All Posts By

Kelley Challen

Summer Learning

By | NESCA Notes 2018

By: Amity Kulis, Psy.D.
Pediatric Neuropsychologist, NESCA

As the warm days are here and summer vacation is either upon us or close by, our minds are shifting away from education: homework, studying for tests, and general stress. However, it is important to keep in mind that while summer vacation should be fun, it also provides an opportunity to build on learning.

Summer learning loss or summer slide is a real phenomenon for most children, even those without learning disabilities. Now, I am not advocating that every child needs to be in summer school to prevent this loss, but I am suggesting that we should be mindful and think about ways to promote learning over the summer. The areas of most concern include regression in reading and math skills, physical fitness, and social skills. These challenges are easy to overcome with some thoughtful planning of activities.

Reading: Studies suggest that just four to five books over the summer help to prevent summer learning loss in reading. Now not every child is going to be excited to read, even if they get to pick out their own books over the summer. However, we can find ways to make it more interesting.

  • Perhaps everyone in the family reads the same book and there are opportunities to read together or talk about the book at night. By reading out loud this would allow for even the youngest family member to be included.
  • Maybe a child is encouraged to pick a book about an upcoming family vacation. For example, a tour guide or the history of the area and they can relate that information when they are actually on vacation.
  • Graphic novels and other books that integrate words and pictures can be more exciting for some children.
  • Visit local museums. Without your children even realizing it they will be reading as they explore the exhibits at the Science Museum or the Aquarium. Boston and New England have many wonderful museums and summer is a great time to explore them with the added benefit of your children being exposed to printed text at each exhibit. It can be expensive to visit all the museums but most public libraries offer free or discounted prices to many museums.

Math: Many studies point to the most concern for regression in math skills. It seems easier to find ways to address reading skills over the summer and more difficult to find fun ways to continue to support math development. The good news is there are fun ways to incorporate math into everyday life.

  • While most of us are trying to limit technology and screen time in our children’s lives, the reality is that most children want it. Make screen time more educational by downloading games that involve math activities that are appropriate for your child’s educational skills.
  • Get cooking! Over the summer have your child help you in preparing a meal or a favorite treat. There is so much math involved in cooking. For young children it can simply be counting out the number of carrots needed for the soup and for older children you can learn about fractions or doubling or even tripling the recipe. You’ll be helping to make math more functional and applicable to real life, plus you’ll have fun and a tasty treat afterwards.
  • Another great way to involve numbers in everyday activities is including your child in planning the schedule for the day. Planning for the amount of travel time, whether it be by car or public transportation, accounting for the amount of time at the various activities and planning in meals can be a great exercise in time management and using numbers.

Physical activity and Social Skills: In addition to the academic aspects of summer slide it is also important to consider the physical and social aspects of an unstructured summer vacation. During the school year children have daily recess and regular gym class where they are presented with opportunities to interact with peers and get their bodies moving. During the summer there are endless opportunities to continue to promote these skills:

  • Sign your child up for a camp. Almost all summer camps have a social component and many also involve regular physical activity.
  • If your child is not doing summer camp there are also plenty of activities happening on a weekly basis throughout the summer. Check out your local recreation department/community center for free or discounted activities.
  • Walk or ride instead of driving the car. In the warm weather over the summer there are so many opportunities to get outside. Ride your bike or walk to the local ice cream parlor or even just around the block.
  • It can also be a great opportunity to learn a new sport like swimming or tennis.
  • Playgrounds, the beach, water parks, among others, are excellent places to meet up with old friends or meet new friends.

The important thing for the summer is to have fun and to never stop learning!

About the Author:

Dr. Amity Kulis joined NESCA in 2012 after earning her doctoral degree in clinical psychology from the Massachusetts School of Professional Psychology, with a concentration in Children, Adolescents and Families (CAF). She completed post-doctoral training in pediatric neuropsychology with an emphasis on treating children with developmental, intellectual, learning and executive functioning challenges. She also has extensive training psychological (projective) testing and has conducted individual and group therapies for children of all ages. Before joining NESCA, Dr. Kulis worked in private practices, clinics, and schools, conducting comprehensive assessments on children ranging from toddlers through young adults. In addition, Dr. Kulis has had the opportunity to consult with various school systems, conducting observations of programs, and providing in-service trainings for staff. Dr. Kulis currently conducts neuropsychological and psychological (projective) assessments for school aged children through young adulthood. She regularly participates in transition assessments (focusing on the needs of adolescents as they emerge into adulthood) and has a special interest in working with complex learners that may also struggle with emotional challenges and psychiatric conditions. In addition to administering comprehensive and data driven evaluations, Dr. Kulis regularly conducts school-based observations and participates in school meetings to help share her findings and consultation with a student’s TEAM.

 

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.

 

 

Remote Real-life Skills Coaching: How Does it Work?

By | NESCA Notes 2020

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

What is life skills coaching?

Coaching services in general aim to target functional life skills and help our children and adolescents to slowly build the ability to independent. While some of these skills, such as taking Uber, riding the T, or ordering in a restaurant, cannot be targeted using an online platform, the majority of these skills can absolutely be built with the help of a dedicated remote coach. Currently, many of our coaches are helping students through the great task of processing a huge life change in response to the COVID19 virus.

What skills can be worked on with a remote coach?

Hard skills are often thought of as specific, functional abilities that one can develop and perform. (In employment, these are often thought of as technical skills.) Options that can be worked on with a remote coach include cooking based on a specific recipe, ordering groceries on-line, calling to refill prescription, setting up a medication management system, typing, using Google classroom or Microsoft suite, electronic calendar management, etc.

Soft Skills include more abstract and broad abilities that are necessary for employment, academic success, and community independence. NESCA coaches work on executive function, social communication, and self-determination skills necessary for long-term independence at home, in school, and at work. Example skills taught include creating daily schedules, goal setting, preparing for interviews, organizing the home environment in order to be productive, reading and understanding IEPs and assessments, using technology to support memory, customer service skills, research skills, and more.

With the current pace and routine of life changing dramatically, NESCA coaches are working to help our clients establish healthy routines and habits. Coaches are available to help develop functional morning and evening routines, set up weekly to-do lists, develop a system to meet deadlines, use online resources for virtual learning, etc.

Who can benefit from this service?

Almost all adolescents and young adults could benefit from building life (and career or college readiness) skills, increasing independence, and practicing executive function; however, our neurodiverse population often has particular difficulty with changes in routine and greatly benefits from having a relational support to build structure and navigate change. All of our coaches have extensive experience working with adolescents and young adults with a wide range of learning, developmental, physical and social-emotional needs. NESCA is committed to helping young people who are struggling with this transition as well as families who are eager to use this unique situational opportunity to focus on skill building at home that is often difficult to fit in simultaneous to normal school demands.

What is a recommended coaching schedule?

Due to the individualized natural of coaching, the schedule and frequency can be incredibly personalized for each individual client. All of our coaching sessions begin with an intake process that includes input from both the adolescent and their family. Schedules are often developed in collaboration with the teen or young adult, the family, and the coach to best meet the client’s needs. Some example schedules that are used by current NESCA clients include:

  • Weekly Skill Building. Clients who are looking to target specific skills often choose to do a weekly session focus on learning and repetition.
  • Monday, Wednesday, Friday 30 Minute Check-ins. This model allows for a student to receive some guidance creating their own scheduling, while simultaneously holding them accountable.
  • Monday Motivation/Friday Follow-up! These sessions range from 1-2 hours and include weekly goal setting, check-ins regarding a weekly to-do list, and personal scheduling. For many clients a Friday follow-up session is an important opportunity to practice self-monitoring and review the previous week.

As somebody who coaches students in person and remotely, what differences do you notice?

I find that the main difference when coaching students remotely is when and how skills are targeted. In person, much of my coaching focuses on community integration, using our transit systems, and navigating the complex social interactions that are necessary when out in the community. Remote coaching can still target pieces of each of these skill areas but the process is in many ways more intrinsic. We may focus on learning to use the internet to find community opportunities, learning to create schedules for travel or complete applications for para-transit, using video learning to “try out” travel, employment, and community activities, and bolstering social media skills. We focused on building global skills in new ways that will help in the future, across environments. For instance, social communication by phone and video conferencing is a skill that will support social and employment success in the future.

In terms of the personal connection and opportunity to build rapport, I find that some teenagers are incredibly adept at communicating over a digital medium. Those who are not, tend to learn quickly. I am continually impressed by their ability to focus, discuss real-life topics, and build skills remotely.

 

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, Transition Services, or Virtual Coaching 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.

 

Planning and Preparing for College from Home during Covid-19

By | NESCA Notes 2020

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

While college in the United States is looking quite different for student’s currently enrolled, many (but not all) high school juniors across the country participated in SAT testing yesterday morning in preparation for their college application process. For teenagers–who have natural difficulties thinking ahead and anticipating consequences–being stuck at home may feel particularly tedious and taxing.

Here are some suggestions for teens that may help to use the time productively and get ahead on next year’s college search and admissions process:

  1. Use this time to draft a college application resume that includes information about your co-curricular and extracurricular activities, employment and volunteer experiences, skills, achievements and awards, summer activities, and any hobbies or interests. Try to include all of the experiences you have had throughout the year (ask your parents if you cannot remember everything you have done). You may not end up providing this directly to a college, but it will be useful when you request recommendations, complete applications, and need to put together a resume for employment. Learn more about building a college application resume at The Balance Careers.
  2. Hop on some college search engines and go through a few search processes. Search engines can help you to think about what characteristics matter to you and which selection criteria are less important. If you happen to find a school that you want to research further, even better. Some of the search engines we like include: BigFuture, Cappex, and Collegedata. There are lots of popular engines and you should pick what works for you.
  3. Take virtual college campus tours to explore colleges of interest and to begin to familiarize yourself with college daily life and vocabulary. Look at admissions sites for tour information or join a site like YouVisit. Learn more about virtual tours in this US News Article: How to Make the Most of Virtual College Tours.
  4. Practice your interview skills! There are lots of great web sites with sample interview questions (e.g., ThoughtCo.com, BigFuture). Practice with a friend via video chat (e.g., Facetime, Google, Skype, Messenger) or record yourself.
  5. Write a practice or rough draft college essay. Common App Essay Prompts remain the same from one year to the next and has already announced that first-year essay prompts will remain the same for next application season. Check those out here: https://www.commonapp.org/apply/essay-prompts

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

About the Author:

Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. 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.

The Use of Adaptive Behavior Rating Scales in Neuropsychological Assessment

By | NESCA Notes 2019

By Jason McCormick, Psy.D.
Pediatric Neuropsychologist

In my work as a neuropsychologist, much of my practice involves assessment geared toward transition planning – the move from high school to college or from high school to the working world. For these cases, I find the use of measures of adaptive behavior skills – day-to-day skills associated with self-care, communication, community navigation, home living, socialization, use of leisure time, and functional academics – to be a critical part of the neuropsychological testing battery.

Historically, adaptive behavior rating scales were developed and primarily used for assessment of intellectual disability. While adaptive behavior has taken rightful prominence in the assessment and diagnosis of intellectual disability – overtaking the importance of intelligence testing – the use of adaptive rating measures also proves quite important to help with transition planning for individuals with a wide range of psychiatric and neurodevelopmental presentations, including those with exceptionally strong cognitive skills.

These measures (e.g., Adaptive Behavior Assessment System – Third Edition; Vineland Adaptive Behavior Scales – Third Edition), which take the form of parent/caregiver or teacher questionnaires/structured interviews, yield detailed information about an adolescent’s readiness for their upcoming transition out of their family’s home. Particularly for bright adolescents with strong academic skills who might, say, present with attention and executive function challenges but have largely been successful in school, an assessment of adaptive behavior skills is often overlooked. However, over the course of my career, I have heard multiple stories of students who have seemed “college-ready” in the traditional sense of the word (i.e., strong academic and cognitive skills) but have suffered “failure to launch” experiences, as they had not learned to take their prescribed medications consistently, never learned to self-regulate their sleep schedule, or were well behind in their capacity to strike a balance between work and leisure activities.

Although the scores obtained on these measures can be a helpful guide, I find that a closer look at the specific components that may point to a need for additional skill development can help generate a sort of “to-do” list for transition planning work. Thus, while at times simply confirming an adolescent’s suspected transition readiness, the administration of an adaptive measure often proves to be a valuable tool to help determine what skill areas need to be targeted prior to the transition and/or supported during the transition.

 

About the Author:

McCormick

Dr. Jason McCormick is a senior clinician at NESCA, sees children, adolescents and young adults with a variety of presenting issues, including Attention Deficit Hyperactivity Disorder (AD/HD), dyslexia and non-verbal learning disability. He has expertise in Asperger’s Disorder and has volunteered at the Asperger’s Association of New England (AANE). Dr. McCormick mainly sees individuals ranging from age 10 through the college years, and he has a particular interest in the often difficult transition between high school and college. As part of his work with older students, Dr. McCormick is very familiar with the documentation requirements of standardized testing boards. He also holds an advisory and consultative role with a prestigious local university, assisting in the provision of appropriate academic accommodations to their students with learning disabilities and other issues complicating their education.

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

 

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

 

State Dyslexia Laws – What do they aim to do and how can we aid their success?

By | NESCA Notes 2019

 

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

While in 2013 there were only 22 states that had laws regarding dyslexia, as of March 2018, 42 states have dyslexia-specific laws, and as discussed in the article Dyslexia Laws in the USA: A 2018 Update by Martha Youman and Nancy Mather, 33 legislative bills related to dyslexia were introduced between January and March 2018 alone. These dyslexia laws address such things as dyslexia awareness, teacher training, early screening of risk factors, interventions and accommodations, and rights of individuals with dyslexia. In addition to identifying the need to address these matters, at least 10 states have developed dyslexia handbooks, and New Hampshire (where I practice as an evaluator and consultant) has developed a dyslexia resource guide. With Governor Charlie Baker’s signing of S2607 on October 19, 2018, Massachusetts now joins the list of states with dyslexia training, screening, and intervention mandates.

To see such progress in the identification and intervention of dyslexia is exciting for everyone who is connected to this community. As a pediatric neuropsychologist, I have worked with individuals with dyslexia and related disorders for many years, and in 2017 I had the pleasure of being one of the many professionals involved in the development of the NH dyslexia resource guide. Since that time, it has been encouraging to see a number of school districts embrace training opportunities and develop early screening efforts. While that is so, across the nation several states still do not have dyslexia-specific laws, and most states that do have them continue to experience uncertainty about how to implement said laws. Based on my personal experience and observations, there appear to be some basic steps or efforts that may improve the effectiveness of these efforts:

  • Use the term “Dyslexia.” Historically, the term “dyslexia” has been rejected or discouraged by most schools, instead preferring to label the associated learning profile as a Specific Learning Disability in reading; however, dyslexia specialists and advocates have long argued that this latter term is problematic because it fails to acknowledge the neurobiology of dyslexia and it does not inform interventions, accommodations, and related services with the level of specificity that is dictated by the defined diagnosed label. To address this concern, in 2015 the U.S. Department of Education issued a formal letter clarifying that “there is nothing in the IDEA or [the] implementing regulations that would prohibit IEP Teams from referencing or using dyslexia, dyscalculia, or dysgraphia in a child’s IEP.” Until schools are willing to routinely use the term “dyslexia,” the potential success of dyslexia laws is significantly challenged.
  • Educate families about universal screening and differentiated instruction. The screening and intervention requirements outlined in most dyslexia laws fall within the purview of general education, aiming to identify children with risk factors for learning disabilities and support their needs through multi-tiered systems of support, such as Response to Intervention (RTI). As such, there are not as many defined requirements regarding progress monitoring and reporting, or the coordination of the child’s “team” (i.e. parents, teachers, and other pertinent school personnel), as there would be within special education procedures. Families need to be educated about these universal screening procedures and methods of differentiating instruction within the general education curriculum so that they can understand their child’s challenges and monitor progress in a more informed manner.
  • Coordinate general education and special education screening and evaluation procedures. While the screening and intervention procedures discussed in dyslexia laws are generally within general education, a child should be referred for special education consideration if he or she is not making progress with the increased levels of RTI support. To optimize the utility and impact of the early screenings and to ease the referral process, the criterion that is measured within the general education setting should map onto the criterion for special education eligibility as much as possible; however, should a child require referral for special education consideration, it will also be critical to conduct a comprehensive evaluation of why the child is not progressing, allowing for more individualized and appropriate interventions.
  • Ensure the dissemination of dyslexia handbooks or resource guides. While the dyslexia community is enthused by state dyslexia laws, many teachers and school personnel are not aware of these mandates or the associated resources. These resources are a treasure trove of information about how to delivery differentiated instruction and integrate instructional methods and accommodations that are likely to be helpful for all students.
  • Continue raising awareness. Parents, teachers, and school personnel should all be educated about learning profiles, early warning signs, screening procedures, and interventions. School districts should take advantage of the resources provided by their state, which often includes the availability of a state-appointed reading specialist who can provide training or aid the dissemination of information or development of screening and intervention procedures.

There has been great progress in the recognition, identification, and remediation of dyslexia within American schools; however, this work is only just beginning. At the core of this issue is the need to recognize dyslexia as a defined, neurologically-based learning disability that can be identified at an early age and can be effectively remediated through targeted, evidence-based interventions.

Through our evaluations with students in New Hampshire and Massachusetts, clinicians at NESCA aim to identify and define learning profiles such as these and provide recommendations for targeted instruction as well as systemic support and training. Please visit our website at www.nesca-newton.com for more information.

 

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.

What is executive functioning? – Part 2 – How can adolescents develop these important skills?

By | NESCA Notes 2019

By: Alissa Talamo, PhD
Clinical Neuropsychologist, NESCA

Cody is a 17-year-old young man participating in 11th grade. He is a talented runner with a good sense of humor and he has achieved mostly Bs in his college preparatory and advanced college preparatory high school classes. However, Cody’s mother describes him as the kind of kid whose “head would fall off if it was not attached.” Cody has an English tutor who has helped him to organize his thoughts and writing throughout high school. He seems to run out of time with everything—homework, tests, showers, video games—unless his parents and teachers provide him with several reminders. He also has trouble starting and finishing tasks, even things that are important to him. For example, he wanted to apply for a job at Market Basket. His mother has emailed him the online application link three times, but he still had not completed it after two months. Cody wants to go to college and is hoping to be recruited by a men’s cross country team. So, his parents took him to see a neuropsychologist to see if he could qualify for extra time on the SAT. They had heard the term executive functioning and knew that this was an area where Cody struggled, but they did not realize how significant his challenges were until the neuropsychologist shared his test results. Cody and his parents were grateful to have a better understanding of Cody’s learning strengths and challenges and also to learn that executive functioning skills can be remediated throughout the lifespan.

What is executive functioning?

Part 1 of this blog defined executive functioning as the “conductor” of all cognitive skills and identified three main components:

  • Working memory (the ability to hold and manipulate information in your mind),
  • Inhibitory control (inhibiting impulsivity, to pause and think before reacting),
  • Cognitive flexibility (the ability to adjust to changing demands).

Part 2 of this blog post highlights activities suggested to enhance the development of executive functioning and self-regulation skills during adolescence (taken from developingchild.harvard.edu booklet titled “Enhancing and Practicing Executive Function Skills with Children from Infancy to Adolescence.”). The full guide is available for download and describes many additional activities and games that provide ways for adults to support various aspects of executive functioning and self-regulation in adolescents (Center on the Developing Child at Harvard University, 2014). While neuropsychological evaluation can be extremely important for understanding an adolescent’s executive functioning profile and planning for postsecondary education, there are a number of activities that young people can work on at home in order to build their executive functioning skills.

Here are some examples of activities suggested for adolescents:

  • Goal setting, planning and monitoring
    • Help the adolescent identify short and long-term goals and think about what has to be done to achieve them.
    • Help adolescents be mindful of interruptions (particularly from electronic communication such as email and cell phones).
  • Activities
    • Sports — The focused attention and skill development inherent in competitive sports improve the ability to monitor one’s own and others’ actions, make quick decisions, and respond flexibly.
    • Yoga and meditation — Activities that support a state of mindfulness may help teens develop sustained attention, reduce stress, and promote less reactive, more reflective decision-making and behavior.
    • Strategy games and logic puzzles — Classic games like chess exercise aspects of working memory, planning, and attention.
  • Study skills
    • Break a project down into manageable pieces.
    • Identify reasonable plans (with timelines) for completing each piece.
    • Self-monitor while working
    • When you don’t understand, what might be the problem? Do you know what the directions are? Is there someone you can ask for help?
    • Think about what was learned from an assignment that was not completed well. Was this due to a lack of information, a need to improve certain skills, bad time management, etc.?
    • Keep a calendar of project deadlines and steps needed to complete along the way
    • Identify ways to reduce distractions (e.g., turn off electronics, find a quiet room).

Are you concerned your adolescent’s trouble with getting organized, starting tasks, or keeping his/her emotions in check could be related to executive functioning issues?

There are many things you can do to get the answers you need to best help your adolescent. The most comprehensive way to assess a child’s executive functioning difficulties and determine a cause is a neuropsychological evaluation. A comprehensive neuropsychological evaluation is made up of a set of tests, questionnaires, interviews, and observations that a clinician will use to gain a good understanding of a young person’s strengths and weaknesses, along with learning how the individual processes information and completes tasks. At NESCA, we offer comprehensive evaluations that can look for potential learning disabilities, attentional difficulties, and other challenges that can negatively impact a child’s executive functioning development. In addition, a NESCA evaluation will include explicit recommendations to address challenges that have been identified.

Also, if you want to learn strategies for helping a teenager or young adult develop executive functioning skills, read Part 1 of this blog!

About the Author:
Talamo

With NESCA since its inception in 2007,  Dr. Talamo had previously practiced for many years as a child and adolescent clinical psychologist before completing postdoctoral re-training in pediatric neuropsychology at the Children’s Evaluation Center. After receiving her undergraduate degree from Columbia University, Dr. Talamo earned her doctorate in clinical health psychology from Ferkauf Graduate School of Psychology and the Albert Einstein College of Medicine at Yeshiva University. She has given a number of presentations, most recently on “How to Recognize a Struggling Reader,” “Supporting Students with Working Memory Limitations,” (with Bonnie Singer, Ph.D., CCC-SLP of Architects for Learning ), and “Executive Function in Elementary and Middle School StudentsDr. Talamo specializes in working with children and adolescents with language-based learning disabilities including dyslexia, attentional disorders and emotional issues. She is also interested in working with highly gifted children.

 

 

 

To book a neuropsychological evaluation or consultation  with Dr. Talamo or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate that you would like to see “Dr. Talamo” 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, 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 is executive functioning? How do I help my child develop these important skills? – Part 1

By | NESCA Notes 2019

By: Alissa Talamo, PhD
Clinical Neuropsychologist, NESCA

Alexis is a 5-year-old girl midway through kindergarten. She is well-liked, social, and has a strong vocabulary for her age. But her kindergarten teacher has noticed that Alexis has some difficulties in the classroom. Alexis raises her hand often during circle time, but when she is called on she  usually freezes or contributes something unrelated to the class discussion. Alexis also frustrates easily. When her first attempt at an art project doesn’t look like the example, she will throw it away or ask to do something else. And when she is given a multi-step direction to put her work away and get on her coat to go outside, she usually stops working but doesn’t move until she sees what her peers are doing, then she will follow along. Alexis’ parents have always noticed similar challenges at home such as giving up on difficult activities, forgetting where she has left her toys, and freezing when given too many choices or directions. But until her kindergarten teacher mentioned these classroom challenges, and they took her to see a neuropsychologist to better understand her classroom struggles, they did not realize that there was a name for her difficulties: Alexis is struggling with executive functioning.

What is executive functioning?

Executive functioning can be considered the “conductor” of all cognitive skills. Research has shown that executive function and self-regulation skills are critical for learning and development and help a person manage life tasks of all types.  While humans are not born with executive function skills, we are born with the potential to develop them. Moreover, studies show that we can continue developing the skills throughout our lifespans.

Executive function and self-regulation skills include three key components:

  • Working memory (the ability to hold and manipulate information in your mind),
  • Inhibitory control (inhibiting impulsivity, to pause and think before reacting),
  • Cognitive flexibility (the ability to adjust to changing demands).

While neuropsychological evaluation can be a critical step in learning about a child’s executive functioning skills and gaining recommendations for helping to remediate executive functioning challenges, there are a number of activities that parents can initiate to develop executive functioning skills at home.

Part 1 of this blog post highlights activities suggested to enhance the development of executive functioning and self-regulation skills from infancy through age 12 (taken from developingchild.harvard.edu booklet titled “Enhancing and Practicing Executive Function Skills with Children from Infancy to Adolescence.”). The full guide is available for download and describes many additional activities and games that provide ways for adults to support various aspects of executive functioning and self-regulation in children (Center on the Developing Child at Harvard University, 2014).

Here are some examples of activities suggested for children of different ages.

Ages 6-18 months old

  • Peekaboo —this activity exercises working memory, challenging the baby to remember who is hiding, and also introduces basic self-control skills as the baby waits for the adult to be revealed.
  • Pat-a-Cake — Predictable rhymes that end with a stimulating yet expected surprise. Infants exercise working memory, becoming familiar with the rhyme and anticipating a surprise.
  • Songs or chants with simple hand motions help develop working memory and language. Infants can learn to copy the movements to a song and, with practice, will remember the sequence (e.g., Eensy Weensy Spider; Open, Shut Them).

Ages 18-36 months old

  • Older toddlers can enjoy simple imitation games (e.g., Follow the Leader) which can help develop working memory as well as attention and inhibition.
  • Song games with many movements are also fun (The Hokey Pokey; Head, Shoulders, Knees, and Toes). These require children to attend to the song’s words and hold them in working memory, using the song to guide their actions.

Ages 3-5 years old

  • Encourage children to tell you stories while you write them down. Also, have the children act out stories they have written. The story provides a structure that guides children’s actions and requires them to attend to the story, while inhibiting their impulse to create a new plot.
  • Play matching and sorting activities that promote cognitive flexibility. Children can first sort or match by one rule (such as by color), and then immediately be asked to switch to a new rule (such as by shape).

Ages 5-7 years old

  • Games that require players to remember the location of particular cards are great at exercising working memory (e.g., Concentration).
  • Games in which the child can match playing cards, either by suit or number, are also good to help strengthen cognitive flexibility (e.g., Crazy Eights, Uno).
  • Games that require attention and quick responses help children practice attention and inhibition (e.g., for younger children – Red Light, Green Light or Duck, Duck, Goose; for older children – Simon Says, Mother May I?).

Ages 7-12 years old

  • Games that require monitoring and fast responses are great for challenging attention and quick decision-making in children at this age (e.g., Spit)
  • Physical activities/games help develop a child’s ability to hold complicated rules and strategies in mind, monitor their own and others’ actions, make quick decisions and respond flexibly.
  • Brain teasers (e.g., Sudoku, Rubik’s Cube) require children to be mentally flexible and consider spatial information.

Are you concerned your child’s trouble keeping his/her emotions in check, answering questions in vague or off-topic ways, managing their belongings, or forgetting what comes next could be related to executive functioning issues?

There are many things you can do to get the answers you need to best help your child. The most comprehensive way to assess a child’s executive functioning difficulties and determine a cause is a neuropsychological evaluation. A comprehensive neuropsychological evaluation is made up of a set of tests, questionnaires, interviews, and observations that a clinician will use to gain a good understanding of a child’s strengths and weaknesses, along with learning how a child processes information and completes tasks. At NESCA, we offer comprehensive evaluations that can look for potential learning disabilities, attentional difficulties, and other challenges that can negatively impact a child’s executive functioning development. In addition, a NESCA evaluation will include explicit recommendations to address challenges that have been identified.

Also, if you want to learn strategies for helping a teenager or young adult develop executive functioning skills, stay tuned for next week’s edition of NESCA Notes!

About the Author:
Talamo

With NESCA since its inception in 2007,  Dr. Talamo had previously practiced for many years as a child and adolescent clinical psychologist before completing postdoctoral re-training in pediatric neuropsychology at the Children’s Evaluation Center. After receiving her undergraduate degree from Columbia University, Dr. Talamo earned her doctorate in clinical health psychology from Ferkauf Graduate School of Psychology and the Albert Einstein College of Medicine at Yeshiva University. She has given a number of presentations, most recently on “How to Recognize a Struggling Reader,” “Supporting Students with Working Memory Limitations,” (with Bonnie Singer, Ph.D., CCC-SLP of Architects for Learning ), and “Executive Function in Elementary and Middle School StudentsDr. Talamo specializes in working with children and adolescents with language-based learning disabilities including dyslexia, attentional disorders and emotional issues. She is also interested in working with highly gifted children.

 

 

 

To book a neuropsychological evaluation or consultation  with Dr. Talamo or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate that you would like to see “Dr. Talamo” 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, 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.

Interview with Dina DiGregorio Karlon, NESCA North Transition Specialist

By | NESCA Notes 2019

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

 

What are Transition Services?

Transition means the process of moving from one life stage to another. In context to NESCA, we are referring to the transition from high school to post-secondary life, and we specialize in working with nontraditional students who often have had accommodations or special education services. While the prospect of leaving high school is exciting, it can be overwhelming as well. The prospect of figuring out what you want to do with your life causes some level of anxiety in all of us; transition services helps to relieve this anxiety by working with individuals in setting short and long term goals and participating in guidance and psychoeducation related to college and/or employment.

How did you get interested in this field?

Helping people understand their strengths and weaknesses while exploring their vision for adulthood is my passion. Upon reflection, I believe that I have always been a transition specialist, long before there was a name for this work. Having worked with adolescents and young adults for more than 25 years, I understand the demands and expectations placed on them and how that can be daunting. Helping people to recognize that their path may be different than they expected is very rewarding, and I do not take that responsibility lightly.

What do you like about your job?

I particularly enjoy working with adolescents and families through the college process; while the process is not difficult to understand, it is time-consuming and can often feel overwhelming. I enjoy assisting students and helping them to accomplish new tasks. I love to help people identify their strengths and use those to minimize and overcome their challenges. Being able to assist people in setting their own personal goals and achieve them is very gratifying to me. Getting to know new people, teaching important skills, presenting a different perspective, piecing together a plan; these are all things I love about the work I do.

Do you have a specialty? What do you specialize in?

I specialize in both college and career counseling. I am experienced in working with high school students as well as young adults.

What do you enjoy about your job?

I particularly enjoy working with adolescents and families through the college process; while the process is not difficult to understand, it is time-consuming and can often feel overwhelming. I enjoy assisting students and helping them to accomplish new tasks. I love to help people identify their strengths and use those to minimize and overcome their challenges. Being able to assist people in setting their own personal goals and achieve them is very gratifying to me. Getting to know new people, teaching important skills, presenting a different perspective, piecing together a plan; these are all things I love about the work I do.

What brought you to NESCA?

My experience as a school counselor and a vocational rehabilitation counselor have given me a unique skill set and provide me with the experience needed to do transition planning for students who are college bound and also students or adults who are seeking employment or support with career exploration. My passion for working with adolescents and helping them maneuver the challenges of early adulthood matches the philosophy of NESCA and I am eager to work as part of a team of specialists providing this support to young people.

What are you most looking forward to about working full-time at NESCA?

I am excited to work with adolescents to help them with the journey into adulthood. The variety of clients and their needs at NESCA is a real draw for me. Whether my work takes me to teaching a teenager how to do laundry, practicing interviewing for a first job or new school, or identifying a college list, it all sounds challenging and rewarding to me.

Who are your favorite students/clients to work with?

I have a lot of expertise in working with all kinds of students. I have worked with students who have been identified with Autism Spectrum Disorders, ADD/ADHD, mental health disorders, and other profiles. With the myriad of clients I worked with at Vocational Rehabilitation, I have developed a solid understanding of many diagnoses and disabilities and how clients’ lives are impacted by the related challenges. I have often worked with students who face multiple barriers; seeing those students work through their challenges and develop resiliency is professionally rewarding.

What advice do you have for parents or young adults who are not sure if they need a transition specialist?

Working with a transition specialist can be very helpful for parents to understand what their children’s strengths and weaknesses are in relation to adult-readiness. Are they ready for a 4-year college? Do they need a gap year? What would that look like? Do they know how to interview for a job? Do they need help getting a job? Do they know what kind of job fits their skills? Do they know to self-advocate? Do they know how to access resources?

Teenagers will often not work with their parents to do goal setting and transition planning, so having a transition expert to work with can often help. Working with a transition specialist can also be a great step toward a student taking ownership of their future planning and a parent releasing some control and responsibility. Most teenagers or young adults would benefit from doing transition planning; but it is a highly personal family decision as to whether to work with a transition specialist.

If you are not sure if you need a transition specialist, you can always come in for a consultation appointment. This is a one-hour meeting that helps a family determine if this is the right time to work with a transition specialist and what type of transition service may be best. For example, does the family need assessment and a report for an IEP process or just help with appropriate college planning? Talking things through with a transition expert can be extremely helpful for knowing what is needed and when.

We are very excited to announce that as of February 1, 2019, Ms. Karlon is working as a full-time staff member delivering assessment services in the state of New Hampshire and college and career coaching services to clients throughout New England! NESCA is thrilled to be able to offer these expanded transition services in our New Hampshire Office in addition to the services we already offer in Newton, MA.

To schedule an appointment with Dina DiGregorio Karlon in Londonderry, please complete our online intake form: https://nesca-newton.com/intake-form/  The address of NESCA-North is 75 Gilcreast Rd #305, Londonderry, NH 03053.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, 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.

Child Feedback Sessions: How and Why We Explain What Testing Means To Kids

By | NESCA Notes 2019

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

“Who get’s the results of the testing, me or my parents?” As a neuropsychologist, clients of all ages ask why they are being tested and who is going to get the information from the testing. Sometimes these questions come from a place of nervousness, while others are asking because they have a general curiosity.

Neuropsychological evaluation is an intensive process where students are trying out all sorts of skill sets, some activities that are familiar (e.g., math problems), and some activities that they will only ever do in the context of an evaluation process (e.g., putting pegs in a pegboard, drawing weird rocketship shaped patterns from memory). Even children as young as elementary school are often curious about the results of the assessment (e.g., how did I do? what were you testing? what is the report going to say?). These are such important questions and I am always excited when the children I am working with are curious about what this all means.

At NESCA, a neuropsychology and integrative treatment practice founded in Newton, MA, we conclude our testing with a parent feedback session where results and preliminary recommendations are clearly presented to parents. This is a conversational format so that we can ensure that there is good understanding and a shared picture of what we have learned about the child. Even with a lengthy conversation, parents often question about how to share the findings with their children because it often results in changes for the child like working with new people or getting more/less or different services at school.

Importantly, we offer child/adolescent feedback sessions for children of all ages. These mini-feedback sessions are presented in a developmentally appropriate manner to share the findings of the evaluation. Often with older children and adolescents this conversation includes discussing any diagnosis that came out of the evaluation. For all individuals the conversation always includes a strengths-based approach highlighting the things the child/adolescent did wonderfully using examples from the testing to explain these strengths and how they might show these skills in real life. Then we move on to also talking about some of the activities that were more challenging and how we envision teachers, providers, or other supports helping them to make progress. For example, a child might do extremely well on tasks of visual problem solving such as recreating block designs or on verbal tasks that ask them to define words, but have greater challenges on tasks that assess processing speed. These findings suggest a child is able to think and problem solve at a high level, yet processes information more slowly and might need more time to show off their strengths when they are expected to produce output. This important difference is so essential to explain to even younger children. Children often value speed over all else, and explaining to them that working slow but producing amazing ideas is a real asset. The same type of careful explanation can be taken when explaining learning disabilities, attentional issues, social difficulties and emotional vulnerabilities. There is a calculated effort to include the child/adolescent in a conversation about their own ideas on how to improve areas of need and I feel this really empowers them to work for the change and positive growth. Plus, these sessions are a great way to gain closure over the experience of testing and allow them to understand what was accomplished and learned through all of their hours of hard work.

About the Author:

Dr. Amity Kulis joined NESCA in 2012 after earning her doctoral degree in clinical psychology from the Massachusetts School of Professional Psychology, with a concentration in Children, Adolescents and Families (CAF). She completed post-doctoral training in pediatric neuropsychology with an emphasis on treating children with developmental, intellectual, learning and executive functioning challenges. She also has extensive training psychological (projective) testing and has conducted individual and group therapies for children of all ages. Before joining NESCA, Dr. Kulis worked in private practices, clinics, and schools, conducting comprehensive assessments on children ranging from toddlers through young adults. In addition, Dr. Kulis has had the opportunity to consult with various school systems, conducting observations of programs, and providing in-service trainings for staff. Dr. Kulis currently conducts neuropsychological and psychological (projective) assessments for school-aged children through young adulthood. She regularly participates in transition assessments (focusing on the needs of adolescents as they emerge into adulthood) and has a special interest in working with complex learners that may also struggle with emotional challenges and psychiatric conditions. In addition to administering comprehensive and data-driven evaluations, Dr. Kulis regularly conducts school-based observations and participates in school meetings to help share her findings and consultation with a student’s TEAM.

 

To book an evaluation with Dr. Kulis or one of our many other expert neuropsychologists and transition specialists, complete NESCA’s online intake form.

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, 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.

 

 

Addressing Anxiety through the IEP Process

By | NESCA Notes 2019

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

Anxiety disorders are becoming more and more common among children and adolescents. Recent data from the National Institute of Mental Health (NIMH) reported that 31.9% of adolescents between 13-19 have an identified anxiety disorder. Although fewer statistics are available, it is clear that students who have a developmental, learning, or attention disorder are at high risk for developing clinically significant anxiety in light of their struggles with academics, learning, and/or social development. Given the rising numbers of affected children and adolescents, it has become increasingly important that a student’s emotional health is addressed both at home through private counseling, as well as through the provision of school-based services. When students experience a high level of unmitigated anxiety throughout the day, they are less able to learn and meet their potential.

When parents are seeking services for anxiety through their school system, there are different levels of support. First, teachers can provide classroom supports and address emotional health with all students, whether or not they have an identified anxiety disorder. Some examples of useful classroom strategies include:

  • Create predictable routines and clear expectations.
  • Provide warnings about upcoming transitions.
  • Have a “cool down space” available in the classroom or another room in the school.
  • Incorporate movement into lessons throughout the day.

There are also programs designed to address emotional regulation that can be used throughout the school or district. For example:

If these supports are not sufficient to meet a student’s needs, then it is necessary to develop goals through the IEP process. In order to make needed progress, it is important that the goals and benchmarks in the IEP are specific. For example, a benchmark might state: “Johnny will show better emotional regulation in stressful situations.” A more specific benchmark might state: “When Johnny starts to shut down or refuse to participate during a math class, he will identify his current emotion(s) in 4 out of 5 opportunities.”

When parents seek supports for their child’s anxiety through the IEP, they should consider whether their child needs accommodations, specialized instruction or both.

Examples of accommodations for anxiety include:

  • Extra time in testing situations.
  • Opportunities to take tests in a quiet setting.
  • Access to breaks as needed.
  • Access to the school counselor as needed.
  • Student does not need to sign out of class to use the bathroom.
  • Student is prompted to take breaks when showing signs of distress.
  • Student has modified homework.
  • Teacher will check in with student before independent work blocks.
  • Specialized instruction can be provided in the classroom (push-in) or in a different setting (pull-out).

Push-in services might include:

  • Provision of an instructional aide to support emotion identification and regulation.
  • The school counselor/psychologist works with the entire class once or twice a month to discuss emotional health.

Pull-out services might include:

  • Regular sessions with the school counselor/psychologist.
  • Social skills groups.

Consultation services are also important, especially if a student participates in private therapy outside of school. Parents should consider giving permission for the private therapist to speak with the school counselor to discuss common treatment goals and ways in which the student’s coping skills can be supported and reinforced in school.

About the Author:

GibbonsErin 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.

Dr. Gibbons recently began serving clients in NESCA’s newest location in Plainville/Foxborough, MA. She is thrilled to bring her expertise in evaluating and supporting children with a wide range of abilities to this area of the state.

 

To book an evaluation with Dr. Gibbons or one of our many other expert neuropsychologists and transition specialists, complete NESCA’s online intake form.

 

 

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