horn, but rather to celebrate a personal success in perseverance and planning. I hope it doesn't come off as purely self congratulatory, as that is not my intention. There were certainly many "learning experiences" and frustrations before achieving this level of "planning zen."

So... it all started in Milton MA in the fall/winter of 2014. When the original window from the 1927 house next door were being replaced, I got my hands on what turned out to be dozens of 6 and 4 pane window. I had a vision of turning them into picture frames for our house. But there were so many questions to answer to get them from crappy old windows to the image I had in my head. Such as...
  • Do they have lead paint on them? How do I test for that? (Answer: home lead test kit and Yes, they do.)
  • How do I get rid of the lead paint safely?
  • Do I need to repair the windows first? (There are about 12 sub-questions about how to do that.)
  • How do I attach the pictures?
  • Do I mount them on the front of the back of the glass?
  • How do I get the paint to look right?
  • Is it worth spending the time taping the windows before painting?
  • How do I secure the pictures to the glass in a non-permanent way?
  • What size pictures should I use?
  • Do I want to frost the glass around the pictures?
  • Once I decide on the size of the pictures, how do I get my digital images to be that size?
  • How to I hang the frame securely without being able to see a wire or a hook?
  • How can I keep parallel to the wall if a hook is involved?
That's a sample of the things that I needed to work through. I had plenty of time just thinking of solutions. I tried repairing the windows. That didn't really work. I wasted a bit of time and money on that. But now I have a heat gun... if I ever need it again. Eventually I had the guys who painted our house strip 6 of them for me for $20 a window. I paid him before looking and he ended up breaking glass on 3 of them. But, I'm not even sure I need to strip them. A little light sanding (wearing a mask) should be fine. I'm going for a rustic look anyway.

I guess my point is that I did a few things that I don't think I would have been able to do 10 years ago. I made sure the idea was "fully baked" before I moved forward to whatever the next step was. I definitely did some research on YouTube. (I learn by watching.) I was patient and didn't put an arbitrary deadline. I asked people for advice. Maybe most importantly is that I didn't get frustrated and give up when the first few things I tried didn't work out. I put the project aside and continued to devote thought to how to solve the problems. And, eventually (roughly 53 months) I came out with exactly what I wanted. And, I got to explain what a prototype is to my son this morning. Now, my plan is to have three more finished by the end of the day tomorrow! Maybe I'll even sell some on Etsy.

Standard Disclaimer:  In an effort to foil my own perfectionist tendencies, I do not edit my posts much… if at all. Please and typos, mistakes, grammatical errors, or awkward phrasing. I focus on getting my content down. An imperfect post completed is better than a perfect post that goes unposted.


Six Pane Window Picture Frame

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Food Prep #2 - Prepping Perfect Peppers... with a sharp knife

Jul 14, 2017

Salad stuff can also be prepped many days in advance. However, now would be a good time to mention how important it is to have a sharp knife. First of all, if it far safer to use a sharp knife. Most people are afraid to use a sharp knife because it seems more dangerous. But, when you use a dull knife you have to exert far more force, which makes it much more likely for your knife to slip and more likely for the knife to be substantially out of control when you do slip. So have a sharp knife!

The other reason to have a sharp knife is that it allows you to prep food that will last longer. When cutting vegetables the goal is to have a nice, clean cut which damages as few of the cells as possible. A dull knife rips the cells open, leaves a jagged edge, and spills the cells contents (mostly water) out which dramatically decreases shelf life. With a sharp knife, a fresh pepper will likely last 7-10 days if you place a paper towel underneath them in the container or bag. 

There are tons of ways to cut a pepper, I find the following the easiest. I take the top and bottom off, pull the insides out, slice down the side to open it into a flat rectangle, then slice off any extra ribs of "pith." Then it's just a matter of slicing or dicing.
Food Prep #2 - Prepping Perfect Peppers... with a sharp knife
Food Prep #2 - Prepping Perfect Peppers... with a sharp knife

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