Dr. Todd Koser is a psychologist practicing in Cherry Hill, NJ. Dr. Koser specializes in the treatment of autism and related conditions, and helps people to cope with their mental illnesses. As a psychologist, Dr. Koser evaluates and treats patients through a variety of methods, most typically testing and talk therapy. Patients usually visit Dr. Koser because they are think they or their child might qualify for an autism diagnosis or are seeking help with academic problems. Dr. Koser also works with members of the transgender and LGBQ communities to help them manage stressors and work towards their goals.
Education and Training
Widener University Psy.D. 2013
Ursinus College B.A. Biology & English 1991
Institute For Graduate Clinical Psychology-Widener University Psy.D. 2013
Dr. Todd Koser PSY.D.'s Expert Contributions
This response if for informational purposes only and does not constitute treatment. ADHD is a brain-based condition where kids have much more difficulty with directing their attention, controlling impulses, and sitting still than most other kids their age. As children get older, the hyperactivity often moves from large movements and "out of chair" behaviors to smaller scale fidgets. We look for these issues across at least two environments - usually school and home. Depending on their age and school demands, some kids have had struggles since they were very little. Others have these problems brought to light when needing to study and do large amounts of homework. Serious disorganization is another sign of ADHD that is very common for kids. You might want to email or call you son's teacher(s) to ask if he seems more active, less attentive, and has a harder time with organization than most of his classmates. This can give you a sense of whether these issues go across several settings or are more restricted to home. If the issues (at home and/or school) are causing fairly big problems, then you can consult a therapist who has experience working with kids and families affected by ADHD. There are a few specific treatments that have been shown to be effective for ADHD, so working with a person who specializes can make sure you get help that will make a difference. READ MORE
This answer is for informational purposes only and does not constitute treatment. For some parents, an autism diagnosis for their child is a huge surprise and disappointment. If the diagnosis is very new, this may be an intense reaction, but within what could be expected. If you notice these changes are ongoing for more than a few weeks and your wife is expressing concern, then finding someone for her to talk with could be helpful. Many autism service organizations run parent support groups where parents come together to talk about their family and challenges. Many parents find this to be very helpful and healing. Knowing the challenges ahead and successes others have achieved can be very hopeful. You can find a listing of local agencies and providers on the Autism Speaks website. Some people feel more comfortable talking about family matters in a private setting with a therapist. You can also search on Autism Speaks for a local provider if you wife is interested in going to counseling. Finding a provider familiar with autism and family therapy might be especially helpful. Depending on where you live, this can be easy or very difficult. Even between the two of you, talking about your plan for treatment for your son and any positive changes you have noticed since the initial diagnosis may help your wife see and focus on some recent successes. Family support can also help a parent remember they don't have to face the big task of raising a child with autism alone. READ MORE
This answer is for informational purposes only and does not constitute treatment. Anxiety is the most common comorbid disorder for people with autism. You little guy sounds like he is likely having classic childhood anxiety symptoms. Just in case though, have you taken him to his pediatrician to be sure there are no medical issues occurring? Better safe than sorry in this regard. Many kids with autism do well in school, but then "fall apart" when they get home. Even if he enjoys it, the complex social and behavioral demands are often really stressful for kids with ASD. The fact that you mention he is very quiet at school but not at home add strength to your thoughts about anxiety. If the tummy symptoms have been occurring for more than the 1st few weeks of school, then it might be time to talk with a therapist. Depending on your son's communication skills, family therapy or art/music therapy might help him find ways to identify his stress and express it. Once you have ideas about what seems to be stressful for him you can work with the school to eliminate those elements as much as possible. Have a chat wit the school counselor, special education person, and/or school psychologist about your concerns. See what they might suggest. If that isn't enough, then consider seeing a therapist. One who specializes in treating children with ASD might be especially helpful. READ MORE
This answer is for informational purposes only and does not constitute treatment. Fear of small, enclosed spaces, also called claustrophobia, is a very really phobia. Given the sweating and seeming nervousness, your theory seems likely. Have you asked her about how she feels in elevators? You can also ask her about other similar spaces she has been in (closets, small bathrooms, etc). If she does seem to have a phobia, and it isn't that she just a little uncertain what to do inside an elevator where most people are weirdly silent, then you can talk with a therapist who specializes in anxiety and phobia about possibly treating her for the condition. READ MORE
This answer is for informational purposes only and does not constitute treatment. ADHD is understood to be a brain-based, developmental disorder present from childhood. Usually adults who have clear signs of ADHD can find a history of attention, impulsive, or hyperactive problems in their childhood. Some adults who have a milder case of ADHD don't "run into the wall" until they get a job or other life circumstance that finally overwhelms their coping strategies. If your parents and siblings are good historians and don't recall you having any issues with attention, hyperactivity, or impulsiveness, then other issues like anxiety, depression, or a really stressful and complicated lifestyle might be the issue. These days, most people are expected to keep a lot on their plate and stay organized in a chaotic world. If you are only in adulthood running into problems, then it may be time to talk with a psychologist about your personal symptom profile and history to see if ADHD, another diagnosis, or "just life" is right for you. If you are feeling overwhelmed lately, even if you don't qualify for a formal diagnosis, having counseling to address your stress (and likely disorganization) can be really helpful. Adult support groups for folks with ADHD can also help normalize your experience. CHADD is a group for folks with ADHD that publishes a list of local groups along with lots of helpful ideas to manage ADHD and its core symptoms. READ MORE
This answer is for informational purposes only and does not constitute treatment. I can't say whether you can cure your depression with exercise. However, I can say that research has shown that physical activity and engagement all on their own can be extremely effective for some people. The main treatment with this name is "behavioral activation." Assuming you aren't exercising to extremes or ignoring other responsibilities, the exercise is unlikely to hurt and every likely to help. If you exercise outdoors, have a plan for how you will manage or vary your exercise routine to accommodate changes in the weather and daylight. Some folks like to walk a long circuit in a local mall to deal with hot/cold weather. READ MORE
This answer is for informational purposes only and does not constitute treatment. Children usually experience grief when a parent they were emotionally close to dies. Children of all ages can be deeply affected by the loss. It seems like you might have him seeing a therapist currently. You might want to talk with the therapist about whether his grief seems unusually intense. At 10 months, it doesn't seem like his mourning period is overly extended or long yet. Some kids work in therapy better with approaches that are different from the adult "we sit here and talk about it" way. Art or music or drama therapy might help him to experience the grief and express it in new ways. Play therapy or sand tray therapy might also be a different modality that could work for him. If he's able to get done most of the things other kids his age are doing - school, some friends - then he may just need more time. You can also talk with him about your experience of losing your husband to let me know the loss and grief are normal. You can also try asking if something else might be the reason he is more quiet lately. Sometimes amidst the huge changes in a household related to the loss of a parent/spouse something unrelated to the death gets overlooked that may be related to a child's changes in behavior. The comedian Patton Oswalt has written very touching and grounded comedy and essays about his experience as a sudden widower and single parent. Some of this writings might give some ideas on how to approach your son and support him. READ MORE
My son has a hard time paying attention to instructions, and tells me he feels nervous all the time. Should he be in counseling?
This answer is for informational purposes and does not constitute treatment. A few possible reasons for your son's difficulty with instructions comes to mind: 1. are the verbal instructions too complex for his age or general language level; 2. does he seem nervous another other stuff, but instructions are places where if you mess up, the consequences are drastic; 3. does he seem to have problems paying attention in other situations. Situation 1 - some kids have language delays or processing problems that make instructions very difficult for them. If your child is in school, you can talk to his teacher about whether they notice this also. If yes, then it may be a good idea to ask the school to do an evaluation of his language abilities. BUT, sometimes parent (and less often, teachers) give instructions in ways that are too complex or too long. This makes anyone nervous. See if you can cut instructions down to a max of 1-3 steps and see how your kid does. Situation 2 - directions/instructions are the key to success for tasks. If you child is anxious by nature, this might be the area where that come out the most. Think about whether they seem worried and easily fixated on stuff. When a person is anxious, it often affects their attention. Situation 3 - some kids have ADHD that makes it hard for them to pay attention to directions that go on for too long. After getting yelled at, they can see the train wrecking coming and can get anxious simply because they almost never get this right. If you see other situations with lots of issues with hyperactivity, a hard time paying attention, then getting an evaluation to check for ADHD might be appropriate. READ MORE
This answer is for information purposes, but is not treatment. Sex and relationships can be a very complex topic of some people with autism. Other folks with ASD date, marry, and have sexual partners with success. Depending on the person's functional level, learning ways to seek out and have consensual sexual partners may or may not be practical. People with ASD who have very intense social impacts may find this to be extremely difficult to achieve. Almost everyone engages in some kind of sexual behavior after they go through puberty. If finding a consensual sexual partner isn't practical, then helping the person understand that masturbation behaviors need to be in a private and safe location is usually the preferred treatment approach. For folks with ASD who likely have the core abilities to date and engage in consensual sex, but lack the current skills, then a young adult social skills group targeted to these area can be huge help. Some autism providers specialize in this area of teaching dating and sex for young adults. Even so, it is often a huge challenge for people with autism to make connections with people to a level where they feel comfortable discussing sex and negotiating sexual consent and contact. Research by Dr. Isabelle Henault has focused on this area of social functioning for young adults. She has written a book titled "Asperger's Syndrome and Sexuality" to help therapists support folks with ASD to learn about this area of life. Lastly, while not considered very appropriate any more, there are some medications that reduce libido. Discussions with a medical professional and consent from the patient, where appropriate, would be needed to access this option. READ MORE
Dear parent of scared exam taker, Please bear in mind this answer is for informational purposes only and does not constitute treatment. If your son has always been an anxious test taker, then perhaps this is not so unusual for him. As students get older, they often become more aware of the relative importance of high-stakes exams. He may just be talking about the exams more now that he is aware of them. If, instead, this seems like a big change for him, then maybe something is up that needs your help. Your son may be aware he is academically struggling more recently and is concerned this will be highlighted by the exams. Some states have certain years that are exam-heavy, so this may be more intense than prior grades. I would suggest you talk to your son and mention you noticed his worries and concerns. You can also contact his school and speak to his counselor, teachers (and maybe the school psychologist) to talk about his concerns. Ask them if they see indications whether he is likely to do well or have a hard time with the state exams. If your son or his teachers express serious concerns, then it could be time to look into having him talk with a psychologist about the worries. A psychologist that is experienced with teen anxiety and academic concerns would seem to be ideal. Licensed psychologists who are also certified school psychologists, or use NCSP as part of their credentials, are likely to be familiar with this area of practice. You can also talk with his school about any supports they can put in place, like tutoring or academic coaching or groups for anxious students, to help him manage and overcome the fear. If his teachers have very significant concerns about his academic performance, then an educational evaluation from the school to better understand why he is struggling could also be very helpful. Best wishes, Dr. Koser READ MORE
This reply is for information purposes only and does not constitute treatment. I can certainly understand your frustration, including with some of the information presented on other portions of the FindATopDoctor website. I scanned some articles and I agree some of the information is outdated and incorrect. I do not review any of the autism content on the site apart from my personal answers to patient questions. You touch on two points that are at the forefront of thought and research on autism diagnosis right now: 1) is the gender gap in the ratio real, and 2) are symptoms in girls and women somehow different than in boys and men? Recent research has sought to address the first question. Researchers using more rigorous methods found the gender ratio narrowed with careful diagnosis to 3 boys for every girl. You can read more about the study here: https://spectrumnews.org/news/estimate-autisms-sex-ratio-reaches-new-low/. This awareness is spreading in the autism-directed service community now, but is making a slower journey outside of those to follow autism research closely. The other question of whether current diagnostic criteria capture the presentation for most girls and women with autism is controversial right now. The ways we understand autism are evolving very quickly in medical and psychological research - faster than most quoted statistics can keep up with. The diagnostic criteria for autism were revised with the recent publication of the DSM-5. I think this has improved the ability to recognize social delays and differences in younger children, including young girls with higher functioning forms of autism. Could clinicians do better? Yes we could. It is often frustrating for us, as well as for the general public, how slowly published diagnostic criteria and ideas about "what is autism" change. Many professionals who work with people with autism try to keep these factors in mind every day and to educate those around us about these issues. I also encourage people with autism to speak out for themselves to spread the word. There are a number of autism groups that seek self-advocates to do this work, like Autism Speaks and the variety of organizations for people with Asperger's. READ MORE
Please keep in mind this answer is for information purposes only and does not constitute treatment. I view stress as events occurring in your life and the lives of those close to you (both positive and negative) that put demands on your time, attention, and emotions. Even someone going through a very happy event like a new relationship or a big life transition like a wedding can feel happy and stressed at the same time. Events and circumstances that make us feel frequently worried and overwhelmed obviously are hard to manage also. Biofeedback can't control the events that are stressing the person, but it is a good way to learn techniques to help control the physical reactions our bodies naturally have to stress. When done well, biofeedback interventions give more immediate and clearer information about our body's stress responses than we can get on our own. Hence the name. Biofeedback is normally paired with an evaluation and interviewing to understand what stressors a person is experiencing, the unique ways that person's body reacts to the stressors, and specific techniques to calm down the stress response. The actual feedback information helps a person learn the best ways to apply those techniques (like deep muscle relaxation or hand/foot warming, self-talk to help control worry). Biofeedback can't control stress, but it is a really good way to measure our stress levels and learn to manage them effectively. READ MORE
This answer is for information only and does not constitute treatment. Changes in appetite can be a symptom of depression, but this can also be related to a number of other health conditions as well as a side effect of some medications. Talking with your father and asking him to participate in some of his doctor appointments to express your concerns to his doctors, assuming that is OK with him, might be a good place to start. If you father receives counseling to help address his depressed mood and help him get support for his health problems, you could also ask for him to raise the appetite issue with his counselor. Similar to his medical doctors, you could ask him if he would bring you to a session so you could raise the issue with his counselor. Ruling out medical issues is usually a good first step when trying to address an issue like change in appetite that can have both medical and psychological causes. READ MORE
This answer is for information purposes only and does not constitute treatment. Some people experience shifts in their attractions, sexual interests, and romantic attachments over the course of their life. You mention "slowly discovering" in your question. This may mean things have shifted for you recently, or these attractions and feelings have been present in the background for a while and you are just starting to recognize them now. Same-sex attraction carries some amount of negative reaction and stigma in many societies and cultures. This often makes it very difficult to face and identify as we mature. People receive lots of signals, some subtle and some as clear as a punch in the face, about who it is OK to be attracted to and feel romantic about. For some, this leads to a suppression of feelings. For others, there is a change as we mature. The nature and meaning of "feelings" is a very huge and loaded topic also. In most of American culture, men and boys are taught that close and tender feelings towards other males, especially those not our father or brothers, is wrong. Sometimes, as men mature they come to feel that closeness with male friends and family is a kind of love that needs to be recognized, but doesn't have any sexual drive to it. Not all attraction is inherently sexual. Feelings of emotional and/or sexual attraction to both men and women are not a problem in and of themselves. Depending on your current partnership status (coupled or single), the opinions of your close family and friends, how much you feel influenced and bound by your culture, and the laws on same-sex conduct in your area (and whether feelings lead to sexual behavior), there may or may not be a problem. If these changes are making your feel really anxious or stressed out or worried, or if they are making problems getting along with those you love, then maybe you need some help to figure out what to do. If these feelings aren't troubling to you and not interfering with your relationships, then maybe that is a different matter. Some information that may help you can be found at the Kinsey Institute (https://www.kinseyinstitute.org/research/faq.php) as well as at the Bisexual Resource Center (https://biresource.org/). READ MORE
This answer if for information only and does not constitute treatment. If this is his first formal school experience, then his fear and difficulty separating from you might be expected. Given that you say "extreme fear" it seems like doing some investigating from a number of sources could be appropriate. Have you asked your son's teacher how he is coping after he is dropped off at school? Is he fine a couple minutes after he separates from you or the person dropping him off? Also, how does your child get to school in the morning? Is the bus ride stressing him out for any reason you can think of? Can you quickly as the bus driver at drop-off how he seems to do on the way there? If your son is the kind of kid who can usually talk about what he feels and what happens to him, you can try asking some open questions to him. Ask at a time when worries about school aren't so immediate. Asking "what's wrong" once the fear has set-in at the front door as the bus pulls up probably isn't the best time. At a calm part of the day, maybe in the evening on Friday or Saturday night, or in the car driving on a regular errand, you could say something like, "Hey, you get really worried/scared/crying when it is time to go to school." See what his response is to just that statement. Leave LOTS of time for him to answer. Count to 20 slowly in your head to give him time to think and respond. If that statement doesn't prompt any response, you can add something to indicate you wonder if he is OK or if something is hard for him about going to school like, "I'm starting to worry about you a little bit because it didn't used to be this way. IS everything OK at school and on the way there?" SLOWLY think 20...19...18... See what he has to say about getting there and being there and if he can report any worries or problems. The feedback from the teacher can also be very valuable. If the teacher reports he is fine within moments of the you leaving, then that is much less of a concern than if the teacher reports he is crying most of the morning and seems to have a much harder time than the other children. Ask if the teacher has any advice about how to help him get to school with less fear. Hopefully your son's school has a counselor. This person can be a good resource as well to see if his reactions seem out of scope to the situation. The school psychologist is also an excellent resource to consult if you are very concerned. The counselor and/or school psychologist might be able to recommend programs in the school to support him and actions to put in place at home/precare to make the transition easier. They might also recommend a child therapist if you want to follow-up with a professional mental health provider for any reason. READ MORE
Please keep in mind this reply is for informational purposes only and does not constitute treatment. I think your question maybe something like, "Are meltdowns still common for 5-year-olds, and why does he do it with me, but not at school?" Children this age still have tantrums at times. Running away from parents, especially out in open public spaces, can be common for some children during meltdowns. If tantrums tend to be related to you saying, "no," or limiting access to something, then running away may feel like getting away from the limit. Some children turn running away into a game that is fun for them, even if you are scared they may go somewhere unsafe. Your son may not be able to recognize the potential dangers of running away from you. Schools often provide more structure, which may help your son avoid tantrums. The things he is having meltdowns about at home may not be possible at school, so the topic doesn't come up. Also, young children in schools are often given very specific instructions about where and how to walk when moving outside the classroom. It sounds like your son is doing well in his classroom this year. If you are looking for ways to manage his running away, you might be able to get some pointers from his teacher about how she manages the class and him to avoid running away. For situations where you are worried about the severity or how long tantrums are lasting, talking to his teacher could again be a good place to start. The school counselor and school psychologist could also be people to talk to if you have concerns. Your pediatrician is another resource available to talk to if you get worried about the tantrums. READ MORE
Some psychiatrists provide therapy as well as prescribing medications. Other psychiatrists only do medication management and other medical procedures. When scheduling an appointment, you can be clear you are looking for a consultation about a certain issue and not currently seeking medication. Ask if the psychiatrist has other ways to help you manage that problem. If you are seeking therapy, then you should be sure the psychiatrist, other other mental health provider performs that service. Most providers are willing to have a brief phone conversation to discuss what you are seeking help with. That phone conversation would be a good opportunity to ask about therapy and what they provide and the costs. There are a number of professionals who provide talk therapy, including many psychologists. Except for a very few states, only psychiatrists and other medical doctors can prescribe medicine. If you are looking for a combined approach, therapy with medication, then a psychiatrist might be a good match for integrated treatment. If you only want to do talk therapy, you would have a much wider set of professionals available. The main distinction between psychologists and other talk therapy providers is the length and kind of training. Most licensed psychologists are required to have a doctoral degree which usually means at least 4-5 years of university training. Most other licensed professionals have a master's degree with about 2-3 years of graduate education, although some non-psychologist therapists also have a doctoral degree. Issues like cost, insurance coverage, whether they specialize in your particular concern, and distance from your home or work may be additional factors you may want to consider when selecting a therapist. READ MORE
Please keep in mind this answer is for information only and does not constitute treatment. Whether a psychologist has a "time frame" in mind for therapy likely depends on the type of issue/goal the client is hoping to address and the techniques that are being used to address the goal. Some techniques, such as specific cognitive-behavioral therapy (CBT) protocols have recommended time frames for the full protocol. The time frames are often given in number of sessions to complete the treatment plan. Other approaches, especially supportive and psychoanalytic/psychodynamic approaches, tend to not be focused on any specific time frame, but rather on general progress and how the client feels over time. If you are currently seeing a psychologist of therapy, this could be a good question to address to them. You might ask to discuss how you feel you are doing so far towards your goals, whether the therapy is based on a time-limited approach, and that the psychologists thought are about likely length of treatment. Also, sometimes a client seeks to address multiple issues at once, which could extend treatment, so chooses to continue to address additional concerns after the first issue is resolved. Lastly, some clients with chronic medical or mental health conditions continue in therapy for long periods of time as part of how the manage their chronic disease. READ MORE
Please keep in mind this reply is for information purposes only and does not constitute treatment. Times when your psychologist can share information about you without your prior consent are generally very limited. The specific limits for this are set by a combination of federal and state law, so where you are seeing your psychologist will set these limits. The psychologist you are currently seeing may have discussed what are often called the "limits of confidentiality" with you at the start of your treatment with them. Again, generally, most mental health providers cannot share your information with other outside parties without your prior consent, which is usually gotten in writing. If you are worried about your information being shared, you can always address this concern to your psychologist at the next session, or ask to review the confidentiality policies they use. READ MORE
This reply is for information only and does not constitute treatment. As you get in touch with therapists, this would be a good question to address to them as part of your selection process. Some therapists are very directive and others tend to let the client set the agenda and pace of the work. If you think you would prefer someone who has a plan for each session and ideas of that needs to be done to address your goals, you can ask that something your therapist is comfortable providing. Setting this expectation at the start of therapy and checking-in about it after a few sessions can help to make certain it happens. The check-in would also give you an opportunity to decide whether that approach continues to be comfortable after the start of therapy. READ MORE
Please keep in mind this reply is for information only and does not constitute treatment. It sound like you are in a chicken/egg situation where you don't know how to start. Maybe you can think a little bit about if you afraid of specific kinds of situations with the psychologist? Do you have a good friend you trust who has also seen a therapist? You might be able to ask them if they had any of these fears and how they overcame them to start therapy. Most mental health providers know it is tough for folks to trust a stranger with very personal information and work hard so that the folks coming to see them feel comfortable. Some clients choose to start off in therapy with a less intense issue and then add in other concerns as they trust their therapist more as time goes by. In some cases, just booking the first session and absolutely committing to going to it can show you that the real situation is not as bad as your fears. That is helpful for some people, they just jump in. This concern is something you could mention when scheduling the appointment so the psychologist knows you are feeling very nervous and can help you get more comfortable during the start-up. READ MORE
Please keep in mind this reply is for information only and does not constitute treatment. Neuropsychology is a sub-specialty of clinical psychologist focused on assessing and treating people with certain kinds of brain injuries and diseases. They have a lot of specialized training in testing, and in some cases, treatment of brain injury. Depending on your referral, the neuropsychologist may conduct testing to better understand your brain injury and make recommendations on how to treat and manage it better. Some neuropsychologists provide treatment customized for brain injury, often called cognitive rehabilitation, that would be specific to your injury and the effects of the injury. Basically, this person would likely either do testing to help describe what you need and how to make your situation better or starting doing treatment to address issues caused by your head injury. READ MORE
Dear Dealing with pain, anxiety, depression, Please remember I am a psychologist, so I can't address medical treatment matters. Also, this reply is for information only and does not constitute treatment. It sounds like moving to a new location has posed serious challenges to connecting with medical professionals and getting effective treatment for your fibromyalgia. Based on the title of your question, it seems that anxiety and depression are also part of the challenges you are trying to manage and treat. You may want to consider looking for a psychologist or other therapist that specializes in Health Psychology and therapy. These therapists often have specialized training in medical issues and the mental health concerns that tend to go along with them. These therapists may also be able to suggest medical doctors they are familiar with, who can provide integrated care for your medical conditions. Each state has a psychological professional association. The Florida state association's member search directory is found here: http://flapsych.site-ym.com/search/. Given that Florida is a very large and populous state, there may be local associations (central, south, north, panhandle, etc). Local associations also usually have directories of members and may include information on specialties (like health psychology). Have a look at the state directory for providers near you. Even if you don't want to see a therapist/psychologist, they may be able to recommend a medical doctor to meet your pain management needs. Welcome and good luck with your search for effective treatment, Todd Koser, Psy.D. NJ & PA Licensed Psychologist READ MORE
Dear parent, Please keep in mind this reply is for information only and does not constitute treatment. Good treatment for issues related to a diagnosis of Asperger's Syndrome should be customized to your child's and family's needs and current concerns. Asperger's Syndrome is one of the labels usually used to describe children and adults with autism, who also have relatively good language abilities and about average IQ. Children with autism have treatment needs that vary a lot. Treatment for your son really should be customized to his presentation. Some approaches that are very common to use with children on the spectrum include structured social skills training through individual or group therapy, Applied Behavioral Analysis (ABA), supportive talk therapy to address possible kid-specific concerns like anxiety, depression, or bullying; and often parent training. Working to determine what sorts of supports your child needs in the school setting is often a major focus of both treatment at school and with outside professionals, if needed. While I've listed the most common approaches, a good treatment plan and/or Individual Education Plan (IEP at school) will consider what your son does well, where he struggles, what you his parents need to help him, and community supports available. The general techniques are usually from some common sources, but should absolutely be customized to his needs and your needs. Sincerely, Todd Koser, Psy.D. NJ & PA Licensed Psychologist READ MORE
Dear Movie on Repeat, Please keep in mind this reply is for information purposes only and does not constitute treatment. Many younger children enjoy the same experience over and over in ways that can make their parents crazy. Disney and other animated movies are a very common area for this along with some YouTube videos. Up to a certain point, this can be common for 6-year-olds. The frequency and intensity you describe may be concerning. If your son has access to lots of other toys to play with and available playmates, but isn't very interested in them, then it may be an issue to look into. If your son is in school, you could ask them if they see the same intense focus there also. You could also ask his teacher if his social skills seem on target for his age. Ask if they think your son should have a developmental evaluation. Even if school reports no concerns, I think it is always good for parents to "trust their gut" and get more information about concerns. You can address the issue to your pediatrician and ask at what level you should be concerned about repetitive media viewing. Also, note if your son has other repetitive behaviors like repeating parts of the movie over and over (especially when it's not playing), spinning, walking in circles, or hand flapping. After discussing with your pediatrician, you can ask if she or he recommends an evaluation and with what kind of professional, if needed. Poor social skills along with intense focus may be signs of some developmental differences that merit specialist evaluation. Given that you have already developed some concerns, following up with the school and your pediatrician could be good next steps to see if your concerns are at levels where an evaluation would be a good idea. Sincerely, Todd Koser, Psy.D. NJ & PA Licensed Psychologist READ MORE
Dear Patient Privacy, Child therapists usually handle this issue based on a few factors: state law, the kid's age and ability, the specific concern, and the therapist's work style. For younger children, many therapists keep parents informed about the developments in therapy that occur, when the parent is not present. For tweens and teens who may be addressing issues that are hard to talk about with a parent, the ground rules may be different. Each state has laws that govern what rights a child and a parent have to manage information and privacy. Because of this, the age a minor can assume responsibility for their information differs depending on where you live and where the therapy is taking place. In some cases, psychiatrists get written permission from a parent to prescribe medication for a minor. It is usually helpful for the parent and therapist/psychiatrist (and often including the child) to have a discussion about what will be updated to the parent and how. Agreements will differ based on the child's age, your local laws, and the issue being addressed. When looking for a therapist or psychiatrist, this is one of the areas you can ask them about as you are interviewing possible providers. Many child mental health workers also have an informal agreement made between the child and parent about how information will be disclosed as the therapist may feel this is important to help develop trust and a good working relationship with the child. Sincerely, Todd Koser, Psy.D. NJ & PA Licensed Psychologist READ MORE
Dear Teenage Years parent, This reply is for informational purposes only and does not constitute treatment. The teen years are indeed very tough. Most adults shudder at the idea of going back to revisit them. While hard, most folks get through them OK. Given that you don't have any specific concerns at the moment, the first step might be to have some talks with your daughter about how she feels she is doing and any of the challenges you are concerned for her. If she feels OK and up to challenges of being 14, then getting out in front of things might not be necessary. You could also contact a local adolescent(teen) psychiatrist to ask for a consultation visit to discuss your concerns. A more detailed and in-person consultation could provide a place to voice your concerns to a professional and see if they feel an appointment for your daughter would be helpful. Sincerely, Todd Koser, Psy.D. NJ & PA Licensed Psychologist READ MORE
Dear Are Friends Important, Please understand this reply is for information only and does not constitute treatment. For most people, having a group of friends that are close is important. The number of friends and how much time we spend with them differs from person to person. There is a pretty wide range in what is "normal" for folks from having a couple good friends to the "social butterfly", who knows just about everybody and hangs out with their friends every day. In some cases, a kid may not have many friends because of a recent move, change in school, or shift in interests away from where most of their friends were (left an organized sports team). With these shifts, it can take some time to develop a new set of friends. In other cases, a kid may have a couple close friends they see primarily at school, but who live far away, so are unavailable to come to the house outside of school. These friends may not be obvious to parents who don't spend the school day with their child. These are different from the child who has not really had any close friendships for most of their life and seem uninterested in developing them. If your daughter is interested in friends, but doesn't know how to go about it, then structured social skills help through school or an outside therapist might be appropriate. Therapists and evaluating psychologists often try to determine whether social isolation is because of peer rejection or lack of interest from the child. These two situations are often approached differently. Have you talked with your daughter about whether she has friends you aren't aware of and if not, whether she wants to make some friends? If she is not interested, it is usually hard to force this onto a kid and maybe not helpful. If the child expresses some interest, structured activities like sports, dance classes, or special interest clubs can put them into contact with kids who like the same things they do. Friendships may develop simply out of contact with peers who have similar interests. Given that you have expressed worry about her seeming lack of friends, it may be appropriate for you to consult with a child and family therapist to discuss your concerns with a professional. If you chose to talk with a counselor, they might be able to help you determine whether the concerns are minimal or if some next steps could be indicated. Sincerely, Todd Koser, Psy.D. NJ & PA Licensed Psychologist READ MORE
Hi, thanks for your question and I'm sorry to hear about the loss of your loved one. For some people, a recent loss can trigger anxiety-based behaviors that were not a problem prior to the loss. Given your loved one's battle with cancer, that fear intensifying makes sense for you at this time. Fear and anxiety reactions can be very powerful and extremely uncomfortable. In order to feel better and make the anxiety go down, we usually seek out some kind of proof the situation is really OK - like going to the doctor and ER. Usually people feel better for a while, then there is a new twinge, or a flutter beat of your heart, so a new pain or trouble sleeping and the cycle starts over again. There are talk therapies designed to address overly intense fears. Exposure therapy is one of the main types shown to be effective in helping people cope with and reduce overwhelming and obsessive fears. Supportive therapy and grief counseling might also be appropriate if there are issues related to the loss of your loved one that are a part of your recent concerns. It's not appropriate for me to provide direct advice about how you should handle your situation, but I can confirm there are psychotherapies designed to address the type of situation you describe in your question. If you are interested in seeking professional help, look for a therapist who has experience with exposure therapy to treat phobias and medical fears. Clinicians in this area often describe themselves as using a cognitive-behavioral therapy or CBT approach. Specific mention of exposure therapy with response prevention and experience with medical phobias/fears could be helpful. READ MORE
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Patient Experience with Dr. Koser
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