Services

Attention Deficit Hyperactivity Disorder (ADHD) Treatment

A major emphasis of The Rochester Center for Behavioral Medicine is the identification and treatment of Attention Deficit Hyperactivity Disorder throughout the life span. We offer comprehensive screening and evaluation of this particular disorder. Screening is done through thorough psychiatric interview and the use of collateral history and symptom checklists. When needed, neuropsychological testing is available.
 

ADHD is a highly prevalent disorder.  It affects between 6% and 10% of the American population.  ADHD is a disorder of attention, concentration, hyperactivity and impulsivity.  This activity persists through the life cycle. RCBM is dedicated to the treatment of children, adolescents, and adults with ADHD.

ADHD directly impacts individuals and their family.  Students with ADHD often struggle in school, academically and socially.  They have a high rates of school failure and struggle with other mental health conditions.The struggle with ADHD does not end in adolescence.  Adults with ADHD report problems with distractability, attention, and impulsivity.  They are much more likely than the rest of the population to suffer from anxiety and depression.  Many report difficulties with insomnia or oversleeping.  They have higher levels of persistent anxiety and depression.  Studies reveal that adults with ADHD have difficulty throughout their lives with their job, schooling, interpersonal relationships and overall well-being.

RCBM is committed to accurately and fully diagnosing ADHD.  We believe that each individual should be carefully evaluated.  Our patients obtain a full diagnostic interview where we can ascertain the full history and the current concerns.  If after this intake we believe that further evaluation is warranted, we will arrange for psychological testing.  The psychological testing process takes approximately two and a half to three hours to complete.  It is conducted by specially trained RCBM psychometricians.  The testing allows us to precisely diagnose the type of ADHD you have (ADHD combined type, ADHD predominantly inattentive type, ADHD predominantly hyperactive impulsive type).

Furthermore, we can diagnose other conditions that commonly co-occur with ADHD.  These include depression, anxiety, post-traumatic stress disorder, panic disorder, learning disabilities, sleep disorders, and substance-use disorders.

Once the testing is completed, our psychiatrist or one of our nurse practitioners will review your findings, combining the initial diagnostic intake with the psychological screening.  A treatment plan will be developed, which usually includes medications and ADHD coaching or therapy.

ADHD coaching can be an important part of comprehensive treatment program for individuals with ADHD.  ADHD coaches educate clients regarding this disorder.  They reframe negative beliefs, identify individual learning styles, and develop systems and strategies to overcome strategies.  Individuals with ADHD struggle with time management, organization, impulsivity, and procrastination.  Coaching offers individualized and action-oriented approaches to combat these issues. Coaches are focused on developing productive habits and systems that lead to more productive lives.  Several of the RCBM therapists are particularly focused on ADHD coaching.  At times, coaching can be conducted on the phone, although different insurance coverage applies.

Sometimes medications are useful for ADHD.  The Rochester Center for Behavioral Medicine prescribes many different medications, and will work with you to develop a medication treatment plan that works for you.  RCBM staff have been involved in many clinical protocols.  Many of the medications currently available for the treatment of ADHD have been tested through clinical trials at the Rochester Center for Behavioral Medicine.  A list of the commonly used AD/HD medications can be found on the medications page.

Cognitive Behavioral Therapy

The Rochester Center for Behavioral Medicine uses Cognitive Behavioral Therapy (CBT) for the treatment of anxiety and depressive disorders. Our specialist is Mindy Layne Young, J.D., M.S.W., C.S.W., trained at the University of Michigan Anxiety Disorders Clinic. This therapy combines behavioral exposure therapy along with cognitive restructuring to help enable the patient to confront avoidances, correct negative automatic thoughts, and return to optimal functioning.

CBT is particularly effective for the Anxiety Disorder spectrum, such as Panic Disorder, Post Traumatic Stress Disorder, Obsessive Compulsive Disorder, Social Anxiety Disorder and Specific Phobias. The hallmark of CBT is the patient’s role in learning and practicing skills outside the session, to maximize the therapeutic benefit of this therapy. In mood disorders, the patient will learn coping skills to master tasks often thought too arduous for the depressed patient. The use of CBT with or without medication management is addressed, and the ultimate decision is made between the patient and the RCBM Professional.

Comprehensive Psychiatric Evaluation & Second Opinions

The Rochester Center for Behavioral Medicine offers independent psychiatric examinations. This can be helpful in challenging cases where a new diagnostic perspective is necessary.

Examinations are performed regularly by RCBM Medical Director, Joel L. Young, MD. Often other RCBM services such as psychological testing or the Dementia and Cognitive Evaluation Program are helpful in the diagnostic process. If treatment is needed, a myriad of services are available at RCBM such as Individual therapy, Marital and Conjoint therapy or Cognitive Behavioral Therapy. Contact RCBM at 248-608-8800 to set up an evaluation.

Dementia / Cognitive Evaluations

For some patients, it is important to assess cognitive functions such as memory, recall, alertness and overall aptitude. This is formally done via neuropsychological and psychological testing.

This type of testing can be ordered following medical illness such as stroke or other brain based diseases such as Parkinson's Disease or Multiple Sclerosis. It is also used to characterize childhood developmental illness such as autism or Asperger’s Syndrome. Psychological testing is also ordered to evaluate dementia. Dementia is the diminution in cognition and memory. It is associated with the aging process. The most common type of dementia is of the Alzheimer's Type. These are important diagnoses to make early on. Some dementias are reversible if caught early. For other types, such as Alzheimer’s and vascular dementias, newer cognitive enhancing medications are available which can improve functioning and prolong quality of life.

Extended Time and Accommodations for Individuals with AD/HD

Some individuals with AD/HD are entitled to special accommodations in the academic and work settings.  The Rochester Center for Behavioral Medicine can facilitate this process by communicating to your school or employer your exact diagnosis.  Some accommodations, particularly in the school settings, are protected by federal mandates.

It is a big decision whether to proceed with accommodations.  For instance, extended time on standardized college examinations is available but there is some concern as to whether schools hold this against applicants.  For this reason, a decision to proceed should be carefully discussed with the school counselor and an RCBM professional.

If a decision is made to proceed with testing, one of our senior therapists, Karen Donoughe, MA, LPC, takes the lead.  Ms. Donoughe will interview you and your family, assess what testing has already been done, and report to you what further testing (if any) needs to be done.  Further testing can be scheduled here at RCBM.  Once all documents are complete, Ms. Donoughe can furnish a report/letter meeting the very high standards set forth by the college board or human personnel department.  Although Dr. Young is not directly involved in the preparation of this report, he does review and sign it in the final step.  The final determination as to whether accommodations are granted is made by the applicable board or department.  You can make an appointment with Ms. Donoughe by contacting our front office.

Fibromyalgia and Chronic Fatigue Syndrome Treatment Program

Grief/Loss/Coping with Illness Issues

Sudden loss of a loved one from a heart attack, stroke, homicide, suicide or accident, often presents many issues for those left behind. People who experience loss from divorce, chronic or terminal illness face a different type of grieving. There are also differences in how adults, children, men and women experience grief and loss.

RCBM clinicians are well-trained in helping individuals through the grieving process, whether grieving the loss of a loved one or coping with their own terminal illness. Some of the therapeutic interventions used at RCBM include techniques in relaxation, cognitive restructuring, stress management, goal setting, learning new coping skills, improving communication skills with loved ones as well as with medical personnel, and referral to community support groups. Each case is looked at individually and the type of loss is taken into consideration when a treatment plan is created. RCBM also offers the services of our Psychiatrist and Nurse Practitioners who can evaluate patients who may need medication as an adjunct to their therapy.

Individual Therapy

Individual psychotherapy is an approach in which all therapists at Rochester Center are trained in. Individuals receive assistance in addressing issues related to self, family, school and work. Clients who chose to participate in individual therapy work together with their therapist to gain insight and increase coping skills in order to improve general mental health.

At the Rochester Center for Behavioral Medicine (RCBM) the therapists work closely with the Psychiatrist and Nurse Practitioners in a therapeutic team approach. This provides a broader viewpoint of existing mental health issues. When deemed necessary by the mental health professionals at RCBM (in conjunction with the patient), Psychiatric evaluations, medication reviews, group therapy, family or marital counseling may be undertaken. The professionals at RCBM also encourage clients to take an active role in participating in their therapy. They may provide psychoeducation through the use of videos, bibliotherapy and opportunities to attend seminars pertaining to individual mental health issues. Please click on the "Meet our Professionals" link to view the background information and related interests of a particular therapist.

Marital & Conjoint Therapy

RCBM offers marital and conjoint therapy sessions. Professionals at RCBM first carefully evaluate each member of the couple to ensure that no other condition is interfering with the marital or familial relationship. From there, individuals are brought together to begin conjoint therapy. Important steps in therapy include: reducing blaming and negativity within the couple or family; creating common goals toward which individuals can work (both and independently and together); and developing and implementing plans in order to accomplish these goals.

The therapist may help the couple or family with: communication skills; coping techniques; patterns of interaction; and any other important areas of stress. Further, therapists will help the individuals to generalize the skills they have learned in therapy so they are able to apply these techniques to any future difficulties that may arise. RCBM therapists are highly flexible and willing to adjust the process of therapy in order to best meet the needs of each couple and family. Confidentiality is priority at RCBM, and the therapists work hard to ensure the privacy of everyone involved. If you are interested in becoming involved in marital or family therapy, please contact us at (248) 608-8800 to set up an appointment.

Mind/Body-Focused Therapy

Mind and body medicine focuses on the connections of the brain to the body and how our emotions, verbalizations, behaviors, and spirituality directly affect our health and well-being. It is a cognitive and behavioral therapeutic practice that enhances our awareness of our thoughts and actions in order to improve our level of self-esteem and self-confidence in order to live the life we want.

Mind and body medicine often utilizes specific therapies such as individual and group psychotherapy, yoga and stress management techniques, progressive muscle relaxation, and hypnosis. There have been a number of clinical studies that indicate these alternative therapies can help patients cope and manage pain, minimize stress and anxiety, and gain an overall sense of control over one’s mind and body.

Obsessive-Compulsive Disorder

Obsessive Compulsive Disorder is an anxiety disorder which involves both obsessions (thoughts, images, or impulses that occur over and over again) and compulsions (acts that a person repeatedly performs in an attempt to make the obsession go away). The brain seems to get “stuck” on a thought or urge and cannot shake it. Individuals with OCD often have the sense that if that “obsession” continues without them taking part in any compulsions, the anxiety will become intolerable.

Cognitive Behavioral Therapy (CBT) is an empirically-validated therapeutic intervention that is often used to help individuals with OCD to manage their symptoms. CBT is a concrete, proactive and goal-oriented therapeutic style. With the help of a trained therapist, individuals with OCD can learn to control and even alleviate their obsessions and compulsions. Individuals will also learn coping strategies such as relaxation exercises and ways to challenge distorted thinking in an effort to reduce anxiety. Psychotropic medications may also be a part of the treatment plan for the individual with Obsessive-Compulsive Disorder.

Opiate Addiction

Non-medical use of opiates is dramatically increasing the U.S. Opiates include prescription drugs such as Vicodin and Oxycontin, as well as street drugs like heroin. A U.S. Government report released in 2005 states that prescription opiates are now the second most commonly abused drugs, after marijuana. Heroin use is also increasing among young people in their late teens to early twenties. Abuse of and dependence on opiates interferes significantly with work, relationships, and education.

Here at RCBM, we offer a collaborative approach to treating opiate-related struggles. Individuals with opiate addiction or dependence are evaluated and treated for other psychiatric problems which may be contributing to their opiate use. Suboxone is a medication used to aid in the cessation of opiate use while controlling withdrawal symptoms. Suboxone may be prescribed as a part of the treatment plan. Individuals on Suboxone are required to take part in counseling. Outside resources such as Narcotics Anonymous are also provided for additional support.

Our Mission

The Rochester Center for Behavioral Medicine is dedicated to improve the quality of life experience for our clients. We combine the treatment modalities of cognitive-behavioral & supportive psychotherapies with medication to help people lead happier, more productive lives.

 

RCBM offers a comprehensive program of individual, group and conjoint therapies across all areas of psychiatry and psychology. RCBM is strongly committed to a “biopsychosocial” approach to mental health conditions. We try to understand the biological basis of an individual’s affliction, the psychological conflicts that might arise from it or give rise to it, and the sociological or community context of one’s life. Our staff is composed of individuals with strengths in these areas.

 

Educating our patients about innovative treatment options and cutting edge research on mental health conditions is vital to our treatment approach. We join our patients in a collaborative effort so that they make informed educated choices for themselves. We attempt to educate through dialogue, referral to patient advocacy groups, and distribution of educational material and videos.

 

RCBM offers services to children, adolescents, adults and seniors coping with anxiety, depression, ADHD, learning disabilities, work related issues, stress and family and marital issues among other conditions.

Outpatient Alcohol and Addictions Treatment Program

At the Rochester Center for Behavioral Medicine, we offer an innovative multidisciplinary treatment approach to recovery. Our program has been developed through years of experience working with addicted clients. In addition, we have utilized many exciting new discoveries in the field of neurobiology.
 

Recent discoveries in the field of addiction science have expanded our understanding of addictions and their impact upon the human brain. We have combined our years of experience with cutting edge discoveries in neuroscience in order to provide highly effective treatment for our patients. Research has shown that the combination of medication and therapy has proven most efficacious in treating mental health conditions. This is the model that we utilize at RCBM. Substance Abuse & the Law Our advice to you: Take control of your addiction Do not wait for the legal system to make treatment mandatory; acknowledge responsibility and voluntarily seek treatment Take your addiction seriously. It is a life threatening problem. But remember there is hope. . . We can help by: Communicating with your attorney & the court system, at your request Ordering laboratory alcohol and drug tests Providing psychiatric consultation Offering individualized and family counseling When appropriate, utilizing cutting edge medications specially developed to help people with alcohol and substance addictions. Understanding Addictions Our knowledge about addictions has rapidly grown. Research into the fields of genetics and neuroscience has produced encouraging new medications, including: Campral™ -- to help control cravings Vivitrol™ -- a new injectable medication with 30 days of coverage Antabuse™ -- a powerful deterrent to drinking Suboxone™--a medication for the treatment of opioid dependence Chantix™—a medication used to aid in smoking cessation Other medications to decrease impulsive choices that can lead to relapse Did you know that . . . Many people with addictions also have undiagnosed and untreated mental health conditions such as: Depression Anxiety ADHD and Learning Problems Insomnia Identifying and treating these symptoms can strengthen the recovery process. Please contact us at: (248) 608-8800 to schedule an appointment or find out more information.
 

Parenting Techniques

It is not uncommon for RCBM clinicians to be faced with overwhelmed parents, many of whom have attempted to implement a variety of parenting techniques but have not found success. These failed attempts can lead to feelings of hopelessness and helplessness for these parents, which often exacerbate the problematic dynamics in the household.

The key elements include consistency and remaining calm, both of which can be difficult during stressful parenting situations. Here at RCBM, our therapists take into consideration the age of the child, the presenting concerns, and the family dynamics in order to tailor-make a treatment plan. Often, therapists will use a combination of techniques to meet their needs. These may include education about special considerations for their child as well as exploration and practicing of parenting techniques. Work with the child alone, the caregivers alone, and the family together are all integral parts of the treatment plan.

Post-traumatic Stress Disorder Treatment

Post-traumatic Stress Disorder is an anxiety disorder which occurs after a person has personally experienced or witnessed a dangerous and life-threatening event. Individuals who are at risk for developing PTSD include but are not limited to: Soldiers who have been in combat, survivors or witnesses of violent crimes (including rape, kidnapping, robbery, etc.), individuals who have lived through a natural disaster, survivors of accidents or grave illness.

These events can cause lasting psychological symptoms, including the following (taken from the National Institute for Mental Health Website--www.nimh.nih.gov): 1) Re-experiencing symptoms: Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating Bad dreams Frightening thoughts. 2) Avoidance symptoms: Staying away from places, events, or objects that are reminders of the experience Feeling emotionally numb Feeling strong guilt, depression, or worry Losing interest in activities that were enjoyable in the past Having trouble remembering the dangerous event. Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car. 3) Hyperarousal symptoms: Being easily startled Feeling tense or “on edge” Having difficulty sleeping, and/or having angry outbursts. Hyperarousal symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating. At the Rochester Center for Behavioral Medicine, PTSD is treated with a combination of cognitive-behavioral therapy and medications (when necessary). This effective approach can help individuals with PTSD to identify situations that trigger their “fight or flight” response. Using the cognitive-behavioral techniques of flooding and systematic desensitization, the therapist and patient can work together to safely reintroduce situations that have become too anxiety-provoking for the patient. Over time, irritability, flashbacks and nightmares will subside and the patient is able to return to their pre-trauma functionality. Treating PTSD is a rewarding experience for our clinicians, as long-term success is highly achievable and patient transformation is astounding to watch.

Pseudobulbar Affect Program

The Rochester Center for Behavioral Medicine maintains the Pseudobulbar Affect Program. This condition, also known as PBA, is characterized by mood swings-- notably tearfulness or laughter that are often uncontrollable and can be incongruent with their actual emotional state. Newer drugs and therapies have been developed to treat this condition, and the Rochester Center for Behavioral Medicine offers these interventions.

The clinic is staffed by Marie McMahon, M.S.W., our lead clinician on geriatric issues. Jaime Saal, M.A., L.P.C., also administers the program. Medical support comes from Joel L. Young, M.D. and Carol Rembor, M.S., A.P.R.N., B.C. For further information, please contact (248) 608-8800.

Psychiatric Forensic Services

Joel L. Young, M.D. is a board certified forensic psychiatrist. Dr. Young has testified in many criminal and civil court cases and has offered testimony as an expert witness.

The Rochester Center for Behavioral Medicine utilizes a team approach (with Dr. Young as primary clinician) in offering the following forensic services: Comprehensive custody evaluations. Geriatric/Competency Evaluations. AD/HD and other Psychiatric Issues in the Workplace. Employment Discrimination. Custody and Divorce Disputes.

Psychological Testing for Accomodations

Psychological testing is a process that can be undertaken to provide: Documentation for special accommodation requests for standardized tests such as the SAT, ACT, LSAT, GRE, MCAT, and GMAT. Educational Testing includes Wechsler Intelligence Scale for Children (WISC). Psychological testing is often used for private school admissions. Specifics of learning disabilities and Intelligence Testing including Wechsler Adult Intelligence Scale (WAIS). Projective Testing, includes the Thematic Apperception Test (TAT), that results in valuable insight for successful psychotherapeutic outcomes.
 

Psychological testing may take anywhere from 6 to 8 hours. The testing battery may include interviews, computerized assessments, paper/pencil assessments, blocks, puzzles, and cards. This comprehensive testing provides information that is explained in a complete, detailed report. Testing done for accommodation for standardized tests will result in reports that meet the criteria of the testing agency for accommodation consideration.

RCBMetrics: Diagnostic Screening

RCBMetrics

The Rochester Center for Behavioral Medicine is committed to accurate diagnosis. We believe that before an appropriate treatment is implemented (either medications, therapy, or both), it is imperative to identify the extent and severity of the mental health issue that you have.

Diagnostic screening often plays a vital role in this process. We have developed RCBMetrics, a protocol designed to help us help you. RCBMetrics uses a variety of standardized psychological and educational testing batteries and rating scales. The evaluation process typically takes two to three hours and it is conducted by an RCBM psychometricians under the supervision of Karen Donoughe, M.S., M.A., L.P.C., and Joel Young, M.D. RCBMetrics uses software-based and pen and paper assessments.

RCBMetrics quantifies the extent of many conditions, including anxiety disorders, depression, AD/HD and its various subtypes, substance use disorders, eating disorders, and personality disorders. The program assesses for cognitive impairments and personality style. Other aspects of RCBMetrics can assess and offer guidance about careers.

RCBMetrics is particularly useful for the evaluation of the various subtypes of ADHD. In addition, RCBM assesses for comorbidities. Comorbidities occur in 25% to 45% of individuals with ADHD. Common ADHD comorbidities include anxiety disorders, depression, and learning disorders. Input from teachers and family is also factored into final report. Once RCBMetrics is completed, a full report is generated. Your RCBM clinician will meet with you to review therapies and develop a comprehensive treatment plan, including medications, psychotherapy, and/or coaching.
 

Diagnostic screening done outside of RCBM may be considered sufficient, provided that the testing has been done recently and includes assessment of the following conditions:

-Depression (including an assessment of suicidality)

-Bipolar Disorder

-Anxiety Disorders

-Fatigue

-Substance use

-AD/HD (Objective testing is required, including assessment of processing speed, psychomotor speed, executive function, complex attention and cognitive flexibility).

 

School Advocacy

The Rochester Center for Behavioral Medicine works with children, parents and schools to provide a comprehensive and integrated treatment program. Children and teenagers spend the majority of their day in the school setting, and their relationships and behaviors in the school setting are often critical pieces of the diagnostic and treatment puzzle. Your child’s therapist or doctor will contact the school to ensure that treatment plans and goals are aligned and well-coordinated.

Navigating the educational system to advocate for your child can be overwhelming. RCBM can assist your family in getting answers to the follow types of questions: How do I know if my child is eligible for an Individualized Education Plan (IEP) or a 504 Plan for my child? When and how do I suggest this to my child’s school? What type of accommodations will teachers make without an official plan? Clinicians at the Rochester Center for Behavioral Medicine are well-versed in these issues and can help your family work through this process.

Social Phobia

Social Phobia, also known as Social Anxiety Disorder, is characterized by marked and persistent fear of situations in which one must perform or interact socially with or in front of others. A person with social phobia fears situations in which he or she is exposed to new situations or people and worries about behaving in a way that he/she might be judged by others as foolish, unacceptable, inappropriate, or inadequate.

When a socially phobic individual is exposed to these situations, he or she feels anxious, both physiologically and emotionally. This disorder causes a negative impact on the individual’s social, academic and/or occupational functioning. Treatment for social phobia focuses on helping the patient to explore and identify possible triggers to their social anxiety, how this anxiety manifests itself, and work on coping skills and tools they can acquire to help overcome their phobias. Furthermore, treatment interventions for social phobia may include individual, family, and group therapy. Cognitive-behavioral therapeutic techniques are often utilized, along with relaxation techniques and psychotropic treatment (if appropriate).

Trichotillomania

Trichotillomania is a disorder characterized by the pulling of hair for non-cosmetic purposes, which can often result in significant hair loss. Hair is typically pulled from eyebrows, eyelashes, scalp, beard and pubic area, though hair from other parts of the body may be pulled as well.

Individuals with Trichotillomania may also play with, bite, nibble or chew the hair. If ingested, this may cause a serious condition in need of medical attention. It is not uncommon for people with this disorder to engage in other damaging behaviors such as nail-biting or skin-picking. It appears that significant emotional experiences or feelings can trigger hair pulling. Anxiety, depression, stress, anger, and tension may increase the urge to pull. However, hair pulling may also occur when the individual is inactive and subdued; while reading, watching television, doing homework or even lying in bed. Here at RCBM, we fully evaluate individuals suffering from Trichotillomania to assess the disorder and determine if any conditions result from or contribute to the pulling of hair. In addition, we assess the impact on social functioning, academic environment and family relationships. Often times, we work with the family utilizing a cognitive-behavioral approach. This consists of putting together a treatment plan focusing on triggers associated with the pulling (thoughts and feelings – physical and emotional) and the situations in which the pulling occurs. We meet with the patient and family regularly to determine progress and discuss the factors contributing to the pulling/picking behaviors. It is not uncommon for clinicians to ask patients with Trichotillomania to complete activities outside of the therapy session, such as journal writing, progress calendars, worksheets, and creating barriers like wearing band-aids/gloves or hats/scarves.

Clinicians

Amanda Moar Kerbawy MA
Karen Donoughe MS, MA, LPC, NCC