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What Families Living With ADHD Need To Know

A health condition impacting many families today is Attention Deficit Hyperactivity Disorder, also known as ADHD. Joel Desotelle, MS OTR/L, pediatric occupational therapist and program director of Keystone Pediatric Therapies in Chambersburg, offers some insight and tips for individuals and families living with ADHD.

ADHD On The Rise

According to the CDC (Centers for Disease Control and Prevention) as of 2016, 9.4% of children (6.1 million kids) ages 2-17 had been diagnosed with ADHD. This is up from 7.8% recorded in 2003. Of those, 64% have another disorder, including behavior/conduct issues, anxiety, depression, autism, and/or Tourette syndrome.

Common Problem Areas

Individuals with ADHD have difficulty paying attention, controlling their impulses, and struggle with transitioning to and from activities. While many individuals have normal and even higher intelligence, their limited ability to focus makes listening and learning hard and even uncomfortable or frustrating. To compensate, they often use behaviors to control their environment to avoid difficult tasks or requests. As a result, individuals are often labeled, have difficulty realizing their potential, and even suffer from low self-esteem.

Contributing Factors

Diet, lack of physical activity, poor sleep schedule, and/or extended time playing video games, watching television, or being on the computer/tablet may contribute to your child’s inattention.

Strategies For Individuals Living With ADHD

If you are concerned that your child may suffer from ADHD, you should consult your child’s physician to learn about treatment options. In addition, there are many strategies that are beneficial for all children. First, kids benefit from structure. Having a good daily routine helps children get organized and learn to stay organized. Keeping toys and activities in separate designated boxes encourages structured play, while “toy boxes” containing all of a child’s toys are often overwhelming. Modeling organized play, especially for young children, sets a good standard they can incorporate as they get older.

Secondly, children need physical activity. Video games, TV, computers, tablets, and phones should be limited. While they offer an almost endless vault of games and activities, it is extremely important for children to use all their senses. Hands-on tasks promote cognitive and motor skills that electronics do not. Third, make sure your child is getting a good, healthy diet and lastly, children need adequate sleep to grow and develop. Setting a regular bedtime and being consistent will make sure your child is ready to go the next day. Remember, tired kids have a difficult time focusing.

Occupational Therapy And ADHD

Pediatric occupational therapists specialize in helping kids regulate, improve attention, address delayed skills related to ADHD (ex. fine motor, writing, etc.), and can help you develop home/school strategies so that your child can be more successful, happy, and confident. If you notice your child is struggling in any of these areas, he or she may benefit from occupational therapy services.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.


Employee Spotlight – Jules Bulka

The Keystone Health Employee Spotlight for June shines on Jules Bulka, Lead Billing Representative at Keystone Dental Care!

Jules began working at Keystone in 2013 as a front office representative.

“I was attending college at the time, but I had no idea what I wanted to major in,” she said. “I decided to take a break and look for a better job in the meantime, which led me to Keystone. What I soon realized is how there are many possibilities of advancing within Keystone. I went from being a front office representative to becoming a billing representative, to now the lead, and I have enjoyed every step of the way.”

One of the things she enjoys about her job the most is her co-workers.

“My favorite part is honestly having the people I work with,” Jules said. “The atmosphere of the office I work in and the team that works alongside me every day makes it worthwhile to be here. We don’t always see eye to eye, but at the end of the day we all have one goal and that is to get the job done and we have fun accomplishing it.”

She also enjoys knowing that Keystone is making a difference in the lives of our patients each day.

“Keystone is an organization that will always put their patients first and I know myself and my fellow co-workers do the same,” she said. “It’s a wonderful thing to see others go the extra mile to help assist our patients in all aspects. I take pride in the fact that many of our patients see Keystone as more than just a business and that they can put their trust in us.”

While Jules does most of her work “behind the scenes,” she still plays a big part in the healthcare team.

“I take pride in being a part of the last steps in a patient’s visit,” she said. “The billing department does not get a lot of face-to-face interaction with the patients, but we make many phone calls either to the insurance companies or to patients to ensure that their experience after they leave the office is just as smooth. At one point I did not know the answers to some of the questions we are asked by patients, but now it makes me feel really good when a patient gets to have that ‘ah-ha moment’ because of the explanation I was able to give.”

While each day can bring new challenges, Jules is always ready to give her best effort to keep her department running smoothly.

“There is always something new to work on in billing,” she said. “You always have your everyday tasks, but there are many different questions that need answered throughout the day as well. On a normal day it’s posting payments, making calls, and keeping up with the constant flow of mail. It is an endless cycle, but I enjoy it.”

In her free time, Jules keeps busy with her favorite hobbies: hunting, traveling, walking and hiking, tubing in nearby creeks, and spending time with her family and friends. Her love of traveling has led her to visiting nine different countries, and she will soon add one more when she and her mother visit Peru this month.

“I have been very blessed to have my mom join me for many of my travels,” she said.

Jules lives in Carlisle with her husband and three pets.

“My husband and I have been together since we were 13, and we will be celebrating our third wedding anniversary in August,” she said. “We have a beagle/rottweiler mix, Luca, a husky, Rumor, and our cat, Echo. We look forward to starting a family of our own in the future.”

Thank you, Jules, for all that you do for Keystone and our patients!


Are You Or Your Children Overusing Electronics?

While many people would seek immediate attention for a physical problem, mental health is often overlooked even though it is just as important to overall well-being. Trond Harman, a Licensed Clinical Social Worker at Keystone Pediatrics Chambersburg, is seeing growing mental health problems in kids and teens related to the overuse of technology. In today’s article, he shares some information that every electronic-user, and all parents, should know.

Are there positive things about using electronics?

Yes. Technology is a great way to connect to people and keep us in touch with the rest of the world as well. If technology is used in moderation, it can be a wonderful tool that includes things such as support groups, so that a person with a particular problem does not feel so alone. And it is obviously full of information that can help us know more about the world that we live in.

What are some drawbacks of too much use?

As I discussed in my previous article, too much use can lead to isolation, difficulty interacting with others face-to-face and an inactive lifestyle. This, in turn, can cause or contribute to mental health issues such as anxiety and depression. In addition, many people take gaming and internet usage way too seriously. Posts on social media can lead to comparison, jealousy, and drama issues. There are also addiction problems in the gaming industry that lead to players continuing to try and try and try to do better in a video game, and therefore spending numerous hours playing.

What advice do you give your patients about proper electronics use?

The best advice that I can give about using the internet appropriately and properly is to set a timer for yourself. When the timer goes off, you need to stop what you are doing and find something else to do. It is extremely easy to spend hours on the internet and not accomplish anything. I would also set goals for yourself when using the internet, because far too often we find ourselves looking for one thing, but instead go off in numerous different directions. We then later realize that we have not found any information about what we were actually researching, because we ended up looking at something else.

What advice would you give to parents about how much time is too much for kids and teens?

Parents need to set firm, strict limits for their children. The biggest issue that I find with technology, video games, and social media with children is that they will tell their parents it is causing them to be more depressed because the parents have taken away their technology. This may be true because it does give kids who are isolated a way to connect with others, but many times it is used as a manipulation by the children to make their parents feel guilty about implementing limits.

I’ve had parents do numerous things to help set effective rules for technology. These include only parents knowing passwords to the internet, setting timers, having their child earn internet privileges, and of course, monitoring what their child is doing on the internet. I am not sure if you can say how much time is too much for being on the internet, but during the school week if your child is spending more than two hours every evening on the internet or playing video games, that is probably too much.

What are some signs that it may be time to cut back usage?

Many times, internet addicts use the internet as an escape from real life, and a fantasy world to connect with people online as a substitute for connecting with people face-to-face. Many of those with an addiction to the internet are unable to achieve these relationship connections normally. Some signs of possible addiction include neglecting work or chores, losing track of time when online, hiding or feeling defensive about the amount of time you spend online or what you do while online, becoming upset when your internet time is interrupted, feeling excitement from being online, using electronics as an outlet for your feelings and feeling that your online friends are the only people who truly understand you.

Parents need to look for signs that their child is isolating themselves more or that their grades are dropping. Parents need to also communicate with their children to make sure that there is no additional drama that is being caused by internet usage.

As an adult, if you are struggling with meeting deadlines at work or you find that you are sitting at home much of the time playing games, then it is time to cut back on your usage.

It can be difficult to monitor yourself and your children, but by implementing a few effective guidelines up front for you and for your family, it can be extremely helpful with making sure you use electronics in a proper and healthy way.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

The Effect of Electronics on Mental Health

May is Mental Health Awareness Month. One of the most widespread things affecting mental health in our society today is the overuse of electronics, including video games and social media. Trond Harman, a Licensed Clinical Social Worker at Keystone Pediatrics Chambersburg, often sees problems related to this in his child and teen patients. In today’s article, he shares some information about how electronics can affect mental health.

What are some of the ways electronic use is connected to mental health?

The use of electronics and mental health are connected in multiple ways with one another. The first, and probably most prevalent, is that electronics, video games, and social media tend to lead individuals to living a much more isolated life. Many times, people will spend hours at a time playing video games or being on some other form of electronic device, which leads to isolation from the outside world.

The argument that I normally hear about being too isolated while on electronics and social media is the fact that there is interaction with other people. This is done through things such as online gaming where you will play as a team and you can interact with these individuals through the use of microphones. The problem is that the players they are gaming with end up being more important to some people than even their own family. I have had numerous situations with teenagers where their parents will tell me that the child will drop everything to engage in playing a game with people that they have no connection to or even know on a personal level.

What problems can this cause?

Isolation leads to people struggling with normal social interactions. I have seen a lot of teenagers who have many issues with a basic reciprocal conversation because they have anxiety when speaking to someone face-to-face. This is an issue that I am seeing more and more of every day. It leads to anxiety levels increasing because of the fear they have of speaking to someone in person.

Another issue that goes along with engaging in these types of interactions is that many times the people with whom you are interacting online may be from another time zone. I have had numerous cases of teenagers playing video games until all hours of the morning and then not being able to wake up for school. The person they were playing video games with may have been in a time zone where it was daytime or an hour where they were not losing sleep or having it interfere in their lives. I have observed this leading to truancy issues with school because of the lack of sleep or the child’s anxiety with leaving the home.

Finally, when you over-engage in using electronics, it leads to a sedentary lifestyle. There are numerous problems that can be caused by this. One of them is that you are more prone to having weight issues, which can lead to low self-esteem and possible depression. Another problem with a sedentary lifestyle is the lack of exercise. There are numerous studies that correlate exercise to good mental health.

What mental health conditions can too much use cause?

The most prevalent mental health issues that are caused or can be contributed to electronics and social media use are depression and anxiety. People develop increased anxiety related to the struggling with basic interactions. They are alone in their home when they are engaging in many of these activities and their anxiety levels increase when they have to go out into the world. The more people are alone and isolated from others, the more likely they are to be depressed. A lot of people will tell you that they have many friends, but when you dig deeper into these friendships they are based on people they know online.

Can it become an addiction?

It can become an addiction and it is actually recognized as Internet Addiction Disorder (IAD) in many other countries. It is not yet recognized in the United States and therefore getting treatment for the addiction can be tricky. The most likely way that people get treatment is through some other diagnosis recognized in the Diagnostic and Statistical Manual of Mental Disorders, which is used by clinicians and insurance companies to classify mental health conditions. The problem is most likely listed under something such as anxiety, depression, or some other obsession related to internet usage such as gambling or pornography. While there are numerous programs around the country that specialize in treating this condition, the person would need to have a diagnosis from the manual for their treatment to be covered by insurance. Internet Gaming Disorder has been added to the manual’s appendix, and will likely make it into the manual itself in the near future.

It can be difficult to determine if and when treatment might be needed for internet addiction, but according to researchers from the University of Iowa’s College of Medicine, “Internet addiction is characterized by excessive or poorly controlled preoccupations, urges or behaviors regarding computer use and internet access that lead to impairment or distress.” Treatment options for internet addiction include inpatient and outpatient treatment facilities, counseling, therapy and support groups.

In the next article, I will give some advice about how much use is too much for both adults and children, and give some tips to parents for helping their kids and teens make healthy choices when it comes to electronics use.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

Employee Spotlight — Shavonne Statum

The Keystone Health Employee Spotlight for May shines on Shavonne Statum, Office Coordinator at Keystone Community Outreach!

Shavonne started her journey at Keystone in June of 2013 at our Chambersburg Pediatric office. When Keystone opened its Community Outreach site on Lincoln Way East in the summer of 2016, Shavonne applied for and received her current position.

“Ultimately, it was Keystone’s mission statement that led me here versus other health care facilities in the area,” Shavonne said. “It gives me a sense of pride when I hear patients talk about how grateful they are for a service that Keystone provided them when no other facility would, due to lack of insurance or inability to pay at the time of service.”

Everyone who visits Keystone Community Outreach and crosses Shavonne’s path can count on a warm greeting and a smile.

“I always start off each day with a big smile and a cheerful ‘Good morning!’ she said. “I think it’s important to spread a little sunshine first thing in the morning to set the tone for the day. I love the fact that we all like to have fun here. It’s a great atmosphere, and patients enjoy the warm welcome too. I love to see people smile and I’m glad that I can be a part of the reason they do so.”

When she’s not welcoming visitors at the front desk, Shavonne keeps busy with many other tasks.

“We typically see patients from 9 am until 5 pm Monday through Friday, with extended hours until 7 pm on Tuesdays,” she said. “You can find me doing a variety of different things such as checking patients in, answering calls, scheduling, scanning, testing, attending meetings and trainings, or working on reports.”

Shavonne enjoys knowing that the effort she and her co-workers put in each day has a lasting impact in our community and beyond.

“I love meeting new people and being able to assist those in need,” she said. “We are fortunate enough to see patients from many different areas. Knowing we are able to help change lives for the better, gaining trust and understanding and building relationships within our community is what makes me most proud of what we do.”

When she’s not at work, Shavonne’s family life and hobbies keep her very busy.

“My immediate family consists of my fiancé Robert, my sons J’Vaughn and J’Lhen, and the newest addition, our baby girl Milan! I come from a huge, close knit, loving family. We always find reasons to get together and if we don’t have a reason, we just make one up. Our family is so large that our family reunions take place in a different city or state each year. The location is decided by the committee, which I’m a part of, and lasts for three days. We have a president, vice president, treasurer, historian, secretary, etc. on the committee. We’ve gathered in places like Charlotte, NC, Kissimmee, FL, Memphis, TN, and Mt. Laurel, NJ just to name a few. Next year is a special celebration in which our reunion will be hosted via a cruise liner. What can I say, we love to have fun!”

Shavonne’s hobbies include reading, dancing (including Zumba), trivia, cooking, baking, skating, swimming, traveling, and sports. She is a team mom for both of her sons’ sports teams which include football, track and field, and Amateur Athletic Union travel basketball.

When asked what people may be surprised to know about her, Shavonne revealed two hidden skills: “I am a certified phlebotomist and also have my Commercial Driver’s License,” she said. “I was teaching preschool in 2009 and we didn’t have enough bus drivers to go on many field trips. I decided to obtain my CDL so I could drive the children myself.”

While she’s originally from Chambersburg, Shavonne moved her family to Shippensburg last year.

“I like the small-town feeling this area provides,” she said. “Wherever I go, I run into people who know me or my family. I often hear ‘Are you related to…’ It’s a great feeling to know that people know you come from a great family! However, one day I plan on moving to Wake Forest, NC. That’s my dream location!”

Thank you, Shavonne, for all that you do for Keystone and our patients!

May Is Mental Health Awareness Month

May is Mental Health Awareness Month and we are doing our part to shine a light on the subject and break the stigma about mental health conditions. If you visit any of our locations on a Wednesday in May, you will spot many of our staff members wearing green to show their support. Our Chief Medical Officer, Dr. Michael Colli, shared the following message with Keystone staff at the beginning of the month:

“Since 1949, May has been designated National Mental Health Awareness Month…The numbers surrounding mental health issues are staggering. One out of every five Americans is dealing with a mental health condition right now, and when seeking treatments or help, almost every one of them has had to overcome the stigma associated with the diagnosis.

“Over the past year, we have worked to eliminate the mental health stigma for our patients. We have begun performing universal depression screens at many of our sites, so that asking the hard questions about someone’s mental well-being becomes second nature, like taking a temperature or a blood pressure…Please join me this month in focusing our priorities on our patients’ mental health, reducing the stigma associated with the diagnosis, and continuing to universally screen our patients for depression.”

If you or a loved one experience an emergency mental health situation, Keystone Crisis Intervention is available to help 24 hours a day, 7 days a week. Click here for more information.



You’re Invited!

Join us on Thursday, May 10, for the grand opening celebration at the new home of Keystone Behavioral Health! Speakers, followed by the ribbon cutting, begin at 4:30 and tours, an open house, and refreshments are available until 7. We hope to see you there!

Interoception – The Least Known Sensory System

Interoception is the least known sensory system that the most people should be talking about.

April is Autism Awareness Month. While many things are still unknown about Autism Spectrum Disorder, researchers, therapists, and the loved ones of those affected are working each day to unravel the mysteries surrounding it. Emily Mason, an occupational therapist at Keystone Pediatric Therapies, works with children and adolescents who live with autism and other medical conditions, and helps them develop the skills they need to be successful and to lead a better quality of life.

One challenge that comes with autism and some other disorders is the ability to process sensory information. In today’s article, Emily shares some information about interoception – the least known sensory system.

What is interoception?

To put it simply, interoception is the sense that allows people to feel internal sensations within their bodies. There are receptors located throughout the inside of our bodies such as in the stomach, heart, lungs, muscles, etc. These receptors pick up on signals within the body, which are then sent to the brain to be translated into body states such as hunger, thirst, being sick, tired, having to use the bathroom, etc.

For example, your body may feel your stomach growl and your brain start to feel foggy. That message is sent to your brain, and your brain interprets it as feeling hungry. You then are able to act on that signal, such as by going to get a snack or having a meal.

So, is the interoceptive system also connected to feeling emotions?

Yes! Our bodies pick up on internal cues and sensations that are also linked to emotional experiences. In most cases, each emotion feels differently within the body.

For example, your muscles may be tense, your heart may be racing, your face may feel hot and your voice may be yelling. Your body picks up on these internal cues and again, sends them to your brain to be interpreted – in this case, interpreted as feeling angry. At this point, you are able to utilize coping skills to return your body to a calm state.

What does interoception have to do with self-regulation?

Having good interoceptive awareness is critical for self-regulation. When a person feels discomfort, whether it be from hunger, anger, feeling cold, etc., they are urged to act in order to remediate that discomfort. This action may come in the form of utilizing coping skills, getting a snack/drink, going to the bathroom, etc. The urge to act and self-regulate is dependent upon being aware of the internal sensations, which is what we call Interoceptive Awareness (IA).

What happens if a person does not have good interoceptive awareness (IA)?

Individuals with poor IA have increased difficulty regulating their body states and emotions. If you do not notice the sensations that communicate you are becoming anxious, you are not going to implement any coping skills to help self-regulate. Therefore, that individual will become more and more anxious until they have a panic attack or breakdown. The individual may know what coping skills to use when anxious; however, if they cannot feel when they are anxious, they cannot use the coping skills and they become ineffective. This same concept can be applied to anger, sadness, etc.

Is there a connection between autism and poor IA?

While there is limited research on the link between autism and poor interoceptive awareness, evidence suggests that interoception may be a critical piece that is being overlooked during the treatment of individuals with autism. Poor IA is connected to many difficulties that these individuals face on a day-to-day basis such as difficulty with self-regulation, social skills, etc.

Can therapy help?

Occupational therapists can work with individuals with poor IA to increase awareness of internal body signals and give those signals meaning. If the individual has increased awareness of his or herself, it can lead to greater awareness of their environment and others. Overall, this can lead to improved quality of life and greater participation in daily activities.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

Employee Spotlight — Kelby Kitzmiller

The Keystone Health Employee Spotlight for April shines on Kelby Kitzmiller, Maintenance Technician II.

Kelby began working at Keystone in April 2016.

“When I saw the job opening I was immediately interested because I had experience in the maintenance and construction field,” Kelby said. “I quickly filled out an application and was later brought in for an interview. When I received the phone call that I had a job with Keystone, I was thrilled. The experience I have had thus far has been one of the best and I look forward to many years here.”

Kelby can be found at any Keystone Health building on any given day, performing a variety of tasks to keep each facility and its surrounding grounds looking nice and operating smoothly. He will tell you that no two days are the same in his line of work.

“One of the best parts of being employed at Keystone is that every day is different,” he said. “There are various tasks that must be completed and I still learn something new every day. When it comes to my work, I am very particular and want it all to be perfect.”

When asked what his favorite thing is about working at Keystone, Kelby couldn’t pick just one answer.

“Honestly, everything,” he said. “Everything about Keystone makes me proud to work here – the people, the family-oriented atmosphere, and best of all I like coming to work every day. I extremely enjoy my employment with Keystone and plan to retire from here.”

Kelby was born and raised in Chambersburg, and has no plans of leaving the area.

“It’s where I met my wife in high school, and where I plan on retiring,” he said. “All of my family and friends live in this area.”

In his free time, Kelby enjoys a variety of activities.

“I have many hobbies that I enjoy,” he said. “But if I had to pick, my favorites would be hunting, fishing, exploring the world with my wife, and being with friends and family. I also try to eat right and stay busy as much as possible.”

Kelby and his wife reside in Shippensburg, and they will soon have a family of three.

“My family is growing,” he said. “By the end of this month, we’re having a baby boy. I’m extremely excited about that!”

Thank you, Kelby, for all that you do for Keystone and our patients!

Sensory Problems and Treatment for Children Living With Autism

For children living with autism spectrum disorder (or ASD), navigating in the world around them can be challenging. Joel Desotelle, licensed pediatric occupational therapist and program director of Keystone Pediatric Therapies in Chambersburg, sheds some light on sensory problems and treatment for children living with ASD.

How The Senses Affect Children Living With ASD

In order to do everyday tasks, our brain needs information to be able to think, problem solve, plan and organize. That information comes in through our senses (sight, hearing, touch, taste, smell, balance and movement) and is quickly sorted and distributed throughout the brain. Each brain center works together to use this information to help us survive, learn and accomplish daily goals (such as getting dressed, completing homework, learning a new subject, etc.). Individuals living with autism struggle to manage all of this sensory information, making these tasks a lot harder.

Common Problems

For an individual to grow and learn skills, the brain centers need talk to each other. This requires a good network of “roads” and the “fuel” (brain chemistry) to get those messages around. While the cause of autism is not fully understood, we do know that individuals living with ASD lack a good road system and brain chemistry for the brain to work efficiently.

The Effect Of Sensory Processing Issues

The world around us moves quickly. From birth, our brains take in an enormous amount of information, helping us to learn and grow. As we get older, we start to talk and work together, sharing information in real time. But what happens if a person’s brain can’t keep up or cannot handle all this information? These individuals struggle to learn and understand, and quickly look for ways to compensate, withdraw from and/or react to these challenges. As time passes, core skills are missed and each child struggles to keep up.

ASD Is Hard For Everyone InvolvedWhether it’s your child, relative, student, patient or client, everyone involved in the child’s life wants to help. ASD is a puzzle because the problem is not black and white. Without understanding all of the issues and how to address them (and in what order), it is easy to set the bar too high or too low for these great kids. Do they truly understand your comments, a situation or the expectations of an activity? This can lead to frustration for everyone involved, putting a strain on relationships and family life.

Treatment: Where to Start

The best way to help individuals with ASD is to start with the basics. Occupational therapists use sensory integration and other strategies to build roads and get the brain chemistry in a good place. These strategies also help to integrate reflexes that can persist in children with ASD, while improving self-regulation and attention and laying the groundwork to work on core skills (awareness, comprehension, initiation, etc.). It is important to work with your occupational therapist to identify where your child needs to start and develop a roadmap for treatment. Starting in the wrong place can lead to further delays, stress and even unwanted behaviors.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.