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Mark Mintz, M.D., Named to South Jersey Magazine's 2009 Top Physicians list

SJ Magazine's Top Doc for Kids 2008, names Dr Mark Mintz in Developmental and Behavioral Category

Mar Mintz M.D. Named to South Jersey Magazine's 2008 Top Physician List

Local Clinic Leads the Way in Measuring Brain Activity in Children with Greatest Comfort and Accuracy

CNNH Uses New "Quotient™ ADHD System" for Diagnosis. Sept 11, 2009

Mark Mintz MD Named Autism NJ's "Healthcare Professional of the Year" Oct 7, 2009

Governor Corzine, Commissioner Howard Meet with Advocates and Parents of Children with Autism at CNNH. April 30, 2009

Children with Autism Should Also be Screened for Epilepsy. April 6, 2009

CNNH Designated a NJ Autism Center. Wait Time Drops for Autism Screenings. February 2, 2009

Classroom Strategies for Students with Autistic Spectrum Disorders, NJEA Review, Jan. 2010

Autism 101 - What are the possible causes, features and treatments of this disorder? NJEA Review, May 2009

The Underrecognized Epilepsy Spectrum: The Effects of Levetiracetam on Neuropsychological Functioning in Relation to Subclinical Spike Production February 2, 2009

The Effects of Levetiracetam on Neuropsychological Functioning in Relation to 'Subclinical' Spike Production December 2006

Mixed-Handedness Is Linked to Mental Health Problems in Children and Adolescents

Lack of hand dominance is associated with a higher risk of ADHD, language and scholastic difficulties, according to a recent study. Children with lack of hand dominance, tested between the ages of seven and 8 and again at 16 years, demonstrated a twofold increase in odds concerning difficulties in school with language and ADHD, as compared with right-hand dominant cohorts. While additional research is needed to assess the neurological components of these findings, the study suggests that early recognition of those children with mixed-handedness is suggested so interventions can be offered.

Rodriguez A., et al. Pediatrics. doi: 10.1542/peds.2009-1165

Attention-Deficit/Hyperactivity Disorder and Urinary Metabolites of Organophosphate Pesticides

Pesticides are linked to the development of ADHD, according to this research study. Children with higher urinary dialkyl phosphate concentrations, such as dimethyl alkylphosphate (DMAP) – commonly found in US food – were more likely to be diagnosed with ADHD. You might want to consider eating organic!

Bouchard M, et al. Pediatrics. doi: 10.1542/peds.2009-3058

Effects of Motivation and Medication on Electrophysiological Markers of Response Inhibition in Children with Attention-Deficit/Hyperactivity Disorder

An interesting study from Biological Psychiatry on the importance of behavioral approaches to ADHD. Using a "Go/No Go" task, and an electrophysiological parameter (event-related potentials), the authors provided motivational incentives (reward and/or response cost) to children with ADHD known to be medication responsive, and a control group without ADHD. They found that motivational incentives increased amplitudes (for N2 and P3) of event-related potentials correlating to attention (on-task) and response inhibition (restraining impulsive responses) of those with ADHD toward the baseline of the control group. Overall, findings implied that motivational incentives could effect those with ADHD and those without ADHD in a similar manner, and that there were additive effects of these behavioral interventions with stimulant medications.

Groom M, et al. Biological Psychiatry. 2010; 67(7): 624-631. doi:10.1016/j.biopsych.2009.09.029

Similarly, the landmark Multimodal Treatment Study of ADHD (MTA) looked at four approaches to treating ADHD: carefully monitored medication management (stimulant medication), behavior modification (a very intensive approach), combination of behavior therapy and stimulant medication, and routine community care (which included medication). Compared to community care, medication alone or the combination of behavioral and medication therapy were superior to community care or behavioral therapy alone. The combination showed additional benefits compared to medication alone, although modest.

MTA Cooperative Group. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Pediatrics.2004;113:754-761.

Although there cannot be major conclusions from this small study in Bio Psych, it provides reinforcement to the fact that ADHD is a neurobiological disorder, and that adjunctive behavioral strategies are important.

See the CNNH Clinical Enhancement Center's Page on Autism.

Autism Articles and Research

The Underrecognized Epilepsy Spectrum: The Effects of Levetiracetam on Neuropsychological Functioning in Relation to Subclinical Spike Production February 2, 2009

The purpose of this study was to determine whether treatment with levetiracetam improves neuropsychological functioning in children and adolescents who have evidence of subclinical spike production associated with attention and learning difficulties. Levetiracetam was generally well tolerated by a group of patients with attention and learning problems that have associated abnormal cortical electrical activity without clinical seizures and associated neuropsychological deficits.

Mintz M, et al. Journal of Child Neurology. 2009 Jul;24(7):807-15.

Case-Control Study of Neurodevelopment in Deformational Plagiocephaly

A case of which came first, the chicken or the egg, this study looked the neurodevelopment in children with deformational plagiocephaly (DP) to determine if a significant relationship exists. By comparing children with and without DP, it was concluded that while DP does not cause neurodevelopmental delay, it is indeed a marker for higher risk of delays, most evident in motor function. Those children in the study with DP demonstrated lower scores on both motor composite scales and cognitive and language composite scales compared to their cohorts without DP. In addition, children with DP had greater deficits in gross motor abilities than fine motor. Follow-up evaluations at 18 and 36 months are needed to determine the stability of these findings.

Speltz M, et al. Pediatrics. 2009. doi:10.1542/peds.2009-0052

Selective induction of astrocytic gliosis generates deficits in neuronal inhibition

This rather complex experiment in mice has important implications for neurological diseases such as Epilepsy. In essence, many brain disorders involve excitation and over-reactivity of neurons (the main impulse-conducting cell in the brain, responsible for receiving and sending "messages" from and to the body and other parts of the brain), in part influenced by excitatory and inhibitory synaptic currents (i.e. the electrical or chemical input to a neuron from other sources can be excitatory or inhibitory). One important influential supporting cell in the brain is the Astrocyte, which serves many functions to maintain neuronal health and influences neuronal stabilization. In this experiment, the researchers (mostly from CHOP) induced selective astrocytosis without neuronal injury in mouse brain samples (i.e. causing an increase in the number of neighboring astrocytes, which is usually caused by damage or death of neurons, but in this case, neurons were preserved). The result was less production of a brain chemical that inhibits neurons, and thus, overall disinhibition of neurons. For a disorder such as Epilepsy, such a deficit could lead to over-excitable neurons, and thus, seizures. Many pharmacological therapies for Epilepsy and other neurological disorders involving neuronal over-excitation or disinhibition have been targeted directly to the neuron, but research such as this study suggests that treatments targeted to astrocytes may hold therapeutic promise.

Ortinski P, et al. Nature Neuroscience. 2010; 13: 584-591. doi: 10.1038/nn.2535

The Effects of Levetiracetam on Neuropsychological Functioning in Relation to ‘Subclinical’ Spike Production

This research investigated the effects of Levetiracetam (LEV) on the neuropsychological functioning of children with attention/learning difficulties and “subclinical” spikes. Results indicate that “subclinical” spikes might be responsible for memory and attentional deficits and that LEV can decrease the associated deficits. Further research is needed to determine the long-term effects.

Click here for article

Behavior Therapy for Children with Tourette Disorder

Just published results from a larger NIMH-sponsored study indicate using a comprehensive behavioral intervention based on Habit Reversal (HR) for Tourette Disorder/Tics results in positive outcomes. This study validates several previously published smaller studies. The authors point out that the magnitude of the positive response to HR is comparable to the results of studies using neuroleptics. Even in those subjects that did not benefit, there was an absence of tic worsening with behavioral interventions. The authors discuss that there may need to be a reconceptualization of Tourette Disorder as not just a neurotransmitter disorder potentially treatable with dopamine-blocking agents (and their attendant side effects), but a more complex motor disorder of cortical and basal ganglia circuits that can lead to habit formation, and thus, may respond to behavioral interventions in some patients, but may necessitate medications in others. However, this study provides substantial support for behavioral interventions, particularly Habit Reversal, expanding available treatment options for patients, and providing an avenue for patients and families to take an active role in treatment.

Piacentini J, et al. JAMA. 2010; 303(19):1929-1937.

However, not to get fully away from the neurotransmitter aspects of Tourette Disorder, as a report from the New England Journal of Medicine links the role of histaminergic neurotransmission as a potential mechanism for mediating tics in one family.

Rates of Major Depressive Disorder and Clinical Outcomes Following Traumatic Brain Injury

A majority of patients hospitalized for traumatic brain injury demonstrated major depressive disorder (MDD) one year after the injury, according to this study. High rates of depression were associated with a history of MDD and was an independent predictor of lower health-related quality of life, particularly related to mobility, performance of usual activities, pain and discomfort and role functioning.

Bombardier C, et al. JAMA. 2010; 303(19):1938-1945.

Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease

Reducing salt intake by about 30% of the current average in the U.S. population, or 3 grams per day, can reduce strokes and myocardial infarctions to a similar degree that smoking cessation and weight loss can. This intervention would not only save lives, but it would also save in health care costs from using medication to lower blood pressure.

Bibbins-Domingo K, et al. New England Journal of Medicine. 2010; doi:10.1056/NEJMoa0907355