Moving Clinics

I owe an intense debt of gratitude to Psychology and Counseling Associates where I started my private practice in 2008.  When I started there, we were small group of about 6 clinicians.  Today PCA has over 40 clinicians and multiple office locations.  I will continue to utilize PCA for it's vast base of therapists and testing resources.

I am moving to a smaller group again at Bridges to Wellbeing which is right across the street on Sunbridge.  I carefully moved all my Legos over the first weekend of April 2026 and will begin seeing patients 4/13/26.  I'm always taking new patients, but still booking out about 4 months.  

New Clinic Information:

Bridges to Wellbeing

28 W. Sunbridge Dr. Fayetteville, AR 72703

479-301-2284

https://bridges2wellbeing.com/

Community Resource Guide NWA

 Thanks to the Bentonville Special Education Equality Network!!  I found the old link was not working and realized the Community Resource Guide has been updated.  There have been many developments in the services in NWA since the original guide in 2014.  Here's the new link:  

https://www.bentonvillek12.org/site/handlers/filedownload.ashx?moduleinstanceid=34226&dataid=30260&FileName=resourceguide.pdf

Update on Medical Cannabis in Northwest Arkansas from a child psychiatrist perspective

I have now had numerous cases of children addicted to cannabis which has impacted their school and family life in such a way that they seek mental health treatment.  This has ranged from severe psychotic reactions to mild cases of addiction and self-treatment.  Children are accessing medical cannabis through friends and family and giving it to other kids at school.  There is widespread use of medical cannabis by parents of the children I treat.  The parents often give children these products due their own experiences. 

My opinions have been confirmed by what I see in the clinic and in the larger public.  Cannabis should be a legal recreational substance for adults like alcohol.  Cannabis is not a recommended medical treatment for psychiatric disorders.  Like alcohol, it can be helpful for acute anxiety and depression in adults. Like alcohol it can be overused and create negative consequences.  Cannabis should not be given to children for any psychiatric diagnosis.  Cannabis is not a treatment for Autism.  Cannabis has unpredictable side effects for all individuals.  The commercially available products are extremely potent.  Cannabis delivered through vape cartridge is powerfully addictive.  Like alcohol, children can not moderate their consumption of cannabis when they have free access to it. 

 

Go get your dang VACCINE

Vaccine hesitancy is rampant. I don't understand why.  Herd immunity is the key to getting us back to normal.  Young healthy adults and kids are some of the most hesitant to get vaccinated.  I admit, they are the group least likely to be affected by the virus, but they are also the most likely to be spreading it.  We owe it to our fellow humans to get vaccinated right now!  The vaccine is safe.  The longer the virus mutates through unvaccinated individuals the more strains we will be dealing with and the harder it will be to predict the next epidemic.  

Vaccines are considered by historians and medical professionals to be the greatest inventions of all time.  Vaccines have saved millions of lives.  The history of vaccines and inoculation goes back hundreds of years beginning with measles and small pox preventions.  Diseases of the past have been virtually eliminated due to vaccines for polio, pertussis, meningitis, cholera and yellow fever among others.  Travel between continents was one of the greatest causes of new disease until the past 2 centuries when universal vaccines helped boost our immunity.  Explorers and conquerors were spreading disease to new places for hundreds of years.  With the global nature of our modern economy, now we can all see the impact of a pandemic.  

The Covid-19 vaccine is based on years of science.  It is NOT a new idea, and should not scare anyone.  We got extremely lucky in this pandemic.  Scientists were doing the groundwork to prepare for the world's next super virus way before Covid hit.  The technology that went into mRNA vaccine has been around for almost thirty years.  It all started at the Salk Institute (Jonas Salk is the guy who invented the polio vaccine).  Look up Katalin Kariko and why she is so important.  She was working on this in 1990, and her work has spawned billions of dollars of research to get us where we are.  We would not have been able to produce such a rapid supply of the Pfizer, Moderna, and Johnson and Johnson Vaccine if not for years of vaccine research. 

Covid-19 Response

The clinic is still operating during Covid-19, but I have been doing 100% telemedicine as of mid-March.  I see a mix of Zoom evaluations and phone calls.  I feel incredibly blessed to be able to continue operating a business during the pandemic.  I am seeing fewer new clients, mostly follow-ups.  The impact of the virus on the kids has been quite variable.  Some have reduced stress due to social distancing.  Some have increased fears especially kids with germophobia and separation anxiety if parents are essential workers.  The response to telemedicine has been immense gratitude.  We have no idea when we will see patients in the office again, but hoping to make some decisions by June. 

Can We Predict Dementia by Personality as a Teenager?

Investigators assessed personality traits in more than 80,000 individuals from a national sample of high school students in 1960 and found that adolescents who rated higher on the "vigor" scale were 7% less likely to be diagnosed with dementia 5 decades later.  Vigor was defined as having a more energetic disposition and more extroversion.  Calmness and maturity in teens also transferred a reduced risk of dementia.  

The interpretation highlights the importance of child mental health with specific reference to encouraging calming techniques and physical activity.  This study meshes well with other studies that have indicated relief from anxiety as well as healthy lifestyle habits have a dramatic positive impact on the prevention of mental illness. 

Chapman BP, Huang A, Peters K, et al. Association between high school personality phenotype and dementia 54 years later in results from a national US sample. JAMA Psychiatry. 2019. 

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2752387

Dank Vapes are not so dank

I have treated kids who have had the lung injury from vaping.  The major culprit is counterfeit THC oil inside of vape cartridges.  These generally come from illegitimate dealers who are making a profit off of gullible children.  The Dank Vapes is not an actual company that makes the cartridge.  They make the packaging that looks appealing to kids.  The dealer can put any type of hardware into the packaging.  There have been high profile arrests of dealers who had thousands of the packages empty and ready to be filled with counterfeit cartridges containing who knows what.

Pharmacogenetic Testing

Many of my families are asking about pharmacogenetic testing (PGT).  Some families are coming with the results of testing and asking for my interpretation.  I often see a child whose parent had the test and their result can help in my recommendations to the child.  PGT is particularly helpful in antidepressant and antianxiety medication.  The tests are primarily of genes for liver enzymes called cytochrome P450s (CYPs).  We know which CYP chops up which medication.  You can be normal for one enzyme, low for another and high for another.  Other tests are related to serotonin and dopamine receptors.  These can help predict response to certain categories of medication.  Methylfolatereductase (MTHFR) is typically in the panel of tests.  MTHFR is an enzyme that helps folate get into your brain.  Folate is used to help make various neurotransmitters and reduce inflammation in the body.  If MTHFR is low, a client can take a special supplement called l-methylfolate or folinic acid because regular folate in diet or vitamins won't help. 

Pharmacogenetic testing should not be used as the sole determinant for choosing medication.  It will not tell you which medication will work.  The test is more helpful in telling me what not to use or why you got side effects.  The reports are typically simplified into categories of green "use as directed", yellow "use with caution" and red "use with extreme caution".  However, the best medication might be in the red zone.  We just might need to start a very low dose of a medication that you metabolize slowly.

There are multiple companies providing similar tests.  All of them are either oral swabs or saliva tests (no needles).  I have used Genesight and Millenium the most and both are great.  Insurance companies often do not cover this test.  PGT tends to save a lot of trial and error so my hope is that insurance will cover it more often.  The benefit is usually a more targeted approach to medication and less time spent switching between meds.  All of the companies allow you to pay for the test privately for about 250$.  The test comes back in less than a week. 

Cannabis

I am seeing a rise in cannabis issues that are probably going to get worse once Arkansas has established dispensaries.  My personal feelings about cannabis are similar to my sense of other recreational substances: some ADULTS can responsibly use these substances and some can't.  Children definitely cannot responsibly use recreational substances especially cannabis.  However, the passing of medical cannabis laws seems to elicit a sense of social acceptance and safety that has detrimental effects on our kids.  Much of the cannabis is coming from legal sources in states with recreational cannabis where an Arkansan buys a large quantity and brings it back to our state.  There are many sources available on dark web shopping sites.  These dealers are typically shipping a large number of dabpens that are preloaded with cartridges of concentrated cannabis oil.  Many parents mistake these as typical vapes or e-cigarettes.  Getting to the root of the cannabis issue is often part of my job.  Some kids are purely using for pleasure.  Some kids are treating an underlying depression or anxiety disorder.  Some kids are very susceptible to peer pressure and can't say no.  If you have a child struggling with cannabis abuse, you are not alone.  My typical recommendation is to drug screen twice weekly and base your child's privileges on passing.  Know where your cash is going, get a receipt.  Check their Venmo.  Check their DMs and Snapchat.  Check your mailbox and their backpack.  Verify your child has not established their own P.O. Box.  Good luck out there.

Fitness in Mid-life reduces dementia in elderly

A recent study reports a 36% reduced rate of dementia in individuals whose fitness was tested 25 years earlier.

To AP or not to AP

Is there advantage for the average high school kid to take AP classes?  Some people would say "absolutely".  You have to go to a great college, and the only way to get in is to have AP classes with a high GPA.  But wait.. even if you get in, can you afford it?  Is it worth it? I see so many stressed out, over-scheduled high school kids that I have come to wonder if the average student needs AP at all.  The sleep-deprivation and anxiety just do not seem worth it sometimes. 

Resource Guide for Northwest Arkansas Families

Parents, this is a wonderful resource guide compiled by a group of parents in the Bentonville School District. 

https://www.bentonvillek12.org/site/handlers/filedownload.ashx?moduleinstanceid=34226&dataid=30260&FileName=resourceguide.pdf

"Fed Up" notes fedupmovie.com

I just watched the new documentary by Laurie David called "fed up".  Here are some notes I made.  It's a great documentary with commentary from some of my favorite food experts like Gary Taubes and Michael Pollan.

Sugar is poison. Sugar is poison.  Sugar is poison.  Sugar drives the pancreas to secrete insulin.  Insulin drives the fat cells to grow.  80% of the food items in a grocery store have added sugar.  Low fat equals high sugar.  All grains and potatoes are digested into sugar in an instant in the digestive tract.  Fruit juice is just as bad as soda.  Americans eat twice the amount of sugar the did 40 years ago. Sugar is 8 times more addictive than cocaine.  The American food industry preys on children from the youngest age causing them to be addicted to sugar laden processedy food.  Simple carbohydrates are the cause of metabolic syndrome.  Junk food is still junk even if it's labelled as less junky.  It is not possible to exercise enough to correct obesity when sugar is too abundant.  The government subsidizes precisely the food that makes us sick.  More than half of all high schools serve branded fast food.  French fries and pizza are counted as vegetables under the school lunch program.  Only eat products that are as close to nature as possible.  Avoid processed foods. Added sugar is in tons of hiding places.  Avoid fast food and kids menus. Replace juice, milk, and soft drinks with water.

Fall is a great time to get the kids outside enjoying the wonders of Arkansas.  Living in NWA we are just a stone's throw from tons of cool outdoor places.  Of course, kids are content to watch their shows, play on their iPads, play more Minecraft, watch more youtube videos (about Minecraft), or kill some more zombies, but that is not what mother nature intended. Our bodies and minds are made to be outside.  We need to walk, to climb, to search, hike, paddle, and gallop.  A night or two of camping can bring family bonds back together like no other activity. There's inevitably something we forgot to bring, a run in with an insect or two, and strange sounds at night. Improvisation and spontaneous reaction to unexpected events is bound to occur.  Getting kids out of their routine is great practice for real life.  It triggers creativity that makes us more well-rounded in our abilities and skills.  Outdoor activities build confidence that kids can tackle unexpected problems.  The unknowable becomes not so scary.  Take a family bike ride, rent kayaks at a local state park, get a couple of fishing poles, pack a hammock, do a trail ride, zipline, read a guidebook with the kids and see what they'd like to do.  These links are some of my recent favorites and places I've been:

arkansasstateparks.com
Buffaloriver.com
www.ziplineeurekasprings.com
http://bearmountainstables.com
http://www.rockclimbing.com/routes/North_America/United_States/Arkansas/
http://www.getoutozarks.com/news/2012/apr/11/get-way-back-kayak/
http://www.recreation.gov/camping/lake-wedington/r/campgroundDetails.do?contractCode=NRSO&parkId=75480
http://www.razorbackgreenway.com
http://www.timernst.com/guidebooks.html

High Price by Carl Hart PhD

I just finished the new book, High Price by Carl Hart PhD.  Dr. Hart had made the rounds on several talk shows and he sparked my interest talking about his research in drug use behavior and decision making.  I thought the book would be an explanation of his research and how it applies to current drug counselling and treatment.  What I found was an autobiography that was quite compelling.  Dr. Hart views himself as profoundly lucky to end up where he did, and he compares himself to many of his childhood peers who ended up in a life of drugs, poverty and crime in Miami.  Dr. Hart grew up in a rather abusive broken home, raised by extended family.  His own family and friends struggled with addiction, violence, and poverty. Somehow, he avoided the path of many of his cohort.  Hart demystifies the addicts behavior and explains it more in terms of a response to poverty and hopelessness.  He stands opposed to the common view of drug addiction as an unstoppable brain illness.  He removes the typical heirarchy of addictive substances and views all intoxicants on a fairly level playing field. His research shows that given sufficient positive rewards even hard core drug addicts are capable of rational decisions.  He criticizes the efforts of the government to respond to drug use behavior with law-enforcement answers and he illustrates how incarceration of addicts results in continuation of the poverty that was the original problem.  

I took away some great advice for teens struggling with substance abuse. Much like a parent might insist on use of birth control and condoms for a teen they know is sexually active, Hart gives similar advice for teens that you know are using drugs:
1.  Combining multiple drug types is the most common reason for an overdose especially alcohol with another CNS depressant.
2.  Do not model your drug behavior off that of more experienced users because they have much higher tolerance.
3.  Drugs off the street are not always pure and can be adulterated with all kinds of poisons that are more dangerous than the drug itself.
4.  Drugs are highly illegal and you are allowing your future to be controlled by lots of other people other than your parents if you are charged with a drug crime.
5.  Adequate sleep is the foundation of mental health.  Any behavior that results in sleep loss will undoubtedly result in emotional and physical deterioration.

Separation anxiety and school refusal

It's week 3 of school on Arkansas and separation anxiety is on my mind.  This time of year usually creates a dramatic increase in anxiety for kids.  Many children will refuse to go to school or will come down with some mysterious medical symptoms that might be explained as anxiety.  The most common complaints are gastrointestinal and fatigue, but they could include headaches, dizziness, and other neurological symptoms.  Sunday nights and Monday mornings tend to be the most common times when those symptoms are coming from anxiety, so if you notice this pattern you may want to consider anxiety as the culprit. The solution?  Well it may sound old-school but a little bit of "tough-it-out" will really help.  The child must go to school for this problem to get better.  Often the pattern develops and is given too much sympathy, then starts to build into days and before you know it a kid has missed two weeks of school.  I often advise a plan to ride with another family or a grandparent to break the pattern of an overly-sympathetic parent caving to the child.  The child will often remain more composed for someone who is not the parent.  In extreme cases, I will recommend a shortened school day, but I generally recommend trying to start the day at the beginning of the school day.  If your family is suffering from this problem, there are many local mental health professionals that can help including psychologists, social workers, and licensed counselors.  In severe cases medication may be helpful.  Pediatricians are usually the first contact when the medical symptoms are prominent.

Connecticut Shooting

The recent tragedy in Connecticut and other previous school shootings highlight the shortcomings of the mental health system in treating adolescents and young adults.  First people will blame the guns, then demonize shooter and his family. Undoubtedly, the shooter will be revealed as having a serious mental illness.  And undoubtedly, there will be revealed a number of tipping points that could have stopped this from happening going all the way back to his early childhood.  This was a human being at some point in his life who had a mother who cared for him, was intelligent, and had his own dreams and aspirations.  Somewhere these dreams were crushed and this is the terrifying result.  Some small acts of kindness formed together over time might have stemmed the tide of rage and anger that overtook him in these horrific acts.

What I am telling my children is to always remember that even the quietest, strangest kid in your class needs a friend.  Even the meanest bully has a heart somewhere.  I am telling my kids to never forget to say I love you to those you are the closest.  Don't pass up the opportunity to do something nice for another person.  Despite the media attention to this horrible tragedy, we live in the safest times that have ever existed.  It is because of our collective small acts of kindness and fostering empathy even to the least of these, that there is much more good in the world than evil.  As a community, we have to help those we know are at risk of these types of acts.  Working together we can help more.

Why I Love Crossfit

This weekend I participated in a gathering of over 500 athletes from around the region for a team Crossfit competition called Heart of America 4.  If you are unfamiliar with Crossfit, it is a fitness movement that focuses on not specializing in any particular aspect of athletic performance.  A Crossfitter strives to be a complete athlete.  Crossfitters work on endurance, stamina, strength, speed, power, agility, coordination, accuracy, balance, flexibility, and sometimes all of these at once.  Team and individual competitions are starting up all over the country, the most esteemed of which is the annual Crossfit Games popularized by replays on ESPN in the past 2 years.

The Heart of America 4 competition included 5 workouts over 3 days that were unknown to the competitors beforehand.  Each team was comprised of 3 men and 3 women.  When we arrived, the first workout was announced.  All six athletes on each team had 5 minutes to do as many rounds of the following exercises: 5 overhead squats, 10 kettebell swings, and 15 double-under jump ropes.  This may sound pretty hard or complicated, but to the average Crossfitter, these were perfectly reasonable requests.  We had trained on these exercises and felt pretty confident we could do it.  The rest of the weekend included lots of other difficult tasks, but we did it all and came away with a great sense of community, accomplishment and team work.  It was really hard, but really fun.  We had some successes and some failures.  The most touching moments came when our female athletes struggled with new movements and weights they had never done before, but kept going and going until the clock stopped.  Even though we struggled, these were our biggest bonding moments of the weekend as we hugged each other and shed a few tears for the disappointment all the while congratulating our athletes for the effort.

One thing I really love about Crossfit, is that there is no defined body type of a crossfitter yet everyone has to do the same workout.  I'm a bit stocky at 5'9" and 180lbs, but two of the guys on our team were well over 6 feet tall.  One of our female athletes is barely 5 feet tall and 100lbs.  Some of the women on other teams were nearly 6 feet tall and stronger than many of the men.  But through our experience of Crossfit, we all approached every workout with the same attitude: "OK, I can try this."  Certain body types do play to certain strengths and weaknesses, but the goal of Crossfit is to be well-rounded and capable no matter what you are asked to do.  I think this translates well into mental health and life in general.  Our lives are unpredictable.  You never know what surprise, joy, or tragedy is coming around the next corner.  Every human has their own strengths and weakness, personality types, and experiences.  If you have never tried something, you are going to be afraid of it.  If you have never allowed yourself to experience failure, you become mentally stuck and sell yourself short of your true potential.  But if you approach life with the attitude of a Crossfitter, things can be very different.  What am I afraid of? Let's go do it. What is my weakness? Let's work on that.  What have I accomplished so far?  Maybe I can do even more.  Crossfit helps the individual become more prepared for the unknown and the unknowable.  It helps you become confident that you can get through adversity.

I also love the social aspect of Crossfit.  As human primates, we all need to feel that we belong to a tribe.  Society is way too large to manage from a psychological standpoint.   Mentally, it comforts us when we break our massive population into manageable factions and groups.  That's why some of us enjoy being on a team, working in our businesses, being part of a church, joining a book club, attending a support group, affiliating with a political party, and hanging with our family. Psychologists and archeologists think our brains are only capable of maintaining about 150 social relationships at one time.  The people who are the closest are those who have been there when we have laughed or cried together. To belong to something bigger than yourself is really important, and it's also important to feel like you are a contributing member of that group.  Not belonging to anything leads to depression, and social isolation is one of the most miserable of human conditions.  Crossfit is a great outlet for the basic human need of belonging.  It fulfills the individual need for praise and it is very nurturing.  As Crossfitters, we enjoy looking to our coaches to help us reach the next goal, working at full intensity with our friends, and passing on our own knowledge to the newer athlete.  I am so thankful for my experiences this past weekend.  Below are some links:

crossfit.com
crossfit540.com
library.crossfit.com/free/pdf/CFJ_Trial_04_2012.pdf
heartofamericacrossfitthrowdown.blogspot.com

Physician, Heal thyself

In my quest to help kids and families, I committed a cardinal sin- I ate red dye number 40!..  And OMG I paid for it.  I was aware of a sensitivity that I have had to red-colored food in the past.  I've had a few minor reactions to red and blue sports drinks containing red 40 in the past.  Yesterday, I ate a huge red pop-ice at my daughter's summer camp.  I have never had such a severe food reaction.  Literally ever fiber of my body paid for it.  Within about 10 minutes, I felt weird and weak.  Later, I felt dizzy, nauseated, and had a continuous migraine that did not remit until about 24 hours later.  I had migrating joint pains for several hours and became incredibly sleepy within about two hours of ingestion.  This was a big wake up call that even a single exposure to red 40 can be incapacitating.  Interestingly, my daughter had an orange pop-ice, also containing red 40, and she had a similar reaction that happened much quicker and was over with sooner.

Artificial food dyes are in a ton of our food supply.  Several have been shown to increase growth of tumors in mice.  Elimination of artificial food dyes has been shown to improve symptoms of hyperactivity in ADHD children.  Many children with behavioral reactions to artificial food dyes would also benefit from elimination of other foods such as soy, wheat, and dairy.  Children with preexisting environmental allergies may benefit the most from elimination diets.

Finding Emo

I walked into Barnes and Noble dumfounded by a new section in the bookstore, Teen Paranormal Fiction.  The popularity of vampire love has skyrocketed in the last few years.  I'm having trouble grasping the appeal.  I know a little about Twilight and sparkly vampires.  Vladamir Tod seems to be the teen vamp heartthrob.  The kids I see liking this stuff are already having some issues.  They tend to be the kids on the fringe of the social hierarchy.  I'm just not convinced that reading about fantasy characters falling in love is very helpful if this is the only thing you are reading.  It seems to cause an unhealthy fascination with being very different.

I'm all for individuality but sometimes it is taken too far with all black clothes, excessive makeup, hair dye, piercings, tattoos.  And scariest of all, these seem to be the kids most likely to cut themselves.  It gets me wondering if all the blood and gore in these paranormal books and shows is doing some type of desensitizing to self-inflicted violence.  Does it encourage strangeness by supporting the idea that even the evil have some redeeming qualities?

Teaching kids to conform a little can really help them fit in.  I think individuality is a bit overrated.  In the end, your kid needs to finish as much school as possible and eventually get a job.  Don't tie one hand behind their back allowing them to be ostracized for the sake of self-expression.  Don't allow permanent changes to hair, skin, and earlobes.  While they're under your roof, require a little conformity, monitor who they are hanging with, and by all means monitor the media and books that they are downloading into their developing little hard drives.  I believe you are what you eat, and to some extent, you fantasize about what you watch, read and hear.  Keep your appetite healthy and varied.