NESCA is open and currently scheduling contactless evaluations in all three of our locations (Newton and Plainville, MA and Londonderry, NH). For more information, please view, “Testing in the Age of COVID-19” on our Video Resources page.

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Jane Hauser

Simple Executive Functioning Strategies When The World Is Anything But Simple

By | NESCA Notes 2020

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

Whether your children have returned to school full-time, on a hybrid model or fully virtual learning, we are all juggling. Juggling work demands, family demands, household demands and educational demands in a time of remarkable uncertainty. The start of the school year typically brings the smell of fresh school supplies and our best organizational efforts, but many of us may feel hesitant to use organizing strategies to manage our lives. Why? Because our lives are unpredictable and anything but typical these days. If you’re hesitating to use pen on a calendar, I hear you!

The ability to plan and employ organizational strategies is a key task of our executive functioning system. It’s what allows us to coordinate multiple schedules, dance and sports practices, projects at work, PTO bake sale reminders, and get out the door each day on time. I have been hesitant to adopt routines because I recall vividly how all those plans imploded in March when the world stood still. I hear the buzz about how school will end up fully remote so “put it all down in pencil before it all changes.”  Maybe that will prove true, but in the meantime, let’s consider the ways that we can rally our executive systems to do what they do best: plan, organize and regulate. Some suggestions for how to do this now while the world is unpredictable:

  1. Adopt the Sunday Game Plan. Put information in a family or personal calendar once a week. Spend a few moments on Sunday night catching up on plans for the coming week. Even if we end up transitioning from “hybrid” to “remote” (or all remote), this planning routine can still be adopted. Conclude your Sunday Game Plan by previewing what may be coming the week after in the event of long-term projects. While the content of your game plan may change, the structure can remain consistent.
  2. Keep a consistent schedule for sleep for the family. When we were all in school and work, we had set times to wake up in the morning. We should adopt more consistent bed times at least from Sunday through Thursday nights. Engage kids and teens in a conversation about the plan for sleep. If there are days when children are not waking up to physically attend school, try to keep wake up times no more than an hour off to allow for more consistency in our overall sleep regulation.
  3. As part of your weekly plan, set aside time for exercise. This is particularly important for children who will have reduced physical education activities. Research about the positive impact of exercise on mood, anxiety and attention underscores how important movement is in the day.
  4. Work together with your child to identify a consistent work space. Needing a work space at home is not suddenly and dramatically forced on all of us like it was in the spring. Take the time to arrange a space that is as distraction-free as you can make it. It’s not necessary to run out and buy things as minimal distractions can allow your child to focus on their school work. Keep the supplies nearby in their own bin, basket or box top.
  5. Help your child to create visual schedules or checklists for the day. Include times for virtual school, times for completing assignments and steps to submit the work either electronically or packed for the next day in school. Keep checklists consistent throughout the week when possible.
  6. Plan and schedule breaks. For young kids, try to plan breaks from tasks for every 15-20 minutes. Incorporate movement or stretching when possible to improve focus. For older students, try to plan breaks every 30 minutes of sustained effort. Try to take a full break from screens rather than replacing a tablet/computer screen with a phone or video game.

Children and teens develop their executive functioning skills over time. Keep this in mind as you set up routines and expectations for your whole family as what is expected for a second grader should and will differ from a seventh grader. Again, the content can differ but the structure of using a checklist, planning a break, or working at a desk or table is the same.

Please remember: the pandemic has depleted our executive functioning systems, so it’s important that we are gentle and kind to ourselves. Think about simple and reasonable systems to organize yourself and your family.  And be flexible when we have to go back to the drawing board.

 

Resources:

Positive impact of exercise:

https://www.sciencedirect.com/science/article/abs/pii/S0022347612009948

Executive Functioning tips and sample schedules:

https://www.smartbutscatteredkids.com/

 

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.

Voting Support for Individuals with Disabilities

By | NESCA Notes 2020

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

General Election season is upon us. The major-party national conventions are over, and the Massachusetts primary results are in.

About 20% of eligible voters have a disabilitybut only 49.3% of individuals with disabilities voted in 2018. And that was an 8.5% increase from previous years among this increasingly important voting bloc. Campaigns, such as the REV UP Campaign by the American Association of People with Disabilities (AAPD), have launched voter registration drives, championed for disability rights and policies to be part of the political conversation, and to increase awareness and action to remove barriers that make it challenging for individuals with disabilities to vote.

So how can we 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 DTA also include voter registration forms.

Absentee/mail-in ballots have been in the news more than ever due to the pandemic. Still, they have long been an excellent strategy for individuals with disabilities who would have difficulty voting in person. Absentee ballots are a great option for individuals who may have difficulty navigating the multiple steps in person or have a lower processing speed.

All citizens are also allowed to bring a person to help them while they are at the polls. Encourage your young person that many people require assistance at the polls, and it is completely normal to have the help available 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. These red booklets can be found at many community locations and frequently include the local library, post office and city/town hall. 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 elected positions.

Help your young adult find out what the different boards do and why there is an election for things such as town selectman or zoning board. Help your young adult 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.

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?

 

About the Author

Tabitha Monahan, M.A., 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.

 

How Do I Prepare My Child for a Neuropsychological Evaluation?

By | NESCA Notes 2020

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

Parents often ask us what they should tell their child about their upcoming neuropsychological evaluation, especially when it is their first experience with testing. I advise parents to refer to the neuropsychologist using his or her first name, as the term “doctor” can be scary and raise fears about medical exams. I might also add that the visit will not involve any shots! In order to describe the evaluation itself; here is some helpful language:

  • They are going to ask you questions, and you just need to do your best to answer.
  • They might ask you to do some drawing or writing.
  • Some activities might feel like you’re in school; for example, reading stories or doing math problems.

It may also be helpful to create a simple social story prior to the evaluation to help preview what to expect for your child.

To explain the reasons for doing the evaluation, some key phrases to use with your child include:

  • We want to understand how you learn, because everybody learns differently.
  • We are going to be “brain detectives” and figure out how your brain works!
  • This will help us identify your strengths and areas that we need to work on. That way, we can help you with things that are harder for you.
  • This will help your teachers understand your learning style so they can help you better at school.
  • Just try your best!

Testing in the age of Covid-19 is different. It can be harder to help children feel at ease when everyone is wearing masks, and we can’t offer a high five for good work. But as we are all learning, children are often more resilient than adults. Prior to coming in for an evaluation, you might want to remind your child to wear their mask, wash their hands and not approach people too closely.

It is also important to understand that a neuropsychological evaluation is a lot of work for your child! Finding a way to reward them for their effort will go a long way in helping them stay motivated and positive. This could be as simple as swinging by the drive-thru for a donut or something more extravagant, like a new video game. Whatever you choose to do, create a plan with your child and let the neuropsychologist know. When I have a child in my office who is starting to fatigue, it’s always a great motivator to remind them of the special prize they’ll get at the end of the visit!

 

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 evaluation with Dr. Gibbons 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.

Sitting Down to Work – Tips for Proper Set-up and Posture

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L

Occupational Therapist; Real-life Skills Program Manager and Coach

When working from home, it’s easy to ignore the important things that most people know about maintaining proper posture. The draw of a bed covered in pillows or a cozy nook on the couch can outweigh the rational knowledge that sitting with good posture will help us to stay focused, decrease back or joint pain, and help build a strong core. When it comes to children, they are often unaware of the ways that posture can affect their bodies and their work. They need cues, reminders and examples of the best way to sit to stay focused and be productive. In our last OT Tuesday blog, we discussed the importance of a child’s physical foundation, the core. When it comes to learning, a strong core helps with postural stability. As the start of a new school year draws near, let’s review some important things to consider about the environment and physical set-up for learning and the best positions for our students’ bodies.

Creating a space for learning helps to differentiate between school and home activities that, for many students, are currently happening in the same building. Here are some tips for setting up this space:

  • Find appropriately sized furniture. Children should have their feet on the ground when sitting at their desk! Tables should be at an appropriate height. Tables that are too tall tend to prompt children to hunch their shoulders or sit on their feet, while tables that are too small cause children to slouch and lean their heads on their hands.
  • Help them organize. Classrooms are built to help students grow their executive function skills, as teachers constantly help set up organizational systems and use tricks to keep students on track. Your child may benefit from color coded folders for each subject, a hard copy of their daily schedule (with pictures for younger kids!) or a visual timer.

There are also a few important things to remember to help with proper seated posture.

  • Use visual reminders. Your child may benefit from a picture of someone using proper seated position posted near their workspace. While they may still need a reminder every so often, having an image gives children a model to mimic.
  • The Rule of 90 Degrees. When sitting at a table, children’s hips, knees and ankles should all be positioned at 90 degrees. This helps to create a solid foundation. When children have a strong foundation and postural stability, they are set up to freely and accurately use their fine motor skills. Being grounded allows for easier writing, typing, cutting and manipulation of all the tools necessary for learning. Ideally, children’s elbows will also create a 90 degree angle.
  • Consider a slant board. Placing a computer or a paper on a slanted board can help students realize that they need to sit up straight, promote proper wrist placement and angle, and draw their eye gaze up from the desk. Writing on a vertical or slanted surface in general can help with the development of handwriting skills.
  • Stabilize that paper. Reminding students to use their non-dominant hand to hold their paper helps with precision and accuracy.
  • Allow them to switch it up! Some tasks really require a child to be sitting up straight, grounded and engaged. For example, a student who is hand-writing a final copy of their paragraph or using scissors for an art class will want to be cognizant of their bodies and how they are seated. In contrast, some activities provide opportunities to move around and change positions. If a student is reading a book for English Language Arts, they may want to lie on their belly or sit in a beanbag chair.
  • Take breaks. No matter how perfect a child’s seated posture is, they will benefit from movement and stretching breaks. Little bodies are built to move, bounce and wiggle!

Prioritizing posture as a child helps to build good habits, evenly distribute stress on the body’s muscle ligaments and joints, and create a strong, grounded foundation.

 

About the Author

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. 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. Dr. 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, Dr. 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 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 Facts about the Rorschach Inkblot Test

By | NESCA Notes 2020

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

As an evaluator, I receive a number of questions about the usefulness of the Rorschach Inkblot Test. The following “10 facts” are designed to answer some common questions and also incorporate some new and fresh scientific research findings related to the Rorschach.

The Rorschach Inkblot Test is a diagnostic tool that should always be incorporated within a comprehensive evaluation which includes projective or “performance-based” testing. If you are considering if your child or teen would benefit from projective testing, please refer to one of my earlier NESCA blog posts: More Than An Inkblot: Measuring Problem-Solving and Critical Thinking Skills with Projective Tests.”

  1. The Rorschach Inkblot Test is a test that provides data and information about how a child or teen problem-solves situations “in the moment.”
  2. Research indicates that the Rorschach is a valid assessment tool (with validity akin to other personality measures, as well as measures of IQ).
  3. Recent fMRI studies show high levels of brain activation in brain regions associated with emotion, emotion memories, perception, attention and visual processing.
  4. After the Rorschach Inkblot Test is administered, an experienced evaluator uses an evidence-based scoring system to compare a child’s responses to a normative sample to evaluate their performance. RPAS (Rorschach Performance Assessment System) is the most evidence-based scoring system to date and has strong empirical evidence.
  5. The Rorschach evaluates and detects psychotic symptoms.
  6. The Rorschach is helpful for evaluating trauma, including dissociation and intrusive symptoms.
  7. The Rorschach assesses both trait (stable characteristics or patterns) and state (a temporary way of being) variables. For example, the Rorschach tells us about how a person is coping with everyday stressors (e.g. from bullying to family loss to lack of sleep). The Rorschach also tells us if a person has a more pervasive habit of “bottling up” emotions or behaving rashly or impulsively when overwhelmed.
  8. The Rorschach quantifies a child or teen’s strengths, such as capacity for insight and adaptability, or resiliency to stress.
  9. The Rorschach Inkblot Test is not for everyone. More research is needed about the utility of the Rorschach for individuals with expressive language communication impairments or visual-spatial processing deficits.
  10. Not every evaluator is equipped to administer and interpret the Rorschach Inkblot Test. The Rorschach is a powerful diagnostic tool when interpreted in conjunction with observation and other test results by a skilled, experienced practitioner with extensive training in Rorschach administration and interpretation.

 

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.

 

Compensatory Services for Transition-aged Individuals

By | NESCA Notes 2020

By: Becki Lauzon, M.A., CRC
Transition Specialist and Consultant

Since the start of COVID, a top concern for many parents and guardians of students who receive IEP services, such as Occupational Therapy, Physical Therapy, Speech and Language, etc., has been how to make up for those services that were missed during school closures and remote learning. One group of parents and guardians who have been especially worried are those who support students who turned 22 and aged out of special education services or will be aging out in the near future.

As we near the end of summer, the Department of Elementary and Secondary Education (DESE) recently released important guidance for schools and families on this topic. Below you will find the links to specific resources, including the presentation from DESE that was given on August 20th during the Special Education Leaders’ Meeting, the official guidance on compensatory services that was shared on August 17th, as well as a very informative article from the Boston Globe that highlights all reopening models.

There is a lot of important information in these documents. To assist with everyone’s busy lives, I have opted to point out some of the key pieces of information.

Helpful Links:

Zoom Meeting Presentation for Special Education Directors on August 20, 2020

Coronavirus (COVID-19) Special Education Technical Assistance Advisory 2021-1: COVID-19 Compensatory Services and Recovery Support for Students with IEPs

List of Reopening Models by District for Fall 2020 (as of noon, August 18, 2020

Boston Globe Reopening Plan Tracker

Important Information:

  • When a student with services and/or related services on their IEP has not been afforded those services due to a failure on the school’s part, compensatory services (i.e., services to make up for something missed) are a consideration by the IEP team through an IEP team process.
  • “COVID-19 Compensatory Services” (CCS) refers to services that a student’s IEP Team determines are needed to remedy a student’s skill or knowledge loss, or lack of effective progress, that resulted from delayed, interrupted, suspended, or inaccessible IEP services because of the emergency suspension of in-person education related to the COVID-19 pandemic.”
  • COVID-19 Compensatory services are NOT the same as typical compensatory services. These services are for students who are on IEPs that have had a lack of effective progress related to changes in service delivery during the COVID-19 pandemic.
  • “Students with disabilities who did not receive or were unable to access any special education services during the suspension of in-person education are likely to require CCS and should be prioritized. Other students with IEPs, including students with significant and complex needs,1 are also likely to require CCS and should be prioritized for consideration.”
  • The Department recommends prioritizing the scheduling of IEP meetings to discuss CCS for several student populations, including “students who turned 22 during the suspension of in-person education or who will turn 22 during the first three months of the 2020-21 school year, and whose transition programs were interrupted or suspended before they aged out.”1
  • For priority populations, the Department recommends that CCS determinations be made as soon as possible but not later than December 15, 2020.
  • Schools and districts are urged to use ongoing parental engagement along with their own judgment when determining which IEP meetings to prioritize this fall.
  • Appendix B Questions and Answers on the Transition to Adult Life for Students Turning 22 between March 17 and December 23, 2020 (pages 14-17 of the Special Education Technical Assistance Advisory)1 has detailed information regarding students turning 22 during COVID.

Transition COVID-19 Compensatory Examples:

There are several examples in the DESE document regarding types of compensatory services that an IEP team might consider providing for transition-aged individuals. I have listed many of the DESE examples below. I have also added some ideas and suggestions in smaller bullets that further break down the examples, which may be helpful for families and teams.

  • Accessing agency/community resources and services
    • Looking at adult resources, such as DDS, DMH, MRC, Centers for Independent Living
  • Instruction in activities for daily living, including personal finance and accessing healthcare
    • Cooking and domestic skills
    • Opening a bank account
    • Learning online banking
    • Make a monthly budget
    • Practice making change
  • Continue specialized instruction for the completion of an MCAS portfolio appeal for students who are seeking to earn a high school diploma
  • Community-based instruction
    • This can still occur!
  • Community participation
    • Accessing local outdoor parks, hiking trails, etc.
    • Grocery shopping
    • Identifying virtual offerings within your community
  • Health and safety
    • COVID safety
    • Learning how to order medication and organize it for the week
  • Pre-vocational/employment support services
    • As the job market has changed for the time being, this may be an opportunity for informational interviews
  • Job search and retention skills
    • Individuals who lost their job due to COVID may need assistance in returning to that place of employment if they are hiring again
  • Job coaching/training opportunities
  • Preparation for college and/or postsecondary training
    • Virtual college tours
    • Making a list of pros and cons for schools
  • Related services, e.g., counseling, occupational therapy, physical therapy, speech-language services
  • Self-advocacy skills
  • Social skills
  • Travel Training
    • Obtaining your Charlie Card
    • Filling out the application for The Ride
    • Studying the driver’s ed manual and taking free online tests
    • Using Google maps to identify distances to and from common places

Our transition team at NESCA is always here to offer consultation and creative options for families and school teams if you find that you and your student are having a difficult time finding ways to make up for lost transition services or implement current transition services.

 

References

1.      Massachusetts Department of Education. Coronavirus (COVID-19) Special Education Technical Assistance Advisory 2021-1: COVID-19 Compensatory Services and Recovery Support for Students with IEPs; Accessed on August 26, 2020.

 

About the Author

Becki Lauzon, M.A., CRC, works with teens, young adults and their families out of the Newton, MA and Plainville, MA offices. Lauzon has unparalleled experience as a Transition Specialist, Transition Consultant and Vocational Program Coordinator. Lauzon will be providing transition assessment (including testing, functional evaluations and observations) consultation, case management, training and professional development for schools; and transition planning, consultation and coaching for transition-aged students and their parents.

 

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.

 

What In-person School Looks Like During COVID-19

By | NESCA Notes 2020

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

Fall is approaching, and school is starting. As a student, I always knew summer was close to ending when Staples started their “Most Wonderful Time of the Year” commercial. The joy that parents and the community feel as fall approaches and another year of learning begins is understandably absent this year. Many parents, teachers and students are still unsure if they will be remote, in-person or both. All are too aware that even if students and teachers return to the school building, school will not look as it did in the fall of 2019. The comradery that our children experience through recess and interactive group work will be limited. Lunch will not be the boisterous room of students comparing who is in each class and what teachers are giving homework the first week.

What can we expect then–especially our students who need the small in-person support they have received from their special education teachers, teaching assistants and related service providers? I was able to get a glimpse of what our new in-person normal would look like providing vocational counseling and support during an extended-school year (ESY) program this summer. When returning to school, the first thing I learned—remembered, is how resilient children are. Most students in the programs had very few issues with masks. For those who did, more frequent mask breaks and workarounds, such as face shields, greater distance between them and other students or neck scarves let them still participate in much needed in-person support. Hand-washing and sanitizer have become the norm, and staff and students had frequent opportunities to use both. Social Skills groups still occurred but were modified to continue to be possible. Community-based opportunities were limited, but again, teachers and service providers have long been accustomed to finding out of the box solutions for their students.

Yes, the first day was nerveracking. How were the students going to tolerate wearing a mask for hours on end? How were my co-workers and I going to wear a mask all day long? How was I going to get a drink safely while wearing a mask? But we did. Staff and students alike remained diligent with hand-washing, and the students were ready to learn. Teachers and teaching assistants (TAs) were available and came together for short periods to help students understand challenging tasks. Some of our children and students have behaviors or need activities of daily living (ADL) support that may have us more uneasy with their health and safety returning to in-person learning. Teachers and TAs were prepared for that, too. Whether it was a face shield with a mask, an extra set of clothes to change into or an additional layer of PPE, the student’s needs were met, and we all returned the next day.

Every district seems to have its own approach and plan. Still, in the end, each plan’s goal is the same: have every student continue to learn and prepare for life after high school and have each person return home safe and healthy.

 

About the Author

Tabitha Monahan, M.A., 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.

 

Core Strength and Stability: The Physical Foundation

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L

Occupational Therapist; Real-life Skills Program Manager and Coach

As our country heads into a period of unique learning, whether through a remote learning experience, a hybrid model or an in-person option with heightened rules and regulations, I find myself focusing on foundation. Foundation, simply defined, means, “the basis upon which something stands or is supported.” Currently, we are looking at a huge shift in how programs will run, how teachers will teach and how schools will support our children, but these principles are rooted in strong foundations. Our educators have knowledge, proven methods and an evidence base that allows for creativity, flexibility and evolution.

With regard to our students, foundational skills are the basics that help them feel secure and grounded enough to tackle the more individualized and creative aspects of learning. It is, in part, due to these foundational skills that many of our surprisingly resilient children have handled the COVID-19 pandemic with more flexibility and grace than the adults in their lives.

Today, let’s highlight the physical foundation that supports a child throughout their day, the core. Anatomically, the core refers to the transverse abdominis, internal and external oblique muscles, rectus abdominis, and the multifidus and erector spinae. This group of muscles holds a child upright when they are sitting at their seat, standing in line and running around on the playground. It is one of the foundational elements that promotes healthy motor development. Having a strong and active core makes it easier for a child to use their fine motor muscles with intent, stay alert for the duration of a class or a Zoom session, and develop healthy postural habits. Occupational therapists are trained to determine whether these activities are being affected by a weak core and if there is a need for intervention. Teachers and parents who spend substantial time with our children may want to be aware of and look out for the clues and signals of core instability, which include:

  • Compensatory strategies for stability – These are the subconscious ways that children compensate for core weakness. Essentially, they are bad habits that initially help to keep kids from getting too fatigued to participate in activities, but can have negative long-term effects. Some common examples include “W-sitting” and holding a breath during activities that require strength.
  • Leaning on anything and everything – Some children sit and lean their head on their hands or the desk when they write, lean against adults when standing up or sitting on a couch, and lean on furniture or tables when they are standing at home. These same students often slouch down in their seats and hunch their shoulders forward when they stand. This could signify a weak core.
  • Difficulty with balance – The inability to stay balanced and upright may be due to core instability. Many children are still developing the ability to run, jump, walk across a balance beam and stand on one foot, but if they seem to be falling over or losing control of their body more frequently than their peers, a weak core may be the culprit. These balance issues may also be apparent when a child is doing daily activities, such as getting dressed, putting on shoes or getting in and out of a car.
  • Difficulty with fine motor tasks – Sometimes children have a strong core and still have weak fine motor skills; however, often a weak core is exacerbating fine motor deficits. There is a little phrase that goes, “proximal stability for distal mobility” that is used by therapists, yogis and personal trainers alike. This means that it is important to have strength and stability at the core to easily move and control the muscles in our arms and legs.

Notably, helping a child to build their core is not always as simple as doing a few targeted exercises. While pure muscle strength may be the root cause of instability, it is not the only possibility. Other causes include poor alignment of the ribcage and pelvis, the need for some neuromuscular reeducation to help children engage the right muscles, and breathing habits that interfere with proper muscle use. If you feel like core weakness may be interfering with your child’s success, it may be worth seeking an occupational therapy assessment or speaking to your school’s occupational therapist about how to help them feel secure, sturdy and grounded. We can all benefit from a strong foundation.

 

About the Author

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. 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. Dr. 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, Dr. 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 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.

 

The Next Pandemic: Mental Health Issues

By | NESCA Notes 2020

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

The return to school, whether remotely or in person, will be a transition that is bound to be stressful for many children and adolescents as well as their parents and teachers. Coming on the heels of five stressful months of lockdown, remote learning, loss of social contact and so many other changes,  children will be meeting this challenge with depleted resources for coping with stress and may show new signs of anxiety or mood issues. This will be particularly true for children and adolescents who have underlying issues with mental health, attention or learning. Prioritizing the mental health of students and focusing on providing emotional support will be key to helping children manage the transition back to school. “When children feel connected, they’re going to learn better, do better, stay on track,” commented Dr. Nadine Kaslow, professor of psychiatry at Emory School of Medicine and past president of the American Psychological Association, in this article. She emphasized that “loving warm interactions need to take precedence” over struggling with them about behavior or about schoolwork.”   Remembering that undesirable behaviors are often driven by emotional distress and are a form of communication can be helpful for parents in responding in a positive and supportive manner. As we continue through this period of unprecedented levels of stress and change, children need to feel connected to and supported by their parents even more than is usual; maintaining this connection is far more important than any academic goals, no matter how far behind parents fear their child is as a result of the interruption to regular schooling.

If you have concerns about your child’s mental health, clinicians at NESCA are available for expert consultation or evaluation of your child’s emotional functioning so that the appropriate supports can be put in place. This work can be done either through teletherapy or in-person through contactless evaluations in all three of our locations (Newton and Plainville, MA and Londonderry, NH). NESCA has several suites in which there is a large plexiglass panel in the shared wall between two offices so that the child/parent and evaluator/therapist are in separate offices but have the benefit of full visibility and communication through headphones. For more information, please view, “Testing in the Age of COVID-19” on our Video Resources page.

If you have questions about your child’s mental health and would like professional help, please reach out to Dot Lucci, M.Ed., CAGS: dlucci@nesca-newton.com for an intake and screening.

 

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.

Processing Speed Deficits and College – Part 2 – Finding a Fit

By | NESCA Notes 2020

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

In my last blog, Processing Speed Deficits and College – Part 1 – The Dilemma, I discussed specialized instruction for students who have processing speed deficits in high school in comparison to the accommodations process in college. Below is a list of some of the accommodations and instructional modifications that are often afforded to students with processing speed deficits in high school, and if/how that support can be replicated in college as well as how hard a student may need to work to bridge gaps in support. One of the most important things to remember when reviewing this list is that modifications to the course of study or workload in a college course are typically not available in college. Students with processing difficulties must be able to keep up with the same instruction provided to every student in the class through a combination of accommodations, self-help strategies and use of supports (tutoring, academic coaching, office hours, study groups, etc.) outside of the classroom.

In the classroom

  • Reduced pace for instruction – High school educators may be used to heavily modifying their instruction (i.e., providing instruction at a slower pace, in manageable “chunks,” sometimes even with breaks between content) when they are teaching a class that includes students with reduced processing speeds. This is a typical methodology for many private special education schools and for special education classes in public schools. However, this is not the typical instructional style at a traditional college. With that said, there is great variety in the pacing of classes from one institution to another, and even from one teacher to another within the same institution. For students who have received specialized instruction in high school, it is important to consider the pace of available instruction and to sit in on college classes when considering this transition. Depending on the student’s learning profile, it may be necessary to seek out a college or support program that is specifically designed for students with learning disabilities or has had targeted programming for students with learning disabilities—especially those with processing speed deficits—for many years.
  • Copies of teacher notes or fill-in-the-blank notes – Note-taking is an important skill for life, and even students who receive accommodations to enhance their note-taking need to build skills for retaining instruction and oral direction. However, some students exit high school without note-taking skills. Upon request, colleges often have one or more ways that they can accommodate students who are unable to effectively take their own notes in class. Students may be able to get copies of teacher notes/slides, copies of notes taken by another designated student or professional note taker, recordings of class or opportunities to use other technologies in class, such as a Livescribe Smartpen. When note-taking is a challenge, it is important to understand what accommodations are typically available at a particular college, including what support might be provided for assistive technology training and usage.
  • Follow-up questions and review of learning – Students who have difficulty processing classroom learning in real-time are often provided lengthy opportunities to ask questions about materials outside of class and/or provided with copies of the teacher’s lecture materials and study guides for separate review. When thinking about college, easy access to course information and resources from outside of the classroom is an important consideration. While many universities and professors use learning management system (LMS) technologies like Blackboard, Canvas, Google Classroom, etc., there are still some professors who have not made the shift to using these systems for the majority of their coursework or student communication. Getting a sense of technology use is important if a student expects to preview and review course materials outside of the classroom (independently or with support). Understanding how easy it is to get ahold of professors outside of class (e.g., percentage of faculty who work full-time at the school, have offices, have office hours), and how to schedule brief times for individual communication with the instructor is also useful.

Managing assignments

  • Reduced writing – In high school, students who struggle with processing speed may be expected to complete fewer assignments or have longer deadlines than typical peers. In college, students are expected to complete the same number of assignments and to have all of their work for each course completed by the end of the semester. It is possible at some colleges to request extensions on assignments as an accommodation or on a case-by-case basis. However, extensions on assignments should be something that are needed as an exception rather than a rule or students may find themselves unable to keep up toward the end of a semester. Instead of extending deadlines, students who struggle with writing demands may benefit greatly by taking a reduced course load (i.e., fewer classes per semester) or by diversifying the types of classes they enroll in during one semester—for example, taking a kinesiology class at the same time as an English Composition class. If these types of accommodations are important, students will need to carefully understand a school’s policies on underloads as well as how much control/flexibility a student is able to have when managing their course of study.
  • Grading based on quality not quantity – Just as described above, it is important to remember that every student in a college course is expected to complete the same quantity of work and same course requirements. Both quality and quantity matter in college and for those reasons it is important to pick a school that is well suited for your pace and style of learning as well as a major that will enable you to fulfill course requirements using your learning strengths.
  • Support with reading fluency – Specialized instruction during K-12 education may have focused on helping a student to increase their reading pace. Reading intervention and readers are not typical in college. However, technology can be a lifesaver in supporting a student’s independent reading fluency. Students may benefit from audio books or from text-to-speech technology so that they can take in information in multiple modes and a faster pace. Practicing with technologies and understanding the related accommodations that will be available in college are important for continued reading success. Some high school students have additionally needed tutoring support because they learn best when discussing aloud content that they have read in a supportive setting—for those students, it has been important to seek out schools or learning disability programs that can provide this type of tutoring (a less common support) or to pay privately for tutoring in addition to college-based learning supports.

Testing

  • Extra time – This is one accommodation that is fairly common in both high school and college settings. One major change is that many high schools provided unlimited extra time to students, even those with no identified learning disabilities. In college, students will typically receive 50% or 100% extended time based on their needs as demonstrated in diagnostic testing. Good executive functioning can be helpful if you are a student who uses extra time on exams, because you may need to schedule your exams in a separate testing setting each time they occur.
  • Shorter length/Reduced writing requirements – As a college student, you are required to meet the same testing requirements as every student in your class. If you are accustomed to reduced writing requirements on tests, you will need to consider some of the other available accommodations (e.g., extra time, assistive technology, etc.) to successfully manage. You may also need support building your test taking strategies so that you can use your time most efficiently on tests.
  • Separate testing space – Taking a test in a reduced distraction environment, or possibly a private room, is another accommodation that is common in both high school and college. Similar to students who receive extra time on tests, there can be a high degree of planning and organization involved in scheduling one’s exams in a separate setting according to school guidelines. Students may want to inquire about the level of support that college personnel will provide to a student when they are first learning to organize and implement their testing accommodations.

Social and daily life

  • Two additional factors that may have been important in high school include Smaller school/class size and Similar peer cohort. Matriculating from a small homogenous class or school environment, where all of your peers have similar learning styles and accommodation needs, can be a shock. When researching and visiting schools, it will be extremely important to get a sense of who the other students on campus are, how common processing speed deficits are among students with learning disabilities on campus, how diverse the school is and how tolerant students generally are, etc. Sitting in on classes and taking part in accepted student days can be critical activities for students who are looking for a college that will meet them where they are at.

When students enroll with disability support services, they are often asked how their disability impacts their learning, what accommodations they were provided in high school, and what accommodations they think they will need. For students with processing speed deficits, it is critical to be able to answer these questions before beginning a college search and to find colleges that truly match their learning needs as well as their more general wishlist!

 

 

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. 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 or call 617-658-9800.