NESCA Blog

October is Dyslexia Awareness Month

Mon, 03 Oct 2022 14:38:22 +0200

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

According to the International Dyslexia Association (IDA), “Dyslexia is a language-based learning disability. Dyslexia refers to a cluster of symptoms, which result in people having difficulties with specific language skills, particularly reading. Students with dyslexia usually experience difficulties with other language skills such as spelling, writing, and pronouncing words. Dyslexia affects individuals throughout their lives; however, its impact can change at different stages in a person’s life. It is referred to as a learning disability because dyslexia can make it very difficult for a student to succeed academically in the typical instructional environment, and in its more severe forms, will qualify a student for special education, special accommodations, or extra support services.” Also, it is important to recognize that dyslexia is not due to either a lack of intelligence or a lack of desire to learn, and with appropriate and sufficient teaching methods, students with dyslexia can learn successfully.

Fortunately, there are effective strategies to help students with dyslexia. However, some common approaches to teaching reading (e.g., guided reading, balanced literacy) have not been found to be effective enough for the struggling reader. What research has found to be most effective is Structured Literacy. Structured Literacy instruction includes specific elements that are necessary for a dyslexic reader to make reading progress. Such elements include phonemic awareness (the ability to notice, think about, and work with individual sounds in words, such as separating the spoken word “cat” into three distinct phonemes), phonological awareness (the ability to recognize and manipulate the spoken parts of sentences and words), sound-symbol association (e.g., identify printed letters and what sounds they make), syllable instruction, morphology (smallest unit of meaning in the language), syntax (e.g., grammar), and semantics (meaning). In order to be most effective, students with dyslexia need to be taught using an explicit instruction method, with a teacher trained in a program that meets that student’s specific needs, the instruction needs to be taught in a logical order (basic concepts before more difficult ones), and each step needs to be based on previously learned concepts (cumulative).

According to the IDA, a comprehensive evaluation to assess for dyslexia, as well as to assess for any other potential language challenges or learning disabilities, should include intellectual and academic achievement testing, as well as assessment of critical underlying language skills that are closely linked to dyslexia, such as receptive and expressive language skills, phonology (phonological awareness, phonemic awareness), and rapid naming (e.g., quickly reading single letters or numbers). Additionally, a full evaluation should assess a student’s ability to read a list of unrelated real words as well as a list of pseudowords (made up pretend words to assess a child’s ability to apply reading rules), in addition to a student’s ability to read in context (e.g., stories). If a student is found to demonstrate that they meet criteria for a diagnosis of dyslexia, a specialized program should be developed by the school in order to provide appropriate services and accommodations.

Sources:

https://dyslexiaida.org/dyslexia-basics-2

https://dyslexiaida.org/effective-reading-instruction-for-students-with-dyslexia

www.readingrockets.org

About the Author

With NESCA since its inception in 2007, Dr. Talamo had previously practiced for many years as a child and adolescent clinical psychologist before completing postdoctoral re-training in pediatric neuropsychology at the Children’s Evaluation Center.

After receiving her undergraduate degree from Columbia University, Dr. Talamo earned her doctorate in clinical health psychology from Ferkauf Graduate School of Psychology and the Albert Einstein College of Medicine at Yeshiva University.

She has given a number of presentations, most recently on “How to Recognize a Struggling Reader,” “Supporting Students with Working Memory Limitations,” (with Bonnie Singer, Ph.D., CCC-SLP of Architects for Learning), and “Executive Function in Elementary and Middle School Students.”

Dr. Talamo specializes in working with children and adolescents with language-based learning disabilities including dyslexia, attentional disorders, and emotional issues. She is also interested in working with highly gifted children.

Her professional memberships include MAGE (Massachusetts Association for Gifted Education), IDA (International Dyslexia Association), MABIDA (the Massachusetts division of IDA) and MNS (the Massachusetts Neuropsychological Society).

She is the mother of one teenage girl.

To book a consultation with Dr. Talamo or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

College Freshman and Executive Function: The Often Unexpected Demands

Mon, 26 Sep 2022 14:14:51 +0200

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Real-life Skills Program Manager and Coach, NESCA

It is no surprise that the experience of a high school student is vastly different than that of a college student. This transition is seen as a pivotal step towards independence as we send students off to learn, grow, and explore in an often substantially less supported and less controlled environment. The hope is that after 13 years of K-12 education, our students have developed the academic, communication, and organization skills needed for success in school. They know the tricks of the trade. They have systems to employ and even more systems to fall back on if needed. They have become experts at learning, and they know the drill. But what happens when students get to college and everything, from the style of instruction, to the flow of coursework, all the way to the demands outside of learning are just…a little bit different? For some students, this is a welcome opportunity to rise to the challenge, but for others, this is a daunting, overwhelming, and seemingly impossible ask. As an occupational therapist specializing in executive function, I have spent the last few years directly supporting those college freshman – the ones who look at the new demands and think, “I was never prepared for this, I don’t know if I can do this.” And I don’t blame them for feeling that way! The demands and expectations truly change. Here are a few that stand out:

Time management – High school schedules are rigid. Students are expected to arrive at a specific time, follow a block schedule, and make it to each of their classes (generally all in one building). If they forget what period it is, they can ask a friend, teacher, or almost anyone in the hallway. Conversely, every student in college has their own schedule that they are expected to track and manage. On Monday, they may be in class from 10am-2pm, while on Tuesday they are in class from 3pm-5pm on the other side of campus. There is no one to quickly ask or check in with regarding when and where they are supposed to be and consistency is rare. This trouble is further compounded by the fact that college coursework requires a substantial amount of work to be done outside of the classroom that must be planned for and built into the weekly schedule.

Reading a syllabus – While “reading a syllabus” may sound simple, these documents are often over 20 pages long, providing information about course content, course expectations, professor’s preferred method of communication, grading systems, and a full schedule of what is due and when. Additionally, each of these documents uses a different format and is frequently amended during the semester. High school students are used to an online portal that is consistently used by their teachers and provides built-in reminders and updates. Syllabi are tricky, and many students skim them without absorbing.

Assignment tracking – As mentioned above, college portals are nowhere near as comprehensive, up-to-date, or accurate as most ex-high school students expect. Professors may change a due date in class without updating a syllabus or expect students to keep track of a paper that is due more than a month away. Many college students need support putting a system in place to quickly consolidate due dates, set internal deadlines, and track what they need to hand in. This is especially important when breaking down large assignments into manageable chunks or learning to prepare in advance to for busy times in the semester, such as midterms or finals week.

Communicating with instructors – Many college students need support in pushing themselves to attend office hours, reach out early and often via email if they have questions about classwork or assignments, and even introduce themselves to their professors.

Developing healthy habits and routines – On top of academic executive function demands, college students are dealing with an increase in life-based executive function demands. They are managing their own eating habits, morning routines, evening routines, and organizing all of their personal belongings in their own space. Completing all of this while maintaining life balance can be tricky, and may require some support.

Accessing accommodations – The accommodation process at a college level is vastly different from the IEP or 504 process in high school. While this topic could be a blog on its own, the biggest takeaway for me is the level of responsibility that falls on the students. They are in charge of letting each professor, at the beginning of every semester, know about their accommodations for sitting in classes, taking exams, or turning in assignments. This requires a level of self-advocacy and functional communication that they may not have had to demonstrate in high school. This demand does not disappear throughout the semester, as they often need to remind professors a week before an exam about their needs or independently book a room to take their test.

While this may seem like a lot, the good news is that our students have learned how to learn. Their systems may need updating, and their strategies may need fine tuning, but with guidance I have found college success to be a truly achievable goal. I often find that once provided with a foundation and tips for how to be successful, my college freshmen do rise to the challenge and eventually build the ability to do all of this independently. If you feel that your student could benefit from some executive function support as they embark on their college journey, please reach out about NESCA’s EF Coaching Program!

About the Author
Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Bellenis has extensive background with school-based occupational therapy services. She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

To book an appointment or to learn more about NESCA’s Executive Function Coaching Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

When the Homeymoon Period Is Over: Signs of School Refusal

Mon, 19 Sep 2022 14:24:00 +0200

By: Moira Creedon, Ph.D.
Pediatric Neuropsychologist, NESCA

As we reach the end of our first month back to school, many of us may be reaching the end of that glorious honeymoon period – the phase when kids are excited to see friends, optimistic for the school year, and reviewing material they likely already know. For some, the return did not start this rosy; the bloom is falling off the rose and kids are getting tired. You and your child are not alone in this. My goal for today’s blog is to share with you some warning signs that your child may be struggling and ways to get support before they grow to become bigger problems. The biggest problem I want to avoid: school refusal.

Have you heard this yet? – “My tummy hurts. I have to stay home.” Or, “I hate school. Please don’t make me go.” Or, “I’m not going!” Or perhaps these messages are communicated more subtly with covers over their heads in the morning, difficulty getting out the door on time, tantrums or disruptive behaviors in the mornings, missed buses, or the overwhelming frustration of homework that erupts into nightly battles. According to researcher Christopher Kearney, these are signs to pay attention to as they can evolve into what he terms “school refusal behavior.” School refusal is an umbrella term used to describe behaviors that interfere with a child being in school for their expected and scheduled time. This is a problem that can impact anywhere between 28-35% of students! While there are the more extreme cases for children or teens who are out of school for months at a time, my purpose here is to address the smaller, but more likely, problems. When we address smaller problems, we can keep them small.

Risky signs that your child is struggling with school:

Consistent statements of hating school, their teacher, or specific peers. A casual mention of a bad day is not cause for alarm. We all have bad days. If the statements keep coming and they get louder and stronger, then parents should pay attention.
The outward behaviors are getting bigger in the mornings before school or over homework. Behavior is a way for children to communicate with us how they are feeling. So, explosions over homework or tantrums in the morning that lead to tardiness are warning signs. The occasional homework meltdown or rushed morning is normal; we are all human! But, the problem is in the pattern.
Avoidance rears its ugly head. While some kids show on the outside that they are uncomfortable through their explosions, others communicate very clearly through their withdrawal. Some kids and teens struggle to get out of bed, are constantly tired, not completing work, falling asleep in class, or sharing every somatic complaint or symptom available on Google. If medical causes are ruled out, anxiety can be a culprit.
Consider the role of a major transition. According to Kearney, the riskiest time for a child to develop a pattern of school refusal is during times of significant transition – like starting kindergarten or changing schools from middle to high school. In addition to the social and emotional jump that these transitions bring, there is also a massive leap in demands for academic independence. It is very common for kids to struggle with the leap initially.

Oh no. So now what?

First and foremost, keep calm. It is far easier to keep small problems small when we have a clear-headed approach. Pull in anxiety management techniques like deep breathing, sleep, and exercise to support your own anxiety as a parent.
Reach out to your child’s teacher or school psychologist. Let them know your child is struggling with homework or coming to school. This is a great chance to gather information on what is going on in your child’s day and put your child on their teacher’s radar. This is critical as the only effective approach to remedy a problem with school refusal is a team approach.
Talk to your child honestly about what is going on. This has to include a chance for kids to talk about what might be happening to make them feel stressed or why they dislike school. Don’t shortcut this step. If your child has trouble explaining what is going on (which can be especially true for younger kids), try this approach: you and your child are both going to be detectives to learn together what is making school feel hard. We can’t solve a problem until we understand it. By joining with your child in gathering information, you are demonstrating great empathy and validating that their feelings are real.
Be careful of your language and conversation about school. It can be tempting to go too far in validating a child to give the message that the assignment really is stupid or their teacher really is unreasonable and mean. It’s best to stick to the feeling (“that must feel so frustrating”) without reinforcing negative messages about school.
Hold the line. As you gather more information, it is really important to maintain the message that it is your child’s job to go to school. It might feel conflicting to both validate the feelings of hating school and give the message to attend school. It might feel something like this: It’s either “I love and support my child OR I’m going to force them to go to school even when it’s hard.” Let’s change that OR to AND. Reframe the thought to: “I love and support my child AND they have to go to school AND they can do hard things.”

For more information, please check out:

Kearney, C.A. (2007). Getting your child to say “yes” to school: A guide for parents of youth with school refusal behavior. New York: Oxford University Press.

About the Author

Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.

If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, please fill out and submit our online intake form.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Election Season: Everyone has a Voice

Mon, 12 Sep 2022 14:15:43 +0200

By: Tabitha Monahan, M.A., CAGS, CRC
NESCA Transition Specialist/Counselor

Election season is upon us once again, and it’s time to let EVERYONE have a voice! In fact, September 12 – 16 is Disability Voting Rights Week.

There’s good news on the voting front. According to Disability Research at Rutgers University and the U.S. Election Assistance Commission (EAC), 62% of individuals with disabilities voted in the 2020 election, an uptick from previous elections that is thought to be due to the increased availability of voting options, such as mail-in and early voting. There was also a significant decrease in the number of people with disabilities who had difficulties voting in 2020 down from 26% to 11%. If you want to learn more about voter turnout by individuals with disabilities, read more in the fact sheet found here.

While numbers are heading in the right direction, we’d still like to help our young people with disabilities exercise their right to vote. In Massachusetts, even individuals with guardianship maintain their right to vote unless the court documents specifically state otherwise. There are many ways to support individuals, but it starts with helping them register. Massachusetts residents can register to vote online, when obtaining or renewing a driver’s license or state ID, or at the local registrar of voters’ office. Notices from MassHealth and the Department of Transitional Assistance (DTA) also include voter registration forms.

Absentee/mail-in ballots have been in the news more than ever due to the pandemic. Every registered voter should have received a postcard/mailing to request an absentee or mail-in ballot.

All citizens are also allowed to bring a person to help them while they are at the polls. Encourage your young person by letting them know that many people require assistance at the polls, and it is completely normal to have someone help them if they need it. Each polling location should also have at least one AutoMARK Voter Assist Terminal, which helps individuals with visual impairments vote independently.

No one wants their vote not to be counted due to errors filling out their ballot. People can request a sample ballot in advance from their local registrar of voters (the Secretary of State’s website can give you the address and phone number of your local registrar). Practicing filling out ballots in advance (even ballots from previous elections) can help a new voter become comfortable with the form and is great fine motor skill practice for those who may need it!

The Massachusetts Secretary of State also creates a voter information booklet for each election regarding the ballot initiatives. Starting in early October, these red booklets can be found at many community locations, such as local libraries, post offices and city/town halls. These booklets offer information on what a yay or nay vote would mean and have information from each initiative’s proponents and opponents. Use that sample ballot as a starting point for the different types of ballot questions and elected positions.

Keep in mind the key dates and deadlines for voting in this fall’s elections in Massachusetts are as follows:

Voter Registration Deadline: October 29, 2022
Vote by Mail Application Deadline: November 1, 2022
Early Voting: October 22 – November 4, 2022
Election Day Polling Hours:7:00 a.m. – 8:00 p.m.

Help your young adult find out what the different roles of government boards do and why there is an election for things such as Auditor, Attorney General, and Governor’s council. Help them find the websites for candidates running for office and review the candidates’ stances on issues. Ask what issues they want to learn more about and are important to them. This fall, Massachusetts voters will be casting their votes for a large lineup of roles to fill, with the following positions on the ballot. You can learn more about who is running for state offices at https://revupma.org/wp/2022-ma-races/.

Representatives in Congress (Federal)
Governor
Lieutenant Governor
Attorney General
Secretary of State
State Treasurer
State Auditor
Governor’s Council
State Senators
State Representative
District Attorney (District Level may or may not be the same as your county)
Sheriff (County Level)
County Commissioner (County Level only in certain counties)
Ballot Questions

Most importantly, remind them that their voice counts. As many disability rights activists have said, “nothing about us without us.” Individuals with disabilities are greatly affected by the policy decisions that occur in government at all levels. Since many individuals with disabilities have frequently experienced disenfranchisement, there are numerous groups working tirelessly to lessen and remove these barriers. How have you helped your young adult exercise their right to vote?

Important Links:

Voting Website for the Secretary of State https://www.sec.state.ma.us/ele/eleidx.htm
Voting with Disabilities Website from the Secretary of State: https://www.sec.state.ma.us/ele/eleaccessible/accessibleidx.htm
Where Do I Vote: https://www.sec.state.ma.us/WhereDoIVoteMA/WhereDoIVote There is an option to see sample ballots.

About the Author

Tabitha Monahan, M.A., CAGS, CRC, is an experienced transition evaluator and vocational counselor. While she is well-versed in supporting a wide range of transition-aged youth, she is especially passionate and knowledgeable in helping clients and their families navigate the complex systems of adult services and benefits as well as medical and mental health systems. She is further adept in working individually with students of all abilities to empower self-advocacy and goal achievement.

To schedule an appointment with one of NESCA’s expert transition specialists or neuropsychologists, please complete our online intake form.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Meet Pediatric Neuropsychologist Lauren Halladay, Ph.D.

Mon, 05 Sep 2022 14:08:57 +0200

By: Jane Hauser
Director of Marketing & Outreach, NESCA

I recently had the opportunity to learn more about Pediatric Neuropsychologist Lauren Halladay, Ph.D., who joins NESCA in September. Learn more about her background and specialties in today’s blog interview.

How did you choose pediatric neuropsychology as a profession?

My interest was originally piqued when I was younger, as early as my high school years. I volunteered at a therapeutic riding program for kids with disabilities. That’s what initially sparked my desire to work with kids, and those with disabilities, in particular. My mother was a third grade teacher, which also imparted the desire to work with kids and help them overcome their challenges at school.

I went on to major in psychology and had a strong interest in pediatrics for the reasons I mentioned previously. Based on some of the work I did in graduate school, I learned that I really enjoyed the assessment piece, especially with the younger kids, helping them in life by identifying the right diagnosis (when applicable) and helping to put the right interventions in place for them to build skills that will equip them for the future.

How have your previous work experiences prepared you to be a neuropsychologist?

I’ve had a wide breadth of work experiences where I was supervised by neuropsychologists, whether it be in satellite health systems, the hospital setting, etc. While in those clinics, I had the opportunity to work with a variety of populations and presentations, including those who have experienced trauma, or have developmental or learning disabilities.

Having worked in several states throughout the country, including Oregon, Ohio, New York and Massachusetts, I’ve had the pleasure of working closely with a variety of families who present with unique backgrounds, experiences, and cultural values, which I always consider when making diagnostic decisions and developing recommendations.

What areas of neuropsychology have you most enjoyed to date? What would you consider your specialty area?

There are several areas that I am very passionate about. I really enjoy working with young kids, those under the ages of five or six. I also have a great interest in working with families who have concerns about their child potentially having an autism spectrum disorder or an intellectual or developmental disability. In addition, I find it incredibly rewarding to work with and help families whose children are medically complex or have moderate to severe cognitive impairments.

Regardless of how the child or student presents or what challenges they may have, I always individualize my approach so that I can meet the needs of each child. This is especially true in cases where families have had a hard time getting assessments done in the school setting or even privately in the past.

What is the most rewarding experience in neuropsychology that you’ve had to date?

I find it rewarding to hear from families when the strategies I’ve recommended are or are not working for them. For example, hearing that parents achieve success in implementing behavior management strategies, accessing support in the community, and/or learning about their child’s diagnosis and how to create an environment that suits their needs is a wonderful feeling. On the other hand, when the initial recommendations are not as helpful as intended, I enjoy approaching the problem-solving process together and discussing alternate approaches.

I also find it incredibly rewarding to offer parents and caregivers a deeper perspective on a child who has a moderate to severe cognitive impairment or is medically complex. Being able to give them a sense of where their child is developmentally in relation to their peers can be enlightening. Additionally, having more information about a child’s developmental level can help families and school staff establish appropriate, and individualized, expectations that set the child up for success. I strive to make a difference in these cases by developing strong partnerships with families, as well as serving as a trusted resource and advocate as they navigate how to best access supports in the community and in school.

What benefits, having been trained in a school psychology department, do you bring to families at NESCA?

My school psychology background allows me to bring a deep awareness and perspective on how the IEP process works. My experience and knowledge of special education rights allows me to be a true partner to families who are trying to navigate and understand the IEP process. I am able to share that knowledge and better advocate for my clients in Team meetings.

Why did you decide to join the team at NESCA?

I knew that in my next career move, I wanted to be part of a collaborative community that puts an emphasis on work/life balance—I feel that both allow clinicians to produce the highest quality work. At NESCA, I will also have the opportunity to use my school psychology skills and be an active participant in the IEP process on behalf of our clients.

NESCA is known for creating and building long-lasting relationships with the families they work with. I look forward to working with families and their schools/districts for the long-term, helping students to build skills along the way that will help them throughout their lives.

Finally, not being a native Bostonian, I am excited to learn more about and partner with the different school systems on behalf of the families and students we work with at NESCA.

About Lauren Halladay, Ph.D.

Dr. Halladay conducts comprehensive evaluations of toddlers, preschoolers, and school-aged children with a wide range of developmental, behavioral, and emotional concerns. She particularly enjoys working with individuals with Autism Spectrum Disorder, Intellectual and Developmental Disabilities, and complex medical conditions. She has experience working in schools, as well as outpatient and inpatient hospital settings. She is passionate about optimizing outcomes for children with neurodevelopmental disabilities by providing evidence-based, family-oriented care.

If you are interested in booking an appointment for an evaluation with a NESCA neuropsychologist/clinician, please fill out and submit our online intake form.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

What Do We Mean by Individualized Neuropsychological Evaluations?

Mon, 29 Aug 2022 14:17:30 +0200

By: Erin Gibbons, Ph.D.
Pediatric Neuropsychologist, NESCA

Previous blogs in our recent series addressing frequently asked questions during the intake process, have covered the important differences between school-based testing and an independent neuropsychological evaluation. A neuropsychological evaluation should always be comprehensive, meaning that it covers various aspects of the student’s learning profile: cognition, language, memory, attention, and social-emotional functioning. However, the evaluation should also be individualized. Essentially, a good evaluation should aim to answer the questions that are specific to that student, not just a cookie-cutter list of tests.

Prior to starting testing, the clinician reviews any previous records and holds an intake appointment with the student’s parents or caregivers. Through this process, the clinician gathers information about the student’s early developmental history, medical background, and current challenges. If the student is already receiving services – either privately or through the school district – that is also important information. All of this helps to shape the “Referral Questions” for the evaluation. In some cases, the questions are very specific; for example, “Does my child have dyslexia?” or “Does my child have ADHD?” In other cases, the question is less defined, such as when we are asked “What is going on with my child and how do I help them?”

We often get asked by parents or caregivers if their child can have all of the tests available performed during their child’s neuropsychological evaluation. As clinicians, we understand that temptation. An evaluation is both an investment of time and money for the parents or caregivers. But neuropsychological evaluations are a lot of work for children, so we want to be sure to tailor the tests to what is actually going to yield beneficial findings for them or will help answer the referral question.

Some families request the list of tests that will be included in the evaluation. Unfortunately, this is not always possible until after testing is underway. Following the intake process, the clinician starts to develop the “battery” – the specific tests that will be administered to the student. Most clinicians have a skeleton battery of tests that they include for every client – an intelligence test, some academic tests (reading, writing, and math), and tasks that assess skills, such as language, memory, and attention – as described above. The clinician then fills in the testing battery based on the specific questions for that student. For example:

An evaluation designed to test for dyslexia should include several tests of reading as well as tests that look at very specific skills related to reading (e.g., phonological processing). When there are no concerns about reading, this aspect of the evaluation would be briefer.
An evaluation designed to assess for autism spectrum disorder should include a variety of tasks that examine social communication and reciprocal social skills. These types of tasks would likely not be included for a student who has never had any challenges in the social domain.

If a school district or another provider is asking for the list of tests that will comprise the neuropsychological evaluation, please talk to your clinician about this during the intake process. The final list might not be available until testing is complete, but this is definitely something that your clinician can provide as soon as possible.

About the Author

Erin Gibbons, Ph.D. is a pediatric neuropsychologist with expertise in neurodevelopmental and neuropsychological assessment of infants,

children, and adolescents presenting with developmental disabilities including autism spectrum disorders, Down syndrome, intellectual disabilities, learning disabilities, and attention deficit disorders. She has a particular interest in assessing students with complex medical histories and/or neurological impairments, including those who are cognitively delayed, nonverbal, or physically disabled. Dr. Gibbons joined NESCA in 2011 after completing a two-year post-doctoral fellowship in the Developmental Medicine Center at Boston Children’s Hospital. She particularly enjoys working with young children, especially those who are transitioning from Early Intervention into preschool. Having been trained in administration of the Autism Diagnostic Observation Schedule (ADOS), Dr. Gibbons has experience diagnosing autism spectrum disorders in children aged 12 months and above.

If you are interested in booking an appointment for the ASD Diagnostic Clinic or an evaluation with a NESCA neuropsychologist/clinician, please fill out and submit our online intake form.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

IEP or 504: What Do They Mean and How Can They Apply to My Child?

Mon, 22 Aug 2022 14:18:47 +0200

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

If your child has ever undergone an evaluation through their school system or received an outside neuropsychological evaluation, chances are you have heard the terms “504 plan” or “IEP” thrown around. Given that it can be difficult to understand the differences between the two, we will break down what both of these terms mean and how they might apply to your child.

What is an IEP?

IEP stands for Individualized Education Program and provides specialized instruction, program modification, and accommodations through the public school system based on a student’s disability and how it impacts access to the curriculum. IEPs must include:

Annual goals that are measurable via benchmarks
Progress reports of the student’s current performance
Descriptions of how services will be provided
Outlined transition services as the child ages

In addition, IEPs must detail what academic environment would be the least restrictive, and therefore, most suitable for the student to appropriately access the educational curriculum.

Who is eligible for an IEP?

In order to qualify for an IEP, students must receive an evaluation either through the school system or through an outside provider that outlines the student’s disability status and how it negatively impacts accessing the educational curriculum. Importantly, a diagnosed disability is not enough to quality for an IEP on its own. Instead, the disability must be negatively impacting the student’s academic functioning. Some examples of qualifying diagnoses include (but are not limited to):

Autism
Emotional Disturbance
Intellectual Disability
Specific Learning Disability

A parent or caregiver may ask what happens if their child has a diagnosed disability but does not require special education services? Instead, the team may determine, through the eligibility process, that the student only requires accommodations, such as extended time on tests.

This is a perfect example of when a student might not qualify for an IEP and would instead be considered for a 504 plan. Simply put, IEPs and 504 plans both provide accommodations; however, 504 plans do NOT provide for specialized instruction or program modifications.

What is a 504 plan?

A 504 plan is referred to as such because it is covered under Section 504 of a federal civil rights law called the Rehabilitation Act. This law works to ensure that students receive appropriate supports and accommodations within the academic setting. 504 plans outline accommodations for students which can include some of the following (but again, accommodations are not limited to the following):

Preferential seating
Extended time on tests and quizzes
Reduced distraction testing environments
Access to class notes
The use of a calculator during exams

As you can see, none of these accommodations is modifying the curriculum or providing a student with educational services as would be the case with an IEP.

Who is eligible for a 504 plan?

Any student with a disability impairing functioning in one or more areas is eligible for a 504 plan. One common example would be a student with diagnosed Attention Deficit Hyperactivity Disorder (ADHD) who requires distraction-reduced testing environments and/or other associated accommodations but does NOT require specialized academic instruction.

Another example is a parent of a child with an autism spectrum diagnosis may find that their child was found to be ineligible for an IEP through the special education eligibility determination process. Shouldn’t the student qualify for an IEP based on the autism disability?

The answer is not necessarily. If a student has a diagnosis of autism but is showing no signs of impairment within the academic setting (i.e., making appropriate academic progress, showing no signs of emotional distress, doing well with their peers, etc.), an IEP would not be warranted. Instead, a 504 plan would likely be considered (but again, is not guaranteed if academic functioning is not impaired).

If you feel your child requires a 504 plan or IEP and you are not sure where to start, contact your child’s special education program at their school. You may also wish to consult with an educational advocate or attorney who has a thorough understanding of special education laws.

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, including attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.

To book an appointment with Dr. Miranda Milana, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

Private Neuropsychological Evaluation vs. School Evaluation

Mon, 15 Aug 2022 14:12:51 +0200

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

While both a school evaluation and a private neuropsychological evaluation often provide valuable information, there are some considerable differences. The primary purpose of a school evaluation is to determine whether or not a student presents with a disability that impairs their ability to access the curriculum and fully participate in the academic and social life of the school. Once a student has been referred for special education, the special education team convenes to determine if, when, and how the student should be evaluated. They decide which instruments will be used for the assessment and who will be responsible for administering them. For example, if a student is referred for a suspected disability, a school psychologist conducts a cognitive evaluation, and a special education teacher will administer an academic assessment. A speech and language, physical therapy, functional behavior, or occupational therapy evaluation may be requested as well. After testing, each specialist writes their report and presents their results individually.

When a student participates in a private neuropsychological evaluation, the parents and student work closely with the evaluator through the entire process, from the intake to feedback and beyond. While there are certainly very comprehensive school evaluations, the information obtained by the evaluators is rarely integrated and instead presented as separate evaluations. This does not allow for a complete understanding of how deficits (or strengths) impact functioning across domains, especially when the child has complex challenges. A comprehensive neuropsychological evaluation is comprised of many elements. Most evaluations consist of a detailed developmental and family history, cognitive, academic, learning and memory (auditory and visual) assessment, visual-spatial and graphical motor skills, and attention and executive function. Depending on the referral question, the evaluation may include reviews of social skills and adaptive functioning or specific measures to assist with making a differential diagnosis. Generally, the assessment is conducted by a single evaluator. The data, including data from prior testing, is synthesized into a detailed report with specific recommendations for school, home, and community life when appropriate.

There are undeniably circumstances when a thorough school evaluation is beneficial. School evaluators have opportunities to observe students at school and consult with their teachers, which can be advantageous (although observations may be requested or necessary to complete a thorough private evaluation, too). School team members also have many opportunities to collaborate when evaluating and working with students. However, school personnel are limited in their ability to integrate data across disciplines, provide diagnoses, and directly assess medical conditions, such as attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and complex challenges, such as dyslexia and nonverbal learning disability (NLD). Additionally, while some parents establish a good working relationship with members of the special education team, they do not have the opportunity to develop a long-term, collaborative relationship with the evaluator as they would when a private evaluation is obtained.

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations.

To schedule an appointment with one of NESCA’s expert neuropsychologists, please complete our online intake form.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Why Delay a Diagnosis?

Mon, 08 Aug 2022 14:09:07 +0200

By Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

As part of NESCA’s ongoing blog series addressing some of the most frequently asked questions about neuropsychological testing, today we are addressing why neuropsychologists may choose to delay a diagnosis.

At NESCA, I often supervise neuropsychology trainees, and one of the first questions I asked them is: “What is the goal of a neuropsychological evaluation?” I often hear answers, such as “to identify strengths and weaknesses” or “to determine appropriate diagnosis.” These answers are not wrong, per se – they are what we are taught in graduate school. However, I often explain that while these may be part of our goal, the primary goal is to tell a client’s story and help them understand a path for moving forward. While this may sound a bit aspirational, it is the approach that best appreciates developmental, systemic, and individual factors that may come into play. As addressed by Dr. Moira Creedon in the first blog within this series, this is also one of the reasons why neuropsychologists want to review all prior evaluations and documentation, as this helps to elucidate the developmental timeline.

When a neuropsychologist is approaching an evaluation through the above developmental lens, it is not always possible to land on a specific diagnosis. This may sometimes be referenced as a “deferred diagnosis” or “differential diagnosis,” meaning there is evidence to possibly support the diagnosis, but not enough evidence at this time to decide for certain. Another term that may be used is “provisional diagnosis.” This indicates that there is enough evidence to support the diagnosis at this time, and there is clinical utility to diagnosing (e.g., informs intervention, qualifies for services, etc.); however, more information or monitoring may be needed to be completely confident, so future reassessment is warranted.

There are several reasons why a diagnosis may be deferred or deemed provisional. First, children are constantly developing, and sometimes the challenges they are demonstrating may be developmental in nature. This may be particularly so when evaluating young children. For example, if a young child has significant language delays, it may be difficult to assess whether they are also on the autism spectrum or have early signs of a learning disability, as their observed weaknesses in these areas may be accounted for by their language. Often times these are children who may “catch up” in skills once provided intervention, meaning their difficulties were related to delayed acquisition, rather than an being an issue of innate impairment.

Similarly, another reason diagnosis may be deferred is if a child’s self-regulation challenges interfere with their ability to engage in typical daily demands. For example, for a child who has significant anxiety or behavioral dysregulation that interferes with their ability to engage in school, it may be difficult to determine if academic delays are related to a learning disability or are a secondary consequence to their dysregulation. While provision of targeted instruction may still be necessary in order to help the child regulate and close gaps in skills, a full understanding of their innate learning profile may not be possible until such supports are in place.

Deferred diagnosis is quite common when more significant psychiatric diagnoses are in question, such as whether a child or adolescent is presenting with a mood or thought disorder, such as bipolar or emerging psychosis. There are many other conditions that may “look like” these disorders, including trauma or co-occurring anxiety and ADHD. When diagnosing more significant, often life-course disorders, it is important to ensure that all other potential explanations are identified and addressed. This is important for informing the appropriate treatments while also allowing the evaluator to outline some of the “red flags” that should be monitored by the client, their parents, and their care team over time.

Another reason why a diagnosis may be deferred is that there may be systemic factors at play. In other words, there may be things going on within the child’s home, peer setting, school, or other surroundings that interfere with the evaluator’s ability to understand the child in isolation. This is a particular issue when evaluating a client with a trauma history. Developmental trauma can often “mimic” other symptom profiles, and so it may be important to first address issues within the system before providing a diagnosis for the individual.

There are other less common situations in which diagnosis may be deferred, but they warrant mention. One is when the neuropsychologist is concerned about possible malingering, which is when certain symptoms are being falsified or exaggerated for personal gain (e.g., a child with learning disability exaggerating mood symptoms to avoid school). Another less common situation is when prescribed medication or recreational drugs may be inadvertently causing the symptoms of concern (e.g., depression occurring as a side effect).

A final reason why a diagnosis may be deferred is simply that things can sometimes be messy. We often evaluate children and teens who have several presenting concerns, and sometimes it takes time to peel away the layers of the onion. In any of the above scenarios, we start with “what we know” and then describe “what is possible.” Regardless of whether or not a diagnosis is certain, as neuropsychologists, we are still able to tell the client’s story, describing how they “got here” and how to move forward. This developmentally-sensitive approach allows us to make recommendations based on their need, not just their diagnostic label. We are then able to assess how their profile and symptoms change as they access intervention. It is for this reason that we enjoy the opportunity to develop long-term relationships with our clients, helping to monitor growth over time. Children do not develop in one finite time point, and the neuropsychological evaluation process sometimes has to be patient and continue to develop alongside them.

About the Author

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

To book an evaluation with Dr. Currie or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician in the referral line.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

Are We Working With a Full Deck of Cards? Why Neuropsychologists Want Results from Previous Evaluations

Mon, 01 Aug 2022 11:27:58 +0200

By: Moira Creedon, Ph.D.
Pediatric Neuropsychologist, NESCA

Neuropsychological testing is a tremendous undertaking in time and effort for a family. It involves intake documents, questionnaires, financial paperwork, insurance information, teacher forms, and the list goes on. I promise this paperwork is meaningful and helpful, a way to get the most out of the time and investment in a neuropsychological evaluation. Over the next few weeks, several of NESCA’s neuropsychologists will tackle a few common questions that we face that will help you prepare for neuropsychological testing.

The first topic to tackle relates to the need for previous records. It can feel time consuming to track down documents from years ago, particularly if your child has grown and changed over time. There are many reasons why it is critical to provide these records so your provider has the full deck of cards as they build an individualized evaluation for your child. I’ll tackle the three most important reasons to me:

First, pediatric neuropsychologists want to understand the development of your child over time. For example, if we are evaluating learning problems, I want to know what it was like in kindergarten and early elementary school when your child learned to read. I want to know when the attention problems started or problems interacting with peers were first noticeable to those around them. As we build a developmental timeline, it can help to conceptualize where it all began to help us get at the magical “root cause” that parents often seek. Understanding development over time also helps us to build a better treatment plan. For example, if I can see that a child struggled to develop early reading skills and then years later is extremely anxious about attending school, it helps guide recommendations in both domains.

Secondly, records are critical so we do not risk “practice effects.” “Practice effects” refer to the improvement in scores that happens simply from being exposed to the task before. While guidelines are not as set in stone as some may think, it is generally advised not to repeat many neuropsychological measures within a year of testing. There may be reasons to speed up this timeline that are client-specific, but we cannot make that determination unless we see the documents. Research says practice effects diminish over a few months to a year. We want to eliminate any interfering factors that would make it harder to draw conclusions about the data in the current evaluation. With the time and investment you make in testing as a parent, I can only imagine how frustrating it would feel to hear that something we can manage interfered with the process. Access to records helps us to choose the right measures for the right moment.

Thirdly, providing previous records also allows us to track skill development over time. This is particularly important if we want to see if an intervention (e.g., reading instruction, therapy, attending social skill groups) is working to build the skills. Put simply, it tells us if a problem is getting better or getting worse. Even if you do not agree with the final conclusions drawn by the previous professional, the scores still provide critical data points in development. For more information on seeking a second opinion when you disagree with results, sit tight – that blog post is coming!

I often use the metaphor with kids and families that neuropsychological testing can help us to develop a type of “instructional manual” for how their brain works. With younger kids, I tell them that I am writing the LEGO instructional manual for which steps to take in what order and with what pieces. Without the prior records, I’m missing a bag of pieces. That is almost as frustrating as stepping on the actual LEGOs!

Please come back over the next several weeks to hear more from my colleagues about how to make the most of your child’s neuropsychological evaluation!

About the Author

If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, please fill out and submit our online intake form.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Parenting is a Hard Job – Remember You are Good Enough!

Mon, 25 Jul 2022 11:31:47 +0200

By Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Counseling Services, NESCA

Much has been published about parenting and parenting styles, whether in YouTube clips, books, podcasts, scholarly articles, newspaper articles, and so much more. But basically, if you are a parent, you are just doing your job – you are parenting, trying to guide your children, teens, and young adults on their own paths so they grow up to be “good humans and lead happy, successful lives.”

My guess is you probably haven’t given your parenting style too much thought. You just go about whatever the day brings you with whatever you’ve got in your tank that day. You’ve probably heard the terms Helicopter Parents, Tiger Moms, Free-range Parenting, etc., to describe different parenting styles. Usually, our parenting styles emerge from our own histories, role models, experiences, and personalities. You may be parenting how you were parented because it worked for you or because you disliked the way you were parented so you moved to the complete opposite way of parenting.

Remember the book, “Battle Hymn of The Tiger Mother,” by Amy Chua from 2011? She wrote this book as a memoir – not as a parenting guide – but what a controversy it stirred regarding parenting styles! Alan Paul, a journalist for The Wall Street Journal then wrote, “Tiger Mom…Meet Panda Dad,” as a commentary against the Tiger Mom mentality and to bring dads into the parenting discussion. During this time period, there was much written about parenting styles, often characterized into four styles: Authoritative, Authoritarian/Disciplinarian, Permissive/Indulgent, and Uninvolved/Neglectful. As you can imagine, each style has its driving principles. In case you are interested in what the research says about the four parenting styles, the Authoritative parenting style wins out over the others in helping children develop into well-functioning adults.

No matter what style you are, you are giving it your best shot. Each of the styles has much written about them and their impact on child development – some good some not so good. Parents may change their style(s) depending upon a variety of factors and adopt new ways. Try to be aware of your style and its impact on your kids – this realization may happen as you go. That’s okay. You are learning this job as you go, and we all know there is no manual. You are just doing it, living each and every day with what it brings to you. Most parents do not think about what parenting style they are going to use in the moment. Sometimes you may “catch yourself,“ see your child’s reaction, and adjust your style. Perhaps you are the “softie” most of the time, but then turn on the “tough love” style when needed.

As a parent consultant, I often hear, “I must be the worst parent you’ve ever seen. You must think I’m a fool. Do all kids do this? Am I the only one who struggles getting their kids to follow directions?”…and so much more. Sure, I give them specific suggestions for parenting their child who has ADHD or is autistic; however, I match my recommendations to their parenting styles and personalities.

As a consultant, I often find myself saying these mantras in parent sessions:

You are good enough.
Show and tell your kids you love them.
You are giving it your best shot in this moment.
Be kind and gentle with yourself and your kids.
Have compassion and empathy for yourself and your kids.
Stay calm in the eye of the storm. ___ Happens!
You are human, and humans make mistakes – own them.
Don’t expect perfection. It is overrated. Cut yourself some slack.
Point out the positives. Catch ‘em being good!
Tell them what to do not what not to do.
Develop honest, authentic relationships with your kids.
Lead with your heart.

And as the saying goes….

If you are interested in learning more about NESCA’s Consultation Services, please complete our online Intake Form.

References

Alan Paul http://alanpaul.net/panda-dad/

4 Research-Backed Parenting Styles and How they affect your kids by Caroline Bologna https://www.huffpost.com/entry/four-parenting-styles-affect-kids_l_6270493fe4b0bc48f57e705f

4 Types of Parenting Styles and their effects on the child https://www.parentingforbrain.com/4-baumrind-parenting-styles/

Here’s what makes ‘authoritative parents’ different from the rest—and why psychologists say it’s the best parenting style by Francyne Zelster
https://www.cnbc.com/2021/10/05/child-psychologist-explains-why-authoritative-parenting-is-the-best-style-for-raising-smart-confident-kids.html

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

To book a consultation with Ms. Lucci or one of our many expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician/consultant in the referral line.

Making the Most of Summer – Setting a Few Life Skill Goals (for College and Life in General after High School)

Mon, 18 Jul 2022 11:33:05 +0200

By: Kelley Challen, Ed.M., CAS
Director of Transition Services; Transition Specialist, NESCA

Summer in the United States is looking more “normal” than it has in three years. Kids are in camps, summer school is in-person, and families are traveling. While there is a semblance of planning and activity that many of us missed greatly in 2020 and 2021, many teenagers are still finding their groove with changing work schedules, driver’s education, etc. No matter what your teenager is doing, this is great time to sit down and set a few “simple” life skill goals for the summer. In 2020, I wrote a two-part blog series focused on eight life skills that are critical to build before college:

Getting up “on time” each morning
Washing, drying, and putting away laundry—including sheets
Basic kitchen skills
Using basic tools (e.g., screwdriver, hammer, measuring tape, etc.)
Medication management
Money management
Routine exercise
Using a calendar for scheduling

For teenagers in high school or heading off to college, these are great skills to begin tackling over the summer months. For example, getting up by a certain time is something that can be especially important to work on when consequences are low. For instance, it is hard to let a teen sleep in when they are going to miss an AP exam, but it can be easier to let them practice using an alarm (and possibly oversleeping) when they are going to a movie with a friend or attending a camp. Summer is a great time for teens to be able to experience natural consequences as they practice taking on new risks and responsibilities associated with some of the life skills above.

A challenge when working with, or parenting, teenagers who have a lot of skills to develop is figuring out where to start or how to gain “buy-in.” One of the ways that I like to work with students to set life skill goals is to have the student take a basic life skills inventory, such as the Casey Life Skills Toolkit, Life Skills Inventory, or Adolescent Autonomy Checklist. After a student rates their own skill levels, I ask them to review skills that they cannot already do and identify how important those skills are on a scale of 1 to 10. Then, we go through the list again, and I ask which skills they would like to learn in the next 2 months, 6 months, and year. Once the teenager has identified the importance of a skill and the desire to work on the skill in the near future, it is much easier to set short-term goals. We can work out a skill-building plan for the summer. including how much time to dedicate on a daily or weekly basis. We can also talk about the types of barriers or challenges that might get in the way of the teenager practicing these skills. Additionally, we can set expectations for how often the teen is going to report back to me on the skill so that there is built-in accountability, and the teen knows to expect the check-ins rather than feeling like someone is checking up on them.

Every teenager is different. If you are a parent wanting to help your child make the most of summer, you may find that you can go through the same process that I do to help your child set a few short-term goals. Other teenagers will be able to work on goals themselves—once they have gone through the exercise of setting them. And others, may benefit from having a coach who can build a relationship, support development of executive function and coping skills, and partner with the teen in making the most of summer. If you think your child would benefit from some coaching or an “expert” to work with them, we have a great team of professionals here at NESCA who are ready to help.

If you are interested in working with a transition specialist, executive function coach or real-life skills coach at NESCA for consultation, coaching, planning or evaluation, please complete our online intake form: https://nesca-newton.com/intake-form/.

About the Author
Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

Why Kids Need to Outdoor Free Play

Mon, 11 Jul 2022 14:34:29 +0200

Edit date and time By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

One of the best ways to make the most of your summer is to get outside and engage in lots of outdoor play. We live in a society where we tend to over-schedule ourselves and our children. Particularly during the school year, this makes it very difficult for children to get the amount of free play that they require. With this, I’m going to tell you five great reasons why you should throw away your schedule, put down the tablet, and get outside.

The first reason is probably the most obvious. Outdoor play provides great benefits to physical development. It improves motor coordination, strength, and balance, and it puts kids in an overall healthier position.

The next reason to play outside is that there are benefits for internal regulation. Not only does it make kids sleep better at night, but there is research to show that it aids attentional control and stress reduction. Being outdoors also provides kids with different sensory experiences – such as feeling the texture of sand and mud, or feeling the wind blow on your face – which will help to build children’s sensory tolerance.

The next reason to get outside is to improve cognitive development. Being outdoors provides a lot of opportunities to make observations, draw conclusions about things, see cause and effect, and be imaginative.

Next, playing outside aids emotional development. When we are over-scheduled, children do not have the opportunity to feel confident in their ability to step outside of their comfort zone or take risks. Experimenting and taking risks during outdoor play can help children understand that they have some control over what they can do within their environment, as well as begin to recognize boundaries.

Finally, the last reason to get outside is that it really bolsters social development. When there is no structure or there are no rules to follow, kids have to learn how to initiate their interactions, engage in conversation with each other, communicate, problem solve, and find ways to along, even when others have different ideas.

With all of the above benefits, outdoor free play is one of the best things you can give to your child. So as the weather is getting nicer and summer is fast approaching, if you are looking for something to do, sometimes it is best to just put down your schedule, get outside, and get dirty.

About the Author

Coping Strategies for Anxiety and Panic

Mon, 04 Jul 2022 14:22:40 +0200

By: Lyndsay Wood, OTD, OTR/L
NESCA Transition Specialist & Occupational Therapist

Do you, your child or your loved one deal with frequent anxiety? Stress? Panic? Sometimes it may feel like you are spinning out of control. With so much going on in the world, in our own lives, and in our own head, it can feel like an impossible task to quiet the mind and calm the body. However, there are things we can do to regulate the nervous system, thereby relaxing the body and reducing the effects of anxiety. Below is a list of these strategies, but they are not one-size-fits all. Try each of them and see what works best for you or your loved one.

5, 4, 3, 2, 1 Grounding Technique: This technique is helpful to ground yourself in the present moment. Often, we can get stuck in our own head, and our worries and fears spiral out of control. This strategy is helpful to pull yourself out of those thoughts and into the present moment. The procedure is as follows:
- Identify five things you can see. Feel free to describe them. What color are they? What are their shapes?
- Identify four things you can touch. Get up and actually touch them! How do they feel? Are they soft? Hard? Squishy? Wet?
- Identify three things you can hear. Is there a car driving by? Are the noises loud or soft?
- Name two things you can smell. Are the smells pleasant? Neutral? Familiar?
- Finally, name one thing you can taste. Can you taste the remnants of dinner on your tongue? Perhaps you have a piece of candy nearby you want to put in your mouth and describe.

Hopefully, completing this technique helps break the anxiety spiral. Feel free to repeat it as many times as you need. You can try to identify new items and sensations each time.

- Weighted blanket or deep pressure: Deep pressure activates the parasympathetic nervous system, which is responsible for relaxing your body. Therefore, if you are feeling anxious, try sitting with a weighted blanket. Alternatively, if you have a pet, put them on your lap. Both the pressure of their body and the act of petting them is great for relaxing. You could also try giving yourself a hand massage or tight hug.
- Box breathing: This is a breathing technique that also activates the parasympathetic nervous system and relaxes the body. The steps of this technique are as follows:
  - Take a slow breath in through your nose (if possible) for four seconds
  - Hold that breath for four seconds
  - Slowly breathe out for four seconds
  - Hold your breath again for four seconds
  - Repeat this cycle three or four times
- Funny videos: Sometimes it can be helpful to distract the mind with a funny video. Animal videos can be great! Or perhaps you have a favorite comedian that will always make you laugh.

Progressive Muscle Relaxation: This technique involves tightening different muscle groups and then letting them go. It helps to relax the body and reduce tension. You can find a guided YouTube video to walk you through the process, or you can also try it on your own by moving from head to toe, tightening different muscle groups. You may start by tightening all of the muscles in your face for 5-to-10 seconds as you inhale and relaxing the face muscles as you exhale. Give yourself 10-to-20 seconds to relax before moving on to the next muscle group.

About the Author

Lyndsay Wood, OTD, OTR/L, is an occupational therapist who focuses on helping students and young adults with disabilities to build meaningful skills in order to reach their goals. She has spent the majority of her career working in a private school for students with ASD. She has also spent some time working in an inpatient mental health setting. Lyndsay uses occupation-based interventions and strategies to develop life skills, executive functioning, and emotional regulation. While completely her doctoral degree at MGH Institute of Health Professions, Lyndsay worked with the Boston Center for Independent Living to evaluate transition age services. She uses the results from her research to deliver services in a way that is most beneficial for clients. Specifically, she focuses on hands-on, occupation-based learning that is tailored the client’s goals and interests.

To book coaching and transition services at NESCA, complete NESCA’s online intake form.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, as well as Londonderry, New Hampshire. NESCA serves clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Learning with Executive Dysfunction—How Graphic Organizers Can Help

Mon, 27 Jun 2022 14:31:22 +0200

By Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

When it comes to executive dysfunction, we often see students struggle with the organization of language. This presents differently in each student, but may be seen as difficulty comprehending information, and getting ideas out of their heads and organized into words or on paper. They might recognize the words when listening or reading, but they hit a wall when it comes to making sense of the message or describing it. This often results in students feeling lost, confused, and overwhelmed.

When students struggle to organize language and grasp concepts independently in the classroom, we need to break it down and teach it differently. Graphic organizers help us to do so.

What is a graphic organizer?

Graphic organizers are tools that use visual symbols to express knowledge, concepts, thoughts, or ideas, and the relationships between them. The main purpose of a graphic organizer is to provide a visual aid to facilitate learning and instruction. They help students see visually what is expected of them, what they should focus on, and break complex tasks down for them.

What does the evidence show?

There is plenty of evidence demonstrating the benefits of using graphic organizers. The results of most studies have voiced the positive effects of graphic organizers in mainly comprehension and writing, in addition to remembering course content. One such study recommended the use of graphic organizers for teaching expository text structures with students to improve reading comprehension. A popular strategy to help students understand expository texts is to teach the various types of text structures: cause-and-effect, compare/contrast, problem/solution, etc. When students know the underlying organization of the information, it helps them create a working model of it in their minds, resulting in a better understanding and ability to recall. (Pyle et al., 2017). Another study sought to investigate how pre-writing activities based on graphic organizers, such as webs, and beginning, middle and end charts, affect the overall quality of student writing. The results of the study indicate that using appropriate pre-writing strategies based on graphic organizers and giving enough time for the students lead to better quality writing (Servati, 2012).

How are Graphic Organizers Used in Speech Language Therapy?

1. Graphic Organizers Help Students Focus

Many students exhibit disorganized thinking processes, poor initiation skills, word recall difficulties, poor attention, and decreased task endurance. These weaknesses can impact a student’s ability to get started on a project, organize a writing assignment, or even complete a math task. Graphic organizers help students access prior knowledge and get them actively engaged in learning.

2. Graphic Organizers Provide a Visual Map and Help Clarify Abstract Concepts

Have you ever had so much information that you couldn’t hold onto it all? Graphic organizers bring together large pieces of information and tie the relationships together. The concepts and linguistic relationships flow better and make sense to students.

3. Graphic Organizers Help Build Vocabulary

Students benefit from graphic organizers as they expand their word knowledge and make connections. Graphic organizers are great for teaching concepts like descriptive adjectives, antonyms/synonyms, items in a category, part/whole relationships, and definitions.

4. Graphic Organizers Improve Expressive Language

Graphic organizers support oral and written language in all areas of academic learning. Some students have difficulty creating pictures in their head, retrieving words to verbalize their ideas, and putting their thoughts in order. Utilizing a graphic organizer can help students when they need to present information orally or develop a draft for writing.

Resources:

Architects For Learning. (2022, May 18). Helping students manage what’s hard about school and thrive as life-long learners. Retrieved June 21, 2022, from https://www.architectsforlearning.com/students-parents/about-us/

Erwin, L. (2017, May 26). 5 reasons to use graphic organizers in speech therapy. My Speech Tools. Retrieved June 21, 2022, from https://myspeechtools.blogspot.com/2017/05/5-reasons-you-should-use-graphic-organizers-speech-therapy-sessions.html

Servati, Katrina, “Prewriting Strategies and their Effect on Student Writing” (2012). Education Masters. Paper 242. https://fisherpub.sjfc.edu/education_ETD_masters/242

Sherman, H. (2017, December 23). Using Graphic Organizers is Essential in Speech Therapy. Speech Time Fun Speech and Language Activities. Retrieved June 21, 2022, from https://speechtimefun.com/using-graphic-organizers-is-essential-in-speech-therapy/

Pyle, N., Vasquez, A. C., Lignugaris, K., & B., Gillam, S.L., Reutzel, D.R., Olszewski, A., Segura, H., Hartzheim, D., Laing, W., and Pyle, D. (2017). Eﬀects of expository text structure interventions on comprehension: A meta-analysis. Reading Research Quarterly, 52(5), 1–33. https:// doi. org/ 10. 1002/ rrq. 179

About the Author

Olivia Rogers received her Master of Arts in Speech-Language Pathology from the University of Maine, after graduating with a Bachelor of Arts in Communication Sciences and Disorders and concentrations in Childhood Development and Disability Studies.

Ms. Rogers has experience working both in the pediatric clinic setting as well as in public schools, evaluating and treating children 2-18 years of age presenting with a wide range of diagnoses (e.g., language delays and disorders, speech sound disorders, childhood apraxia of speech, autism spectrum disorder, social communication disorder, and Down syndrome). Ms. Rogers enjoys making sure therapy is fun and tailored to each client’s interests.

In her free time, she enjoys listening to podcasts and spending times with friends and families.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

To book an appointment with Olivia Rogers, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

Testing Outside the Box—Vocational Assessments for Nonverbal, Nonreading and/or Hard-to-Test Students

Mon, 20 Jun 2022 14:05:08 +0200

By: Kelley Challen, Ed.M., CAS
Director of Transition Services; Transition Specialist, NESCA

My colleague Tabitha Monahan and I have dedicated several recent blog entries to vocational assessment—a vital tool for helping students to learn about career planning and employment and to set career goals for themselves. Previous blogs have included an overview of vocational assessment as well as an in depth look at career interest inventories, career aptitude testing, assessing work motivation and values and real-life experiences, such as informational interviews and job shadows.

However, many of the most “popular” or common tools for vocation assessment are intended for use with students who have functional reading abilities (i.e., basic reading skills at or above 5^th grade levels). While there are many accommodations a skilled evaluator might use to help a wide range of students effectively access these tests, there are also students who receive special education services and cannot access these word-based and rating-based assessment tools. So, what tools can be used effectively with these students? How do we assess interests and aptitudes for students who are nonverbal, have reduced reading skills, or may provide unreliable responses to language-based testing methodologies? Below are a few of the methods that we find particularly useful at NESCA.

Picture-based Interest Inventories

Instead of using text-based items and rating scales, picture-based career interest inventories help individuals to express their occupational interests by selecting preferred pictures of people at work or people performing work-related tasks. Pictures are presented in sets of two, three, or more, and the student points to or circles the picture that seems most interesting. Based on the number and types of pictures selected, the test identifies work themes that are most appealing to the student. Evaluators can also look for themes among pictures selected, such as a student who selects a high number of pictures that have multiple people, computers, vehicles, outdoor activities, etc. Three popular picture-based assessments are the Picture Interest Career Survey (PICS) published by JIST, the Reading-Free Vocational Interest Inventory-Third Edition (RFVII-3) by Katherine Synatschk and Ralph Becker, and the Career Interest Inventory – Pictorial Version by Shasta Twenty-first Century Career Connections.

Video-based Interest Assessment

Video-based career interest assessments are more difficult to find but can be incredibly useful nonverbal tools for vocational evaluation and career planning. A tool that we use at NESCA is Your Employment Selections (YES), which is a CD-ROM-based reading-free job preference and career exploration program that has 120 videos of different jobs which are viewed and compared strategically in pairs. Through initial video-based trial, students indicate preferences, such as a desire to work indoors or outdoors, work alone or with coworkers, interact with the public or coworkers, and do light or heavy lifting work. These preferences are used to determine which subset of job videos the student will view. Traditional testing involves the student watching two videos and pointing to, or clicking on, the one they like more. However, the evaluator can work with a student who has limited verbal abilities to determine some of the features or tasks the student likes most, or dislikes most, within the specific job videos shown. While this video program is no longer available for retail, there are plenty of great career videos that can be used to carry out similar informal assessment on web sites, such as CareerOneStop, Dr. Kit, MassHire Career Information System, and even YouTube.

Functional Assessments and Observations

For all students, regardless of communication or self-determination skills, functional assessments and real-world observations play a vital role in career assessment and planning. For students who struggle with reading- and writing-based assessments, it can be important to have access to more hands-on standardized assessments of employment strengths and abilities. One such assessment tool is the Skills Assessment Module (SAM) published by Piney Mountain Press, which includes an auditory directions screen to determine how well a student can follow verbal directions and 12 work-related activities that simulate actual work aptitudes required in training and jobs (e.g., mail sort, ruler reading, assembling small parts, etc.). However, evaluators who do not have access to formal assessments can purchase or create pre-vocational and vocational kits for assessing and learning work skills and can carry out functional assessment of real or simulated work-related tasks in school, community, and work settings.

Observing students performing work-related behaviors and tasks is one of the most powerful evaluation tools that we have for determining strengths and needed areas for growth. If a student is performing vocational activities at school or has a volunteer or paid job during the week, that can be critical for an evaluator to observe. There are also protocols that can be used to formally assess students’ skills during observations, such as the Vocational Skills Assessment Protocol from The Assessment of Functional Living Skills (AFLS), and the Becker Work Adjustment Profile – Second Edition (BWAP-2).

Interviews and Parent/Educator Participation in Interest Inventories

While some transition-aged students may have trouble clearly expressing interests using words or inventories, all students have some way of communicating information to people who know them well. Transition and vocational assessments often require creativity and effort to gain informal, subjective, and anecdotal information from educators, parents, and other stakeholders who know the student well. It is useful to interview several people, asking questions about the student’s preferred leisure and school activities, areas of strength, preferences that need to be taken into account when planning for future employment, and specifically asking if there are any jobs that the interviewee is aware of that they think might be a good fit for the student in the future. Another technique is to use career interest inventories which are intended for self-report, such as the O*Net Interest Profiler (IP) or RIASEC, and ask parents or educators to fill out the inventory with what they believe the student’s preferences would be. Having a high level of correlation between parent report, educator report, and the student’s responses on picture-based or video-based testing can be extremely helpful in knowing where to focus career planning energy for the student.

Conducting vocational assessment, or any assessment, for this population of students—when tests are often not explicitly designed for them–is difficult. There are some tremendous tools specifically designed for testing students who are nonverbal or nonreaders, and there are many other assessment tools which can be made, modified, or used in nontraditional ways to gain a more complete picture of the student. The most important aspect of assessment is to choose the tools that are going to best suit the student.

For more information about vocational assessment and transition assessment at NESCA, visit our transition services page and our transition FAQs.

ADHD & Social Skills

Mon, 13 Jun 2022 14:32:59 +0200

By: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

When most of us hear the term “ADHD (attention deficit hyperactivity disorder),” we think of the little boy who can’t sit still at his desk or the girl gazing out the window lost in her own thoughts during class. While difficulties with hyperactivity and/or attention are core features of ADHD–embedded directly in the diagnostic label–there are often co-occurring features that are less obvious. Moreover, even the central aspects of ADHD can have far-reaching impacts beyond the classroom. One of the most frequently misunderstood and overlooked facets of ADHD is its potential impact on social functioning.

In clinical practice, parents of children with ADHD are often confused by the unexpected and indirect ways that attentional and executive functioning deficits can affect social functioning. They sometimes wonder if their children have an additional challenge, such as autism spectrum disorder. Most often, that’s not the case. Rather, it’s more likely that one or more of the following is at play:

Kids with ADHD can have difficulty selectively attending to relevant social cues
- Imagine looking through a camera with a broken zoom lens. At first everything is in frame at once; it’s too much information. Then you try to zoom in, but when you do, sometimes the lens focuses on unimportant things (like the random details in the background), leaving out what’s most relevant (like the person you’re trying to capture in your photo). Children with ADHD have difficulty figuring out what details to focus on and struggle to effectively “zoom in” on those elements. In social settings, which are often unstructured, kids with ADHD are even more prone to “zoom in” on unimportant things and miss the more salient information. They can also become easily distracted and fail to register important information in the moment. To others, this can come across as lack of interest (for instance, the child who seems not to be listening or is distracted by sounds, sights, or other sensory information in the moment). It can also lead children with ADHD to overlook contextual cues about what’s expected in a given social setting, which can lead to inappropriate behavior.

Children with ADHD often struggle with nuance, making inferences, and reading between the lines
- Social situations are much more complex than we often realize. Successfully navigating social interactions requires paying attention, not just to surface level information but to the often subtle, implied meaning embedded in things like figures of speech, tone of voice, and body language. For many with ADHD, it’s already a challenge to maintain focus at the surface level; the task of trying to simultaneously attend to and interpret subtext is too much. Individuals with ADHD may focus on what another person says (the content of their speech) but fail to notice the eye roll or sarcastic tone of voice that goes along with it.

Impulsivity can lead to social faux pas
- Impulsivity is a central feature of ADHD in many cases. In social settings, difficulty inhibiting impulses can take many forms. For some, it may simply present as rapid-fire speech, leaving little room for others to respond in conversation. It can also look like interrupting, cutting others in line, or expressing ideas and opinions in a way that can be hurtful or seem rude. Especially in younger children, impulsive behavior can lead to difficulty sharing, physical aggression towards others, and trouble with turn taking. Children who have more difficulty slowing down and inhibiting impulses are more likely to inadvertently offend others or to engage in behavior that their peers may view as odd or inappropriate; in turn, this can lead to trouble developing and sustaining friendships and other positive relationships.

Hyperactivity makes participating appropriately in some social settings difficult
- There are some social contexts in which an abundance of energy is a very good thing. For this reason, many ADHD kids can excel in activities like sports, into which they can channel their high energy. But other social situations demand a different set of skills. For kids with hyperactivity as part of their ADHD, sitting still and maintaining quiet can be a challenge. They may struggle with activities like going to the library, watching a movie in a theater, attending church or religious ceremonies, or sitting at the table in order to have family dinner.

The good news is that there are ways to manage these social challenges. If your child with ADHD has difficulty with any aspects of social functioning, it may help to seek out social skills training with a therapist or through a structured social skills training program. Interventions often include a combination of explicit instruction, modeling, role playing, and feedback. Parents can also help by implementing simple, consistent ground rules for behavior and providing gentle but clear reminders as needed. Additionally, parents can facilitate play dates with peers, during which the parents take an active role in helping children utilize social skills and engage with each other appropriately.

Finally, though ADHD can present challenges in the social domain, kids with ADHD often possess many strengths that can help actually them succeed socially. Children with ADHD can be highly engaging, curious, energetic, creative, and open-minded. When these strengths are reinforced, kids with ADHD can often utilize them to create fun, rewarding social interactions and to develop rich, dynamic relationships.

About the Author

Maggie Rodriguez, Psy.D., provides comprehensive evaluation services for children, adolescents, and young adults with often complex presentations. She particularly enjoys working with individuals who have concerns about attention and executive functioning, language-based learning disorders, and those with overlapping cognitive and social/emotional difficulties.

Prior to joining NESCA, Dr. Rodriguez worked in private practice, where she completed assessments with high-functioning students presenting with complex cognitive profiles whose areas of weakness may have gone previously undiagnosed. Dr. Rodriguez’s experience also includes pre- and post-doctoral training in the Learning Disability Clinic at Boston Children’s Hospital and the Neurodevelopmental Center at MassGeneral for Children/North Shore Medical Center. Dr. Rodriguez has spent significant time working with students in academic settings, including k-12 public and charter school systems and private academic programs, such as the Threshold Program at Lesley University.

Dr. Rodriguez earned her Psy.D. from William James College in 2012, where her coursework and practicum training focused on clinical work with children and adolescents and on assessment. Her doctoral thesis centered on cultural issues related to evaluation.

Dr. Rodriguez lives north of Boston with her husband and three young children. She enjoys spending time outdoors hiking and bike riding with her family, practicing yoga, and reading.

To book a consultation with Dr. Rodriguez or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

Summer Reading Ideas

Mon, 06 Jun 2022 14:33:16 +0200

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

Research demonstrates that children lose reading skills over the summer break. A 2020 study found that students in 3rd to 5th grades lost, on average, about 20 percent of their school-year gains in reading during the summer. So, how do we encourage a reluctant reader to read during the summer? There are several fun opportunities that allow your child to read a book of their choice and earn prizes at the same time!

For example:

www.scholastic.com/site/summer-reading.html Scholastic Books offers a program that encourages children to “read books and stories; attend author events; interact with their favorite characters; play book-based games and activities; join dance parties; and more!” Children can read any book of their choice. They can also download and print a report of their reading progress. Additionally, by keeping Reading Streaks, your child will help unlock a donation of 100,000 books from Scholastic to Save the Children, providing books to children in rural America with limited or no access to books.

Bookworm Wednesdays | Showcase Cinemas According to their website, Bookworm Wednesdays is “A fun and rewarding summer reading program developed to encourage young children to read during the summer months.” Bookworm Wednesdays allows children to earn free movie admission to a select children’s film when they present a book report at a participating Cinema de Lux, Showcase, or Multiplex Cinemas box office. There are several local participating sites, including Patriot Place and Legacy Place. (Parents, as well as children under the age of 6, receive free admission and do not need to submit a book report).

www.barnesandnobleinc.com This is an opportunity for your child to earn free books! Your child can read any 8 books and complete the reading journal available at the Barnes & Noble website. Then your child brings the completed reading journal to any participating Barnes & Noble bookstore and chooses their free book from the books listed on the Reading Journal list (see the website for the list of titles available to choose from this summer). Free reward books must be collected from a local Barnes & Noble store during July and August.

Finally, check out your local library for programs! Most local libraries have reading incentive programs that children can participate in all summer long.

Other ideas include…

Have your child read a book that has been made into a movie (If the book is above their reading level, read the book to them or allow them to listen to the book as an audio recording). Once the child has completed their reading, enjoy a family movie night with popcorn and more.
Have your child read about a specific topic or place and then plan a field trip. For example, an older student could read “Little Women” and then visit Louisa May Alcott’s house in Concord, MA, or watch the 2019 version of the movie and then visit Lyman Estate in Waltham where some of the filming took place!
Allow your child to pick their own books. Allow them to choose from subjects of interest to them (parent-approved, of course), as they are more likely to read something they picked! Also, allow them to choose books from different book types (e.g., paperback, graphic novel, audiobooks).
If you are going on a family vacation, encourage your child to read books about the area (fact or fiction) and plan to visit some of the places mentioned in the book. Day trips are also encouraged. Your child could read a book about animals and then visit a local zoo or aquarium.

If you are unsure of which books are at your child’s reading level, many libraries break down books by grade level. Ultimately, summer reading should not be so easy that it is boring, but it also should not be too difficult, as that can cause frustration. Allowing children to pick out books at their independent reading level is best. Research has found that children read more and learn best when they are allowed to select the books they read.

Happy Summer Reading!

About the Author

She is the mother of one teenage girl.

To book a consultation with Dr. Talamo or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

Executive Function: Skill Building and Maintenance over the Summer

Mon, 30 May 2022 14:45:39 +0200

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Real-life Skills Program Manager and Coach, NESCA

With summer right around the corner, many students are thinking of warm evenings outside, days at the beach, pool or park, summer camps, and summer jobs. For parents, summer can sometimes feel like both a time of fun and a time of struggling to keep up with skills mastered and learned throughout the past school year, all while acclimating to a completely new summer routine. While some students receive summer services to keep up with important academic and executive function skills, there are absolutely ways for us to help support children and adolescents at home. Consider these three ways to incorporate executive function skill building into your child’s summer.

Plan and Complete a Project – Work with your child to brainstorm a project that they would like to complete this summer. Some examples include having a lemonade stand, building a tree fort, doing a full bedroom makeover, or raising money for a cause they care about. Help your child figure out how to put together a plan to complete their goal. This will likely include a timeline complete with a comprehensive “To Do List,” a list of materials or supplies, and a list of people they may need to ask for help. The more intentional the planning of these steps is, the more a child will internalize the level of planning and prioritization that goes into accomplishing such a goal. You may need to jump in to help, but take every opportunity to defer to them and let them actively think things through before making suggestions or solving problems for them. Planning and executing a personal summer project helps to build organization, planning and prioritizing, flexible thinking, working memory, and task initiation.
Organize a Family Outing – Summer can absolutely be a whirlwind, but reserve a day in the calendar for your child to plan a family outing or activity. This could be as big as a full day at the beach or as simple as a trip to lunch at their favorite restaurant. Help them think through everything that will be needed. What time will we leave? How long will it take to get there? How can you find that information? Should we check Google Maps together? How will we pay for the meal? By guiding your child through all of the steps before these activities, you help them recognize the level of planning and forethought that is necessary. For older children or adolescents, consider giving them a budget and asking them to plan a family outing independently, taking into account each family member’s preferences and schedules.
Add a Weekly Task – During the school year, parents often do not have time to add chores or anything new at all to their child’s calendar. Dinners are often prepared and eaten on the fly between rehearsals, appointments, practices, and homework, and laundry gets done when someone has a free moment. Summer can be a great time of the year to add in an expectation for students who have been a bit overloaded with homework or other distractions. Consider adding a weekly task that student both need to complete and figuring out a way to remember (often a digital reminder!). One of my favorite options is to have a student cook a meal for the family one night per week. Have them set an alarm for 12pm that day, or even the day before, that prompts them to “figure out the plan for dinner.” This may look drastically different at various ages. An eight-year-old may be very proud of themselves for serving boxed macaroni and cheese (made with supervision), while a high school student may be up for trying to recreate a family recipe. The goal is not a gourmet Tuesday night meal, but practice with prior planning, sequencing, following directions, and building time management skills.

Incorporating children and adolescents into the planning, hard work, and many executive function tasks that go in to making a summer run smoothly allows them to build skills naturally. By handing down responsibility and increasing expectations bit by bit, we can allow our students to build their skills slowly and confidently. It’s important that students realize all of these many steps before they are expected to do everything on their own. Often, allowing children to feel this level of control and responsibility leads them to feel quite accomplished and proud of themselves! If you feel that facilitating this may be tricky, consider reaching out about executive function coaching, as all of these strategies can be practiced one-on-one with a coach!

To book an appointment or to learn more about NESCA’s Executive Function Coaching Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

Screen Time’s Impact on Child Development and How Play Can Be One Solution

Mon, 23 May 2022 14:43:51 +0200

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

The pandemic has made the already complex job of parenting even more challenging. With parents having to balance working from home and remote learning, many families relied on screens for learning, socialization, and entertainment. Questions about screen time and the impact on child development were already hot topics in our digital age, but the pandemic brought about new and perhaps more compelling concerns.

It is common for children of all ages to engage with digital devices. Even prior to the pandemic, approximately 80% of parents reported that their child between the ages of five and 11 interacted with a tablet or computer, and 63% used a smartphone. For children under the age of five, 48% engaged with a tablet or computer, and 55% with a smartphone (pewresearch.org, July 2020).

While screens are an inevitable part of 21^st century life, too much screen time can have a detrimental impact on child development. The American Academy of Pediatrics recommends no screen time for children younger than two years of age. Older children should limit their screen time to no more than one or two hours a day. According to the American Academy of Pediatrics, too much screen time can be linked to:

Obesity
Irregular sleep
Behavioral problems
Impaired academic performance
Desensitization to violence
Less time for play

It has been established that excessive screen time may lead to obesity due to inactivity and increased snacking that often coincides with screen use. Using screens too close to bedtime may disrupt the body’s biological preparation for sleep, making it difficult to fall asleep and disrupting sleep schedules. Research has shown that elementary school students who spend more than two hours a day watching TV, playing video games or using a computer or smartphone are more likely to have emotional, social, and attention problems. Furthermore, increased time spent on screens results in less time available for learning and practicing skills important for academic and social development. Such skills include, but are not limited to, managing emotions and behavior, paying attention, solving problems effectively and independently, dealing with conflict, and resilience. So, what is the remedy? Limited screen time and more opportunities for play.

The benefits of play are almost limitless. Play is brain building and leads to changes in even the smallest structures. Play develops skills in planning and organization, cooperation, self-control, and communication. Often play involves trying and failing, and learning from mistakes, which enhances children’s capacity for solving problems and learning to focus attention, ultimately promoting the growth of executive functioning skills. Play also provides opportunities for learning to cope with adversity, resulting in increased resilience. There are many great blog articles on NESCA’s website offering information and tips for engaging in play and its benefits. They are written from a range of perspectives, which aids in understanding the wide-ranging value of play.

References:

https://www.pewresearch.org/internet/2020/07/28/parenting-children-in-the-age-of-screens/

https://publications.aap.org/pediatrics/article/119/1/182/70699/The-Importance-of-Play-in-Promoting-Healthy-Child

About the Author

To schedule an appointment with one of NESCA’s expert neuropsychologists, please complete our online intake form.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.