NESCA’s Londonderry, NH location has immediate availability for neuropsychological evaluations. Our NH clinicians specialize in the following evaluations: Neuropsychological; Autism; and Emotional and Psychological, as well as Academic Achievement and Learning Disability Testing. Our NH clinicians also conduct evaluations for students who are at boarding schools, and two of our NH clinicians have PsyPACT authorization, allowing them to conduct evaluations out-of-state.

Visit www.nesca-newton.com/intake for more information or to book an evaluation.

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5

Meet NESCA Pediatric & Adult Neuropsychologist Miranda Milana, Psy.D.

By | NESCA Notes 2021

By: Jane Hauser
Director of Marketing & Outreach

This September, NESCA welcomed a new neuropsychologist to its team. Learn more about Pediatric & Adult Neuropsychologist Miranda Milana, Psy.D., in my interview with her below.

Where did your interest in neuropsychology come from?

I knew from an early age that I wanted to work with children. I initially thought I would work with children in the medical field, but I ended up being fascinated by child psychology, which led to my focus on the clinical aspect of therapy with kids and their families.

I then started to notice the importance of neuropsychological reports in schools, treatment planning, formulating diagnoses and determining the tools needed to help kids be successful. I knew I wanted to do that! I saw my fair share of unhelpful reports and wanted to take the opportunity to write truly beneficial ones.

Over time, I’ve gotten to work with families and have been able to offer evaluations to the adults as well as young adults.

Who do you evaluate??

I really enjoy working with all kids, but have a particular intertest in early elementary-aged kids – toddlers through early elementary schoolers. I love to get to know kids whose parents, caregivers or educators are questioning whether they may have an autism spectrum disorder (ASD) or some kind of learning challenge. It’s exciting to start to work with a child as they are entering school and continue to watch them progress throughout their education.

Additionally, I have a particular interest in working with older adolescents and adults who feel there may be a “missing piece” in their understanding of themselves, or who seek greater insight into their personal profile to inform appropriate therapies, access relevant services, and enhance self-awareness.

Tell me about your clinical experience prior to joining NESCA.

Before coming to NESCA, I was a post-doctoral fellow at Boston Children’s Hospital, which provided me with great exposure to a wide variety of kids and the challenges they were experiencing. My case load there exposed me to a vast range of educational and developmental concerns and presentations. Working with children aged 2 through 17 who showed a wide-ranging array of presentations really helped me to become a flexible thinker.

It was a great opportunity to work with all types of clinicians, families and children. Also, having such a diverse case load afforded me the opportunity to become part of so many teams within the hospital, including the Down Syndrome, Adoption and Teenager teams, among others. It was rewarding to be able to learn from each one of them.

What drew you to NESCA?

I wanted to continue to work in a collaborative environment, where it wasn’t just me contributing to a child’s evaluation and plan. I really wanted to learn and collaborate with a team of psychologists and other providers in a group practice, outside of the hospital setting. Being part of a child’s trajectory in school is exciting, and NESCA allows me to do just that!

Joining NESCA also allows me to work with a more diverse group of individuals based on age. While I love working with children and adolescents, I also welcome the opportunity to work with more adults, parents, or young adults who are trying to secure adult services and supports.

What are some of the more rewarding experiences you’ve had as a neuropsychologist?

Getting kids who are closed off to share their experiences with me is very rewarding. With these kids, we have to be creative in how we approach them, get them to share and play. Having anxious, resistant children feel comfortable opening up to me in conversation or who allow themselves to be vulnerable by sharing personal information, is such a rewarding part of what I do. To know you have built that kind of trust with a child is so fulfilling.

Working with adults has also been rewarding, as it allows me to provide meaningful insights and answers to individuals who have often spent years seeking clarity without success.

What’s your secret sauce in building that trust with a child who is anxious or resistant?

I am kind of a kid at heart, so I use that in testing children to engage them and create a more fun environment. I take pride in getting to know a child beyond the test scores and collected data. Finding common ground and relating to them is so important. I also like to make sure they know I am part of their team who will support them as they move forward in school and in life. It’s a personal challenge to me to get the most resistant kids to engage and maybe even crack a smile during the evaluation!

 

About Miranda Milana, Psy.D.

Dr. Miranda Milana provides comprehensive evaluation services for children, adolescents, and adults 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 individual’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 person’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 evaluation with Pediatric Neuropsychologist Dr. Milana or one of our many other expert neuropsychologists or therapists, 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.

22

Myth Busters: Bilingualism and Language Delays in Young Children

By | NESCA Notes 2021

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

Bilingual and multilingual children are often diagnosed with both language disorders and autism spectrum disorders later in development than monolingual children. There are a variety of reasons for later diagnosis, such as disparities in service access or structural inequities in society which limit diagnostic or treatment services for bilingual and multilingual families as well as disparities in the availability of providers and experts capable of diagnosing communication disabilities and language delays in bilingual and multilingual children. Another main factor I often see in practice as a neuropsychologist is a “myth” related to language development in bilingual/multilingual children. The myth is that “bilingualism or multilingualism causes language delay.” This is not accurate and not concordant with the scientific research. If a parent, educator, pediatrician, or therapist raises concern about a bilingual or multilingual child’s language development, do not delay an evaluation to consider the presence of a language delay, communication disability, autism spectrum disorder, or a neurological or cognitive disability. It is likewise critical to not delay access to helpful interventions for language development (e.g., speech/language therapy, early literacy/phonics interventions, social skills/play interventions). Early detection of language delays improves outcomes for monolingual and bilingual/multilingual children.

Here are important key facts about language delay and bilingual/multilingual children which can be helpful for parents, educators, therapists, and other professionals:

  • While there are some differences in bilingual and multilingual language development from monolingual development in the brain, those differences do not produce speech delays.
  • Bilingual/multilingual children and monolingual children develop expressive language skills and reach early speech and language milestones at similar times in early development. For example, single-word vocabulary size of bilingual/multilingual children is equitable to vocabulary size of monolingual children.
  • Language regression (a “red flag” for autism spectrum disorders) occurs regardless of language status and is not dependent on a child’s monolingual or multilingual abilities.
  • There is much scientific research indicating that bilingualism/multilingualism enhances social communication skills (including children with autism spectrum disorders). Likewise, bilingualism/multilingualism does not in itself produce or explain social communication challenges for children.

Additional Resources

If you want to learn more about bilingualism and language delay, Dr. Brenda Gorman, Associate Professor in Communication Sciences and Disorders at Elmhurst College, and Dr. Alejandro Brice, Professor in the Department of Education at the University of Florida at St. Petersburg offer an informative YouTube video for parents and clinicians regarding bilingualism, “late talkers,” and language delay: https://www.youtube.com/watch?v=zT0x-EqanGg

This scientific article is also a helpful resource for parents and professionals: “Bilingualism in the Early Years: What the Science Says” (Byers-Heinlein and Lew-Williams, 2013): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168212/

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

To book an evaluation with Dr. Marchant 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 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.

 

156

What’s the Big Deal about a Pencil Grip?

By | NESCA Notes 2021

By: Jessica Hanna MS, OTR/L
Occupational Therapist, NESCA

With kids back in school, drawings, coloring pages, and written work will make their way from the classroom to backpacks and eventually to the fridge for everyone to admire.

From infancy to adulthood, we all hit many milestones in life. Some milestones stand out more than others, but the little ones are no less important. The ability to hold a writing tool is a milestone that moves through various stages from infancy through adulthood. If you get the chance to view and capture each stage along a child’s development, it’s genuinely fascinating!

So, what’s the big deal about the stages involved in holding a writing tool, such as a crayon, marker, or pencil? These stages are the foundation for developing the tiny muscles and arches of the human hand, creating strength and endurance during a writing/drawing activity, and developing stability to manipulate the writing tool to use it the intended way. As humans, we all move through these stages at one point. The progression through each stage is not uniform or standard. The ultimate goal is to reach the ability to hold a writing tool with a functional grasp pattern that promotes adequate speed, accuracy, and legibility without it being the cause of pain or fatigue.

For many kids, achieving fine motor precision and the skill for written output is challenging. However, as NESCA Occupational Therapist Sophie Bellenis, OTD, OTR/L, reminds us in her recent post, “Handwriting vs. Typing: Where do we draw the line?,” handwriting is still a valuable life tool.

So, what does the progression of pencil grasp development actually look like?

Primitive Stages – Observed between 12 and 36 months. The art of drawing and coloring is often the first exposure and gateway to children learning how to hold a writing tool. There is all the freedom, no pressure of writing, and no right and wrong to their drawing.

  • Radial Cross Palmer Grasp (Fig a.) – Full arm and shoulder movement is used to move the writing tool. The writing tool is positioned across the palm of the hand, held with a fisted hand, and the forearm is fully pronated with elbow winged high out to the side.
  • Palmer Supinate Grasp (Fig b.) – Full arm and shoulder movement is used to move the writing tool. The writing tool is positioned across the palm of the hand, held with a fisted hand, with slight flexion of the wrist, and the elbow slightly lowered out to the side.
  • Digital Pronate Grasp (Fig c.) – Full arm and shoulder movement used to move the writing tool. Arm and wrist are floating in the air, and only the index finger extends along the writing tool toward the tip.

Schneck, CM, and Henderson (1990)

Children will begin to shift between the various pencil grips as their shoulder and arm muscles become stronger and steadier.

Immature grasp or transitional grip phase – This grip has been observed as young as 2.7 years of age through 6.6 years of age as stated through research (Schneck, CM, and Henderson (1990)).

  • Static Tripod grasp (Fig g.) – The child will use their forearm and wrist movements only keeping fingers stationery and wrists slightly bent. Movement of the hand can be observed as not graceful. The thumb, index and middle finger will work together as the shaft of the pencil is stabilized by the 4th finger.

Ann-Sofie Selin (2003)

Mature grips – There is so much talk about what looks right and what looks wrong. Traditional pencil grips have evolved through time. There have been four pencil grips now classified as a mature grasp pattern. All mature grips use precise finger movement to manipulate a writing tool while keeping the forearm stabilized.

  • Dynamic Tripod Grip (Fig 1) – Previously known as the golden standard of all grips, where the thumb, index, and middle finger function together, while the pencil shaft rests on the middle finger.
  • Dynamic Quadrupod Grip (Fig 2) –The thumb, index, middle, and ring fingers function together while the pencil shaft rests on the ring finger.
  • Lateral Tripod Grip (Fig 3) – The pencil shaft is stabilized by the inner (lateral) side of the thumb and index finger while resting on the middle finger.
  • Lateral Quadrupod Grip (Fig 4) – The pencil shaft is stabilized by the inner (lateral) side of the thumb, index, and middle finger while resting on the ring finger.

Koziatek SM, Powell NJ (2003)

Pencil grips are generally believed to affect handwriting, and awkward pencil grips become the most commonly assumed cause as to why that is (Ann-Sofie Selin, 2003). However, the production of untidy or illegible handwriting does not always correlate to an unusual pencil grip. The most efficient pencil grip for a child is the one that will help them write with speed and legibility, without pain for an extended period of time.

When should a parent, caregiver or educator be concerned?

  • There is pain and excessive pressure on the writing tool by holding on too tight
  • Illegible handwriting
  • Writing speed is compromised
  • Complaint of hand fatigue during writing and coloring activities
  • Holding the pencil with a primitive grasp (e.g., full fist) after 4 years of age
  • White knuckles or hyperextended joints in fingers holding a writing tool
  • Visible flexed wrist and forearm lifted off the writing surface
  • Inability to choose a clear hand preference between ages 4 and 6 years of age
  • Complete avoidance of all drawing or writing activities

If you are concerned about your child’s pencil grip and/or handwriting, an Occupational Therapist can work with you to identify challenging areas and determine next steps. Let us know if we can help support your child.

References

Koziatek SM, Powell NJ. Pencil grips, legibility, and speed of fourth-graders’ writing in cursive. Am J Occup Ther. 2003 May-Jun;57(3):284-8.

Schneck, CM, and Henderson (1990) Descriptive analysis of the developmental progression of grip position for pencil and crayon control in nondysfunctional children. American Journal of Occupational Therapy, 44, (10) 893 – 900

Ann-Sofie Selin (2003). Pencil Grip: A Descriptive Model and Four Empirical Studies. Åbo Akademi University Press.

 

About the Author

Jessica Hanna has over 10 years of pediatric OT experience in conducting assessments and providing treatment of children and adolescents with a broad range of challenges and disabilities, including autism spectrum disorders, sensory processing disorders, visual impairments, cerebral palsy, executive function deficits and developmental disorders of motor function. Prior to joining NESCA, Jessica trained and worked in a variety of settings, including inpatient and outpatient hospital settings, private practice, schools and homes. She has served on interdisciplinary treatment teams and worked closely with schools, medical staff and other service providers in coordinating care. In addition, Jessica provided occupational therapy services at Perkins School for the Blind and Spaulding Rehabilitation Hospital pediatric inpatient unit, where she conducted comprehensive evaluations and interventions for children with a broad range of presentations.

 

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

 

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.

 

10

The Power of a List

By | NESCA Notes 2021

By Yvonne M. Asher, Ph.D. 
Pediatric Neuropsychologist

For so many children, adolescents, and young adults, I find myself recommending something that seems too simple to be of much use – a list. The power of lists has been identified and described in depth by several experts, such as Atul Gawande (The Checklist Manifesto – an excellent read). These books often discuss efficiency in the workplace, health and safety practices, and maintaining consistency in products or services. As adults, these are the things we often care about – ensuring that we are efficient, consistent, and getting things done.

In my practice, I recommend lists for different reasons. I recommend lists to teach executive functioning skills, such as planning, task initiation, organization, and task monitoring. Lists are also incredibly helpful for children who struggle to hold on to information. These children often miss information that is stated aloud, such as a parent giving directions or a teacher explaining instructions. Their brains often struggle to “keep up” with the pace of information presented in the world. Having the information written down in an organized manner, such a list, can help them access the information without time constraints.

Here is a quick example:

On a typical weekday morning, parents alternate checking on their 8-year-old as he gets ready for school. They give reminders of all the things left to do – “Brush your teeth!” “Get dressed!” “Put your homework in your backpack!” Time before the bus becomes shorter and shorter, as does everyone’s patience. Parents think, “We do the same things every single morning! Why is it so hard for him to remember?” Child thinks, “Why can’t they just leave me alone!” Voice volumes increase, tone shifts, and before anyone knows it or means to, there is a shouting match as the bus is pulling up.

Of course, a list won’t stop hurt feelings or eliminate frustration. However, if the child’s “morning routine” is posted somewhere easy to see, he may need far fewer reminders from his parents of all the tasks he has left to do. Frustration may be reduced, and the child can feel successful completing tasks with greater independence.

A list may be steps in a routine, as illustrated above. A list could also be of materials the child needs for baseball practice, the chores that should be done each week, or the limits and expectations around “screen time.” I often spend time with parents discussing the contents of a list, where the list should be placed, and the format it might take. For example, do you want checkboxes next to each item? Do you want the steps to be numbered? Maybe you love arts and crafts, and you want to laminate the list and have Velcro tabs with a “checkmark” that can be placed next to each completed task. The format and purpose vary, but lists are infinitely useful.

For many children, practice using lists is not only helping them to build skills in the moment, but is excellent practice for later life. Developing comfort with the tools and strategies that work best for you is an invaluable aspect of raising our children to become independent adults who can achieve their goals.

 

About the Author

Dr. Yvonne M. Asher enjoys working with a wide range of children and teens, including those with autism spectrum disorder, developmental delays, learning disabilities, attention difficulties and executive functioning challenges. She often works with children whose complex profiles are not easily captured by a single label or diagnosis. She particularly enjoys working with young children and helping parents through their “first touch” with mental health care or developmental concerns.

Dr. Asher’s approach to assessment is gentle and supportive, and recognizes the importance of building rapport and trust. When working with young children, Dr. Asher incorporates play and “games” that allow children to complete standardized assessments in a fun and engaging environment.

Dr. Asher has extensive experience working in public, charter and religious schools, both as a classroom teacher and psychologist. She holds a master’s degree in education and continues to love working with educators. As a psychologist working in public schools, she gained invaluable experience with the IEP process from start to finish. She incorporates both her educational and psychological training when formulating recommendations to school teams.

Dr. Asher attended Swarthmore College and the Jewish Theological Seminary. She completed her doctoral degree at Suffolk University, where her dissertation looked at the impact of starting middle school on children’s social and emotional wellbeing. After graduating, she completed an intensive fellowship at the MGH Lurie Center for Autism, where she worked with a wide range of children, adolescents and young adults with autism and related disorders.

 

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 Dr. Yvonne Asher, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

36

Vocational Assessment and Transition Planning

By | NESCA Notes 2021

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

Transition planning is a complex process centered around helping students, typically who receive special education services, to set goals for their postsecondary adult lives and to engage in learning, services, and experiences that will help them to ultimately reach those goals. Assessment is a critical aspect of this process, both as a means for collecting baseline information about the student and measuring progress throughout the planning process. While transition planning focuses on outcomes in several key areas (e.g., further education and training, employment, independent living, community engagement, adult service involvement), many families who seek transition assessment and planning help are specifically concerned about employment. What can my child do? What career path is best for my daughter? Will my son be able to support himself? For these families, vocational assessment is a critical piece of the transition planning process. Yet, many families do not have a good understanding of what a vocational evaluation includes and the types of results and recommendations that can come from such evaluation.

Vocational assessment has a relatively simple definition. It is the process of gathering information about a student’s interests, abilities, and aptitudes as they relate to the student’s work potential.[i] However, there is not one universal test or process used to collect this information. In fact, any of the following types of tests might be part of vocational assessment:

  • Record review
  • Informal interview with the student
  • Informal interview with parents, teachers, or other professionals who know the student well
  • Observation of student in current familiar environments
  • Interest inventories (informal or formal)
  • Learning style inventories
  • Self-reported skill, ability and achievement inventories
  • Work preference and motivation assessments
  • Work-related behavior inventories
  • Employability/Life skills assessment
  • Formal aptitude assessment
  • Situational assessment of a student in a controlled work environment
  • Work samples
  • Functional assessment of simulated or real job tasks

Importantly, most students do not need to participate in all of the above types of assessments. In fact, a lot of the best information comes from the first few informal steps of the process, record review (which often includes rich data about a student’s cognitive skills, sensory and motor skills, perceptual skills, and learning style) and interviews with the student and adults familiar with the student. Ultimately, the purpose of vocational assessment is to develop a profile of the student’s interests, skills, and aptitudes and formulate measurable short- and long-term career goals. However, it is important to remember that participation in vocational assessment typically does not, and should not, result in identification of one specific career to pursue. That’s not how any of the tests, or the overall process, is designed. Instead, results of vocational assessment will suggest a variety of careers or career families that a student may be interested in exploring more in depth. It is an important starting point of career exploration, especially for students who are unsure about their career goals. Results can also be helpful for identifying where there is alignment in a student’s aptitudes and interests or where more exposure and instruction may be needed to support a student’s career development. The information that comes out of vocational assessment is an invaluable part of comprehensive transition assessment and planning for students with and without disabilities.

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

Also, stay tuned for more blogs about vocational assessment this fall as my colleague Tabitha Monahan and I will be specifically breaking down some of the above types of testing in greater detail.

[i] Instructional Materials Laboratory. (1998).  Vocational assessment for students with special needs. Columbia, MO: Author.

 

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.

 

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, call 617-658-9800 or complete our online Intake Form.

11

When Gaming Is No Longer A Game

By | NESCA Notes 2021

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist and Therapist

Many parents are wrestling with how much time their children are engaging with screens, and finding themselves wondering how much is too much. Children who experience difficulty related to symptoms of ADHD are especially drawn to the stimulation of screens. And children with ADHD tend to require frequent and immediate rewards, making them especially drawn to screen-time activities. While a specific cause for ADHD has not been identified, there is some consensus that a shortage of dopamine could be to blame. Dopamine not only plays a role in how we feel pleasure, it is also significant in the uniquely human ability to think and plan.

Part of the allure of gaming – and social media – is that each new level reached and each new “like,” instantly releases a small dose of dopamine directly into the brain’s reward center. If you have ever had to fight with your child to get off technology, this is likely why. A deficit in dopamine is easily fed by screen-time activities, leading children to want more. This has led to a demand for content, resulting in tens of millions of dollars having been made by YouTubers whose entire platform is gaming, and children love watching them. They are entertaining, and kids learn tips for improving their own gaming.

Children worship gaming YouTubers, and many strive to be one someday. It is challenging for parents to keep up with the content their children are accessing largely because YouTube has created an algorithm in the system that suggests what to watch next based on frequent views or recent searches. YouTube’s recommendation system is specifically engineered to maximize watch time and often “up next” videos play automatically. In fact, this feature is responsible for more than 70 percent of all time spent on the site, indicating that children, and others, are consistently and reliably exploring recommended “up next” content. It is important for parents to do their research and know who their children are watching and following on YouTube, as they may be drawn into content that could be highly influential and contrary to family values. While many YouTubers are harmless, there are those who include brief, perhaps undetectable messages (e.g., PewDiePie) that influence what shows up next. Children are curious, and YouTube’s goal is to keep them engaged, which can turn into the perfect storm.

YouTube consists of a business model that rewards provocative videos with large sums of money. They strive to attract viewers by leading them down paths meant to keep people engaged. While much of the content may seem innocuous, there are reasons to be cautious as things aren’t always as innocent as they seem. Provocative content creates intrigue. It piques interest and may be especially attractive to older children and adolescents. As individuals strive to create the next viral video, putting forth extreme beliefs and violent content may be their pathway to becoming a celebrity. For these reasons, and as technology becomes increasingly embedded in children’s lives, it is important for parents to do their research and stay informed.

Some helpful resources include:

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

https://chadd.org/wp-content/uploads/2018/06/ATTN_06_15_TooMuchScreenTime.pdf

https://childmind.org/article/healthy-limits-on-video-games/

 

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.

 

3

The Path Back to Fitness

By | NESCA Notes 2021

By: Ann Helmus, Ph.D.
NESCA Founder/Director

One of the well-known impacts of the pandemic has been the loss of physical fitness in children and adolescents because of the loss of opportunities to play sports and generally move around. In addition, many children and adolescents have gained weight during this time. Maintaining a healthy weight and being physically fit offer many benefits for social-emotional development as well as academic performance. Numerous research studies link physical exercise to significant improvements in the regulation of mood and anxiety as well as attention and executive functioning.

Parents are often at a loss for how to help their child get back into good habits to lose weight, exercise regularly, or get back into a sport. Common parenting approaches, such as offering “helpful suggestions,” encouraging, nagging and bribing usually don’t work for long term—or even short term—positive change. Instead, these approaches often “back fire,” making the child feel even more ashamed or powerless—emotions that are not likely to fuel motivation to change habits.

So how do we support children and adolescents in developing the positive habits that are necessary for maintaining health and fitness? The key lies in empowering the child to determine his or her own goals and establishing their “why” through discussion of why they would like to reach this goal, what they will get by achieving the goal, and, perhaps most important, how they will feel when they reach this goal. This type of motivational interviewing builds internal motivation, which beats external motivators every time in terms of creating long term change.

Once the child or adolescent is clear on what they would like to achieve and why, the next step is determining the behavior changes that will help the child achieve their outlined goal and working with the child to figure out what’s manageable so that success can be ensured. For example, one adolescent might easily commit to a 30-minute daily bike ride, whereas another might want to start with a daily 10-minute walk. Success breeds success, so it is important to set goals that are challenging but also achievable. Throughout this process, the focus is on creating a positive mindset and positive emotional state of empowerment, hopefulness, optimism, and pride.

Some children may be open to this type of process with their parents; however, most adolescents will likely not want to be involved at this level with a parent. NESCA offers health and life coaching, aimed at helping adolescents and young adults with this process. Coaching offers a structured approach to helping an adolescent or young adult define his/her own goals and motivations as well as understanding the obstacles that they have encountered in reaching those goals, which are usually limiting beliefs (e.g., “I can never stick to things.”) or faulty self-identities (e.g., “I’m not athletic.”). The coaching process works through a combination of structured activities as well as a highly supportive personal relationship. To learn more, please join us for a webinar on Thursday, September 23 at 1:00 PM ET, view a previous webinar on this topic on our website or contact Health & Life Coach Billy Demiri for a free 30-minute consultation to determine if health coaching might be helpful for your child.

 

About the Author

NESCA Founder/Director Ann Helmus, Ph.D. is a licensed clinical neuropsychologist who has been practicing for almost 20 years. In 1996, she jointly founded the  Children’s Evaluation Center (CEC) in Newton, Massachusetts, serving as co-director there for almost ten years. During that time, CEC emerged as a leading regional center for the diagnosis and remediation of both learning disabilities and Autism Spectrum Disorders.

In September of 2007, Dr. Helmus established NESCA (Neuropsychology & Education Services for Children & Adolescents), a client and family-centered group of seasoned neuropsychologists and allied staff, many of whom she trained, striving to create and refine innovative clinical protocols and dedicated to setting new standards of care in the field.

Dr. Helmus specializes in the evaluation of children with learning disabilities, attention and executive function deficits and primary neurological disorders. In addition to assessing children, she also provides consultation and training to both public and private school systems. She frequently makes presentations to groups of parents, particularly on the topics of non-verbal learning disability and executive functioning.

To book an evaluation with Dr. Helmus, NESCA Founder and Director, or one of our many other expert neuropsychologists or therapists, 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.

14

Going with the Flow

By | NESCA Notes 2021

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

It’s September, and a new school year has already begun for most children. We had hoped that Covid would be behind us and the start of this school year would begin with a greater semblance of the old normal. Sigh…it has not. We are still wearing masks, keeping our distance and washing hands amongst other health considerations. Many students are eager to get back to school and in-person learning even though they have to wear masks. Many are accustomed to it, and it is no big deal. However, there are those students who preferred virtual learning and have grown more and more anxious at the thought of going back to in-person learning.

Back at the start of the pandemic, I wrote a blog about going with the flow, and it seemed appropriate to reintroduce the topic again as we start another school year still with so much uncertainty. Will there be outbreaks of the new variants at school? Will there be quarantines happening again? Will someone in my family, class, school get sick and how serious will it be?  We don’t know the answers to these questions, and worrying about them doesn’t help us be in the moment. In Bostonia’s current cover piece, “The kids are stressed, anxious, lonely, struggling, learning, grateful, adapting, alright,” Eric Moskowitz summed it up accurately. What researchers found is that children who were at a disadvantage before the pandemic suffered the most – which is not surprising – yet overall kids are resilient.

In  Angela Currie’s recent blog, “Helping Students Transition Back to School,” she covers the essentials of establishing bed time/morning routines, connecting with teachers, mask wearing routines and many more. I would like to add to her list with the psychological, social and emotional routines and ways of being that will also make the transition smoother.

Education Week offers a few social-emotional checklists that are good to review to help you set your student off on the right foot as they start this school year.

  • First check in with yourself and your own emotions/feelings. If you are feeling anxious, do something to help calm your emotions and gain some centeredness. Take care of yourself so you can take care of others.
  • Establish those all so important sleep, eating and exercise routines.
  • Establish a calming routine that the family can do together for a few minutes (i.e., yoga, mindful minute, deep breathing, etc.).
  • Acknowledge the breadth of feelings your child may have and how rapidly they may change. Point this out to him/her when they are calm. Introduce the realization that thoughts are connected to feelings, and they can change their thoughts to help their feelings change. Be understanding, supportive and empathetic yet also encourage your student to use their “past data” to support their progress forward through their feelings.
  • As Angela said, establish routines and predictability at home but also model and help your child know that things don’t always go as planned. Have routines yet be flexible, adaptable and a “go with the flow” mindset will be essential as s/he enters this school year. There are always Plans B, C, and D when Plan A doesn’t work. For instance, you may insist your child wear a mask and another child in his class, or afterschool activity/sport, may not. Preview this possible scenario so your child can adept and accept. Or, a student starts the year in-person, but then hybrid (hopefully not) happens…again. You get the idea about teaching flexibility.
  • Stay positive even in the midst of uncertainty, as this helps create the right biochemical mix that allows you to think more clearly.
  • Be aware of your thoughts and help your child be aware of their thoughts. Thoughts influence our mood, feelings and behavior, and we can exert control over them.
  • Be grateful (end the night with a gratitude moment).
  • Be supportive. Acknowledge the efforts, tasks, feelings, etc. that your kids are taking on and experiencing. It helps them develop self-confidence, self-esteem, self-efficacy, pride and a sense of competence.
  • Be hopeful. Yesterday is history (don’t dwell there), tomorrow is a mystery (don’t worry about it) and today is a gift (even if you don’t feel like it is). Be present and allow whatever feelings come up (positive or negative) to flow through you so you can make way for new feelings.

Wishing everyone a smooth start to the 2021-2022 school year, and may the force be with us as we continue to combat Covid.

Resources

https://www.bu.edu/bostonia/

https://www.edweek.org/leadership/preparing-for-in-person-learning-a-covid-19-checklist-for-parents/2021/08?utm_source=nl&utm_medium=eml&utm_campaign=eu&M=63136722&U=1970318&UUID=f2e19d19dbb5bd4e92068a32311b141c

 

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.

 

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.

 

152

Back to School: Tips for the Sensory-savvy Parent

By | NESCA Notes 2021

By Lauren Zeitler, MSOT, OTR/L
NESCA Occupational Therapist; Feeding Specialist

Just like that, summer is over and it is finally time for children to head back to school! This year might look a little different as we move from remote learning and ease back into the school building full time. For children with sensory processing issues, the school building poses a great deal of anxiety as they try to deal with various sensory stimuli. The noisy bus, smells of the cafeteria, and visually overwhelming classroom are just a few examples of the daily overstimulating experiences a student with sensory processing issues encounters. Don’t fret! We will break down the school day and the core sensory systems that are impacted along with strategies to help your student succeed.

Starting the Day: Auditory Processing

As the day starts, many children hop on the bus and ride to school. This means they are encountering a noisy, chaotic vehicle filled with many other children. You might see kids respond negatively by running away, crying, or holding hands over their ears to block out the noise. Startling easily, the bus ride can be a stressful start that will set the tone for the rest of the day for students with sensory issues. It is important to utilize different strategies to prepare your child for the bus. Try these ideas to help with auditory processing:

  • Provide over the ear noise canceling headphones to wear on the bus ride
  • Provide calming music on an iPod, etc. to listen to during bus ride
  • Wear a weighted vest or lap pad during bus ride
  • Provide heavy work input to the student’s body in the morning before entering the bus

Learning in the Classroom: Visual Processing

Walking into the classroom, there are bookcases lined up, posters on the walls, desks in rows, and lots of bright lights. When it comes to visual processing, children respond in different ways. Some children avoid these stimuli, while others seek out visual input. Squinting, blinking, and covering their eyes are just some of the quick fix responses to the bothersome lights. Some kids have trouble paying attention if there are too many things to look at. To some children, the flickering lightbulb in the corner of the ceiling is much more interesting than whatever the teacher has to say. It is very easy to become distracted and overwhelmed in the visually overstimulating classroom environment. Teachers: try these strategies to help with visual processing:

  • Remove distracting posters, pictures, etc. from the walls
  • Place busy bookcases, lockers, etc. in the back of the room
  • Have easily visually distracted children sit in the front of the room closest to the board
  • Provide a calming corner with a sensory bin filled with items, such as noise cancelling headphones, stuffed animals, lavender lotion, books, etc.

Time for Art Class: Tactile Processing

It is time for art class, and your child freezes at the doorway refusing to enter the room. Glitter and glue are everywhere, and the fear of being dirty strikes again. The feeling of touching messy media can send some children into panic fight or flight mode. This goes well beyond art class’s requirement to interact with different media, often branching out and impacting their ability to participate in social experiences, such as playing on the playground. To avoid overstimulation, prepare your child’s body with these strategies:

  • Prepare the student before art class by reviewing the schedule
  • Provide heavy work breaks, such as wall push-ups before entering the art room
  • Provide a weighted vest or lap pad to use during art class
  • Find adaptations to the art project to decrease interaction with sticky substances (i.e., using glue sticks, spoons to spread glitter, etc.)

Lunch in the Cafeteria: Olfactory and Gustatory Processing

It is now time for lunch. As your child walks into the cafeteria, they look around to find their friends and are greeted with a really strong smell. What is that?! Your child is no longer looking for their friends; instead, they are trying to find a way out because the smell is too overwhelming. Try these strategies to help kids with sensitive noses:

  • Find a place in the cafeteria that your child can eat away from the food serving area (where the smells are the strongest)
  • Provide an essential oil patch or roller ball that the student can smell to calm their body and move their focus away from the cafeteria smell
  • Use essential oils, such as lavender or eucalyptus, which help calm
  • Provide heavy work opportunities before entering the cafeteria to help organize the body

Once your child has gathered their food and found the best place to eat, they sit down and look at their meal. Oh gosh – why does it look so squishy? This sandwich is slimy – that is a big no! The gustatory – or taste system – kicks in, and it does not appear happy. What can we do to help kids with sensitive taste systems? Try these strategies to help make mealtime easier:

  • Provide lunch from home to help control what options the child has to eat during the day
  • Provide crunchy food items, such as pretzels, raw veggies (carrots, peppers, cucumbers, etc.), or popcorn to promote “heavy, organizing input” to the mouth and jaw
  • Provide thick drinks, such as smoothies, to drink through a straw
  • Promote drinking water through a water bottle with a mouth piece, such as those from Camelbak
  • Provide a special treat, such as licorice, Twizzlers, or sucker candy to provide alerting and organizing input

Gym Class Makes Me Nervous: Vestibular and Proprioceptive Processing

Afternoon gym class has arrived, and your student is too afraid to participate. Bumping into the wall, being hit by a ball, or playing in a coordinated group activity is hard for some children. Echoing voices and shoes squeaking on the floor, bright colors and moving objects are enough to overstimulate anyone. With the right environment, gym class can be fun for everyone! Here are some strategies to help with vestibular and proprioceptive processing in gym class:

  • Provide the opportunity for the student to leave the gym. Let them know that if the class becomes too overwhelming they can ask the teacher for a break. Going for a walk to the bathroom or grabbing water is a great, brief break.
  • Adapt games or activities as necessary. Students will be at different skill levels, and physical activity can present unique challenges. Provide simpler options when possible.
  • Create space boundaries. Using visual cues for personal space, and working in small groups can relieve anxiety. Visual cues may also be helpful in showing children where they should position themselves for games and exercises.
  • Provide activities that promote consistent, linear movements instead of sporadic, rotational movements, to help keep these sensory systems organized.

Remember to keep school fun! The school day is where kids spend most of their week, and we want to ensure they have the best experiences possible. Recognize that not all students with sensory processing issues will have the same strengths and difficulties. Meeting a student where they’re at and discovering their specific strengths is the greatest way to set them up for a successful school year! If you have any questions or to learn more about occupational therapy services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

About the Author

Lauren Zeitler is a licensed Occupational Therapist in Massachusetts, specializing in pediatric occupational and feeding therapy. Ms. Zeitler joined NESCA full-time in the fall of 2020 to offer occupational therapy assessment and treatment for children of all ages, as well as to work in conjunction with Abigael Gray, MS, CCC-SLP, on the feeding team.

 

 

 

 

 

 

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.

 

1

Helping Students Transition Back to School

By | NESCA Notes 2021

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

Back in June, I wrote a blog about dealing with uncertainty at the end of the school year. Now, two months later, families are focused on the transition back to school, and a level of uncertainty still remains. Many children are re-entering full in-person learning for the first time in over a year and a half. We are also facing the reality that our overall community health is not as improved as we hoped it would be by now. There is debate about how to appropriately re-enter school, and this stress is likely palpable for many children and teens. As a community, we are grieving the continued loss of “normalcy,” with no clear idea of when that will be recovered.

How do we help children, and their adults, transition back to school during such a time? Some of the basic strategies are similar to those that we do to help them cope with the end of the school year. This includes watching for signs that your child may be struggling (e.g., difficulty sleeping) and talking about their feelings related to starting school in an open and validating manner. In addition, here are some strategies for helping to ease the upcoming transition to school:

  • Start to work into your schoolyear daily routine within the last week or two of summer. This includes bedtimes and wakeup times.
  • Create a morning and evening routine checklist or schedule. Use visual prompts for young children. For example, a morning checklist may include: Wake Up, Get Dressed, Eat Breakfast, Brush Teeth, Pack Bag (listing words or pictures of what to pack), and Departure Time. Practice this checklist for a couple days ahead of school starting to help you child get into the routine and understand how long each task will take.
  • Preview your child’s schoolyear to the extent possible. This may include reviewing their class schedule, looking at their teacher’s profile or picture on the school website, going to a back-to-school event at their school, etc.
  • Help your child set some goals for the upcoming year, trying to create intrinsic goals (e.g., build confidence with reading; make a new friend; ask questions more; etc.), rather than extrinsic (e.g., get straight As).
  • For children who were full remote last year and whose schools have mask mandate, practice wearing a mask at home for increasing durations of time.
  • Avoid scheduling extra activities during the first two weeks of school, such as weekend trips or appointments, allowing for a more relaxed transition.
  • Particularly for elementary age children, email your child’s teacher ahead of the year starting in order to briefly introduce yourself and your child. If you child has specialized needs, concisely highlight key things that the teacher should be aware of heading into the year.
  • For children who will be using a locker for the first time, have them practice opening a combination lock at home before the year starts.
  • For families feeling dissatisfaction regarding your school’s COVID-related mandates or plan, work to keep this conflict or stress away from your child.

Understood.org has a range of tools to help children transition back to school, including a Back to School Update for teachers, Backpack Checklists, Back-to-School Worksheet, Introduction Letter templates, and a Self-Awareness Worksheet, among others. Consider the above tips and resources and determine which are most appropriate for your child and their current skill set and feelings regarding the return to school. With the right tools in place, children and families can feel more confident entering the school year.

 

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.

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