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NESCA Notes 2017

Special Holiday Edition: ‘Tis the Season for Self-Care

By | NESCA Notes 2017

 

By:  Jackie Reinert, Psy.D. LMHC
Pediatric Neuropsychologist

As a child, the idea of Christmas meant cookies, presents, time with family, and of course, giving up TGIF’s Full House in favor of holiday movies. Everything from Scrooged to A Miracle on 34th Street to Home Alone, and every clay animated favorite served as the framework for my formulation of what the holidays truly meant; “It’s Christmas Eve. It’s the one night of the year when we all act a little nicer, we smile a little easier, we cheer a little more. For a couple of hours out of the whole year we are the people that we always hoped we would be.” Frank Cross’s commentary on Christmas set expectations high, and year after year, we hoped to top the magic and splendor of the previous year’s festivities.

As a parent, the holiday season conjures up warm memories of childhood, ignites aspirations to establish new traditions, and creates opportunities to share experiences with our loved ones, particularly our children. The magic of the holidays can also cultivate high expectations; to act nicer, smile easier, and to cheer more. These expectations more often than not exceed our capacity to truly encapsulate the hopes and aspirations we drum up in our heads. High expectations can pave the way for increased levels of perceived stress.

The American Psychological Association recently released its annual review, Stress in America (November, 2017), which indicates the United States has reached its highest stress level yet. Acute arousal stress in isolation can activate and enhance mobilization, sharpening our concentration and preparing our bodies to engage in challenging tasks, such as wrapping those last two presents and baking another round of cookies. This basic human reaction known as the “flight-or-fight” response has served us well, priming our bodies to flee or combat unsafe situations; however, our bodies can also overreact to simple, non-threatening situations, such as holiday pressure, financial difficulties, and increasing family demands.

Chronic stress has far more lasting and serious complications, particularly when it exceeds our ability to cope and leads to emotional and physical dysregulation. Stress is negatively related to our coping potential and our perception of control, which decreases use of problem-solving coping strategies and increases negative coping strategies, such as alcohol consumption and avoidance tactics (Rui Gomes, Faria, & Gonçalves, 2013). Individuals who experience elevations in stress and engage in maladaptive coping strategies such as drinking more alcohol, complaining, sleeping less, and consuming unhealthy foods which increase chances of becoming physically and mentally run down.

For parents, the added stress of the holidays and high expectations can have a significant impact on not only themselves, but those around them. Research suggests that adults are more likely to find family responsibilities stressful than they have in the past (APA, November, 2017). High expectations can make capturing the perfect holiday, particularly when parenting a child with special needs, a stressful time, leading to feelings of resentment (“I’m doing all of this and no one is helping me”), frustration (“I have no time to fit this all in”), and disappointment (“It seems like they didn’t have a good time”).

This year, I encourage you to lower your holiday expectations, increase self-care and self-compassion. While practicing self-care may be the furthest thing from your mind, the following may offer some reprieve from the hustle and bustle of the holiday season.

  1. Expect that things will go wrong, and that’s okay. Someone will get sick, you might burn a dish, and yes, that’s okay. Avoid catastrophic thinking, a common cognitive distortion where we imagine and worry about the worst possible situation, either consciously or subconsciously. For example, your ability to prepare the perfect holiday dinner for twelve people is an act, not a representation of how good of a person you are. You are not the sum of how well-executed things are, how perfectly the house looks, how your children act.
  1. Practice self-regulation and utilize coping skills. The easiest way to understand the subtle difference between these two concepts is to imagine yourself in a car, driving down I-90 into Boston and someone cuts you off. To access a coping skil to manage your anger, you would first need to pull off the highway, put the car in park, and throw on your hazard lights. Conversely, if you were utilizing a self-regulation skill, you could continue driving and manage your thoughts and feelings in the moment. Self-regulation is the ability to modulate our emotions and impulses, to keep ourselves in check, whereas coping is a process or actions that help you manage difficult emotions. Examples of self-regulation skills include diaphragmatic breathing (learn more here: https://www.youtube.com/watch?v=hFcQpNr_KA4&t=140s) and box breathing (https://www.youtube.com/watch?v=dP4Jxxhhzl0). Coping skills can include meditation (https://www.youtube.com/watch?v=4Bs0qUB3BHQ), and progressive muscle relaxation (https://www.youtube.com/watch?v=1nZEdqcGVzo).
  1. Practice micro-moments of positivity. Research suggests that rather than pursue the perfect gift to demonstrate your love for a family member, seeking out opportunities to be present and make a meaningful connection have a more lasting effect (Heshmati, Oravecz, Pressman, Bathcelder, Muth, & Vandekerckhove, 2017). Crawling into bed and reading a holiday book with your children, or complete a small craft together can have a more lasting impact that securing a sloth Fingerling for them. You can read more about micro-moments here: https://www.npr.org/sections/health-shots/2017/12/09/568834440/what-s-better-than-expensive-presents-the-gift-of-presence
  1. Opt outside! Research suggests that spending time in nature can have a significant effect on mood (https://www.npr.org/sections/health-shots/2017/12/09/568834440/what-s-better-than-expensive-presents-the-gift-of-presence) and can increase sun exposure and the benefits of Vitamin D. Locate a winter wonderland hike here: http://www.bostonmagazine.com/health/2016/01/11/winter-hiking-massachusetts/
  1. Finally, don’t forget about self-care. Self-care is a deliberate act to support and nurture your physical and mental health. Taking care of yourself not only helps you but those around you. There are several TED talks highlighting the benefit of self-care: https://www.ted.com/playlists/299/the_importance_of_self_care

 

About the Author:

Dr. Reinert is a Pediatric Neuropsychology Postdoctoral Fellow who joined NESCA in September 2017. Dr. Reinert assists with neuropsychological and psychological (projective) assessments in the Newton office and in the Londonderry office. In addition to assisting with neuropsychological evaluations, Dr. Reinert co-facilitates parent-child groups and provides clinical consultation. Before joining NESCA Dr. Reinert worked in a variety of clinical settings, including therapeutic schools, residential treatment programs and in community mental health. She has comprehensive training in psychological assessment, conducting testing with children, adolescents, and transitional-aged adults with complex trauma. Dr. Reinert is particularly interested in researching the intersectionality of ASD and gender exploration.

 

To book a consultation with one of our many 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.

 

Increasing Reading Success: Early Identification of Reading Challenges

By | NESCA Notes 2017

 

By:  Alissa Talamo, Ph.D.
Pediatric Neuropsychologist

I recently attended the International Dyslexia Association Conference in Atlanta, GA (dyslexiaida.org). Among the conference attendees were researchers, teachers, speech-language pathologists, psychologists, and parents of children with dyslexia. One recurring key point was the importance of early identification of reading difficulties, as early provision of appropriate interventions and services leads to better outcomes.

It is important to remember that unlike seeing, hearing, and eating, reading is not something humans do naturally. Reading must be learned and it is not easy (Maryanne Wolf, Proust and the Squid).

As a parent, your early observations are important as there are many developmental indicators that may signal a risk for reading difficulties such as:

  • Experiencing repeated early ear infections
  • History of speech delay and/or pronunciation problems
  • Slow vocabulary growth, frequent difficulty finding the right word, use of less specific words such as “the thing,” “the stuff,” or “that place.”
  • Your child struggles to recognize words that start with the same sound (e.g., cat and car) or end with the same sound (rhyming).
  • Difficulty learning letter and number symbols when in preschool
  • Family history of reading problems

During first grade, you can watch for these warning signs as you listen to your child read aloud:

  • Does not know the sounds associated with all of the letters
  • Skips words in a sentence and does not stop to self-correct
  • Cannot remember words; sounds out the same word every time it occurs on the page
  • Frequently guesses at unknown words rather than sounding them out
  • If you ask your first grader to read aloud to you and he/she is reluctant and avoidant

Remember: 

Early identification of reading issues is extremely important for outcome. If children who have dyslexia receive effective phonological awareness and phonics training in Kindergarten and 1st grade, they will have significantly fewer problems learning to read at grade level than children who are not identified or helped until 3rd grade.

What should I do if I suspect my child has challenges with reading?
If you suspect your child is struggling to learn to read, have your child receive an independent comprehensive evaluation so that you understand your child’s areas of cognitive and learning strengths and weaknesses. This evaluation should also include specific, tailored recommendations to address your child’s learning difficulties.

To learn more about evaluations and testing services with Dr. Talamo and other clinicians at NESCA, you may find the following links helpful:

What if I am not sure whether my child needs a neuropsychological evaluation?

When determining whether an initial neuropsychological evaluation or updated neuropsychological evaluation is needed, parents often choose to start with a consultation. A neuropsychological consultation begins with a review of the child’s academic records (e.g., report card, progress reports, prior evaluation reports), followed by a parent meeting, during which concerns and questions are discussed about the child’s profile and potential needs. Based on that consultation, the neuropsychologist can offer diagnostic hypotheses and suggestions for next steps, which might include a comprehensive neuropsychological evaluation, work with a transition specialist, or initiation of therapy or tutoring. While a more comprehensive understanding of the child would be gleaned through a full assessment, a consultation is a good place to start when parents need additional help with decision making about first steps.

Sources used for this blog:

 

About the Author:

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

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

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

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

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

She is the mother of one teenage girl.

 

 

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

 

 

 

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

 

Emerging Psychosis: When to worry about your teen’s thinking

By | NESCA Notes 2017

 

By:  Stephanie Monaghan-Blout, Psy.D.
Pediatric Neuropsychologist

Emerging Psychosis: When to Worry about Your Teen’s Thinking

Teenagers are famous for incidents of bad judgment and poorly considered decisions; it is one of the rites of passage for parents and children to have had at least one “What were you thinking?” discussion before the teen leaves the family nest for college or employment. These events are often memorable, however, because they tend to be outliers, occurring simultaneously with instances of relatively accurate appraisals of situations and relatively adequate problem-solving as they navigate the expectations of school, family, friends, and community.

Some parents must confront a separate set of ongoing concerns about their child’s thinking that effect their assessment of the world and themselves. In this article, I will talk about the nature of psychosis, describe the changes leading up to an episode of psychosis and outline emerging models of treatment which aim to prevent the first acute episode or at least delay onset of the episode as much as possible. These findings emphasize the critical importance of early identification and treatment of symptoms to prevent or reduce future impairment.

The Nature of Psychosis
Psychosis refers to a condition in which a person has lost contact with reality and is unable to distinguish what is real and what is not. Psychotic symptoms include what are called “positive” (what is present) and “negative” (what is absent) symptoms.

  • Positive symptoms include: abnormalities of thinking in both content as well as form; the former refers to distortions of reality such as hallucinations or delusions, and the latter refers to disorganization of thinking and bizarre behavior.
  • Negative symptoms refer to the reduction of emotional response (“blunted” or incongruous affect), apathy and loss of motivation, social withdrawal, impaired attention, reduced speech and movement, loss of enjoyment in life (“anhedonia”).

Researchers have also identified subtle cognitive impairments that include:

  • Deficits in processing speed
  • Executive function
  • Sustained attention/vigilance
  • Working memory
  • Verbal learning and memory
  • Reasoning and problem solving
  • Verbal comprehension
  • Social cognition

The impact of these issues can result in severe functional deficits across a range of domains such as work, school, and relationships.

Psychosis is now thought to be a neurodevelopmental disorder, meaning that it is thought to be related to abnormalities in brain development that become apparent as the brain matures in adolescence. Psychosis is thus a condition that emerges gradually as the underlying dysfunction comes to the fore. It is also thought to be a neurodegenerative disorder, meaning that the disease causes physical changes to the brain that results in impaired functioning. These changes include, on average, slightly larger lateral ventricle and slightly less cerebral gray matter for people at the first psychotic break compared to controls. From a behavioral perspective, researchers have found that the longer people live with an untreated psychosis, the more likely they are to experience functional impairments, have a poor response to psychiatric medications, and experience a poor quality of life. These alarming findings have prompted researchers and clinicians to research the period of time before the first psychotic break, referred to as the prodromal period, where symptoms start to emerge, in an effort to discover a way to divert or slow this process.

The Prodromal Period

The prodromal period is a time when “subclinical”, or milder symptoms of psychosis begin to appear. This period can vary in length from a few weeks to a few years. During this period, the adolescent or young adult may experience mild disturbances in perception, cognition, language, motor function, willpower, initiative, level of energy, and stress tolerance. These are differentiated from frank psychosis by lower levels of intensity, frequency or duration. The teen may complain of nonspecific clinical symptoms such as depression, anxiety, social isolation, and/or difficulties with school. They then may start to occasionally experience positive symptoms that are brief in duration and moderate in intensity. These events may become more serious over time, although they don’t happen often, last for only a few minutes to hours, and the person still retains some insight as to the unusual nature of the phenomena. However, this situation changes as the person comes closer to the initial psychotic break, signaled by the emergence of unusual thoughts, perceptual abnormalities, and disordered speech.

Risk and Resource

Who is most likely to move from the prodromal period to frank psychosis? Factors most predictive of this transition include people with a family history of psychosis and a recent deterioration of functioning, a history of substance abuse, and higher levels of unusual thoughts and social impairments. Other mediating factors include poor functioning, lengthy time period of symptoms, elevated levels of depression or other comorbid conditions, and reduced attention.

What factors appear to ameliorate risk of descending into psychosis? Risk/protective factors include higher premorbid cognitive skills and social skills and lack of a history of substance abuse.

How and When to Intervene

The information provided here about emerging psychosis underlines the critical importance of early intervention to address the serious and pervasive impact on functioning. Professionals who treat people at risk of psychosis are now beginning to use a clinical staging of treatment, meaning treatments should be tailored to the client’s needs, starting with safer and simpler interventions for the prodromal stages and increasingly intensive and aggressive treatment for people who are already contending with psychosis. This requires starting with what appears to be most problematic at the time for the person. For some people, this means treating the comorbid psychiatric conditions. For those who are experiencing difficulties with attention/executive function or reporting elevated levels of unusual symptoms, it may mean starting the person on an atypical antipsychotic. The use of targeted psychosocial interventions such as cognitive behavioral therapy, social skills training, and family therapy have all been found to be associated with reduced or delayed transition to first episode psychosis.

Where to Go for Help

Living in the Boston area, we are fortunate to have a wealth of resources in our hospitals and training sites that are engaged in cutting edge research and intervention to address the needs of young people who are contending with emerging psychosis. These include Beth Israel-Deaconess Hospital’s Center for Early Detection and Response to Risk (CEDAR) and the Prevention and Recovery in Early Psychosis (PREP) jointly run by the Beth Israel-Deaconess and Massachusetts Mental Health Center. Also, Cambridge Health Alliance offers the Recovery in Shared Experiences (RISE) program for the treatment of first episodes of psychosis.

Neuropsychological testing, augmented by psychological testing can be a useful tool to learn more about cognitive and emotional functioning. However, this is best undertaken as part of a comprehensive program of intervention.

 

Articles used for this blog:

  • Larson, M, Walker, E, and Compton, M (2010) Early Signs, diagnosis, and therapeutics of the prodromal phase of schizophrenia and related psychotic disorders, Expert Review of Neurotherapy. Aug. 10 (8), 1347-1359. https://www.nimh.nih.gov/health/topics/schizophrenia/raise/what-is-psychosis.shtml
  • NPR Your Health Podcast (2014) Halting Schizophrenia Before It Starts
  • Miller, Brian Negative Symptoms in Schizophrenia; The Importance of Identification and Treatment, Psychiatric Times, March 2017

 

 

About the Author:

Monaghan-BloutFormerly an adolescent and family therapist, Dr. Stephanie Monaghan-Blout is a senior clinician who joined NESCA at its inception in 2007. Dr. Monaghan-Blout specializes in the assessment of clients with complex learning and emotional issues. She is proficient in the administration of psychological (projective) tests, as well as in neuropsychological testing. Her responsibilities at NESCA also include acting as Clinical Coordinator, overseeing psycho-educational and therapeutic services. She has a particular interest in working with adopted children and their families, as well as those impacted by traumatic experiences.

 

 

To book a consultation with Dr. Monaghan-Blout 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.

 

Director’s Update

By | NESCA Notes 2017

 

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

NESCA was founded on the idea that a thorough evaluation reflecting careful analysis of information gathered from history, observations, and testing data is crucial in formulating a comprehensive, individualized plan for supporting a child to realize their potential. Increasingly, NESCA is expanding its intervention services, which allows for a higher level of integration between the evaluator and treater. Clearly recognizing the benefit of psychopharmacological intervention for many children and adolescents, at NESCA, we focus on the powerful benefits of many non-medication approaches.

Our experience, supported by research, is that significant improvements in functioning result from psychoeducation, direct teaching of strategies to parents and students, and intervention at the physical level. Psychoeducation refers to the process of educating clients and their parents about the nature of challenges such as anxiety or ADHD.  Beyond gaining a thorough understanding of the challenges faced by a client, parents, teachers, and students need strategies for managing problematic symptoms and behaviors. Teaching and helping parents and students practice these strategies often yields huge changes in functioning.  Finally, the mind and body are interconnected and intervening at the physical level is often more straight-forward for many of our clients, leading to impressive changes in cognitive and emotional functioning.

NESCA offers the following therapeutic interventions:

Cognitive Behavioral Therapy (CBT):

CBT is an evidence-based therapy that focuses on identifying and changing thoughts patterns and behaviors that are interfering with functioning.  Of note, we have a therapist who is highly experienced in psychotherapeutic intervention with children and adolescents who are on the autism spectrum, including the use of the Sidekicks app developed by the Affinity Project.

Acceptance and Commitment Therapy (ACT):

ACT uses approaches such as mindfulness and behavioral change strategies to help clients increase flexibility and reach goals.

Intensive Outpatient Therapy:

Many children require more frequent meetings in order to master the strategies that are being taught for behavioral/emotional regulation or social functioning. NESCA’s intensive out-patient therapy programs generally involve three weekly sessions of direct service for the child followed by brief parent guidance meetings.

Therapy Groups:

NESCA offers a group for school-age children with ADHD and their parents. Children meet in one group while their parents meet concurrently in another group, both led by experienced psychologists.  Starting in 2018, NESCA will be offering drama-based therapy groups based on the Spotlight model developed at the Northeast Arc and researched by the Social Competence and Treatment Lab at Stony Brook University.

Back to School Program:

This intensive program was developed to address school refusal through both home-based and center-based psychotherapy, parent guidance and school consultation.

Community Based Skills Coaching:

Many clients struggle to generalize strategies that they have learned in therapy to daily living. NESCA has highly skilled coaches that work with adolescents and young adults in the community to practice skills and strategies.

Postsecondary Transition Planning:

Adolescents with developmental challenges, learning disabilities, and psychiatric issues often need support in planning for “life after high school”. Our veteran transition specialists work with adolescents and their parents to identify strengths, formulate realistic goals and a plan for reaching goals over their high school years.

Yoga-Based Therapy:

Individual or small group interventions in our yoga studio to build self-awareness and the ability to use breath and movement to address symptoms of anxiety and enhance attention.

Acupuncture/Acupressure:

These ancient treatments can be highly effective for treating anxiety,  ADHD, and other childhood conditions.

 

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 a consultation with Dr. Helmus 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.

 

A Tale of Two Social Styles: Classical and Jazz Socializers

By | NESCA Notes 2017

 

By:  Jason McCormick, Psy.D.
NESCA Pediatric Neuropsychologist

I work with a number of parents concerned about the quality of their child’s social life.  Lamenting that their child has no true friends, many parents I see note that that their child doesn’t “hang out” with peers.  However, when asked about how their child does spend time with peers, many parents report that their child is involved in several different structured after-school activities, such as a church youth group, scouting, or a gaming club.  In other words, while not getting together with peers in less structured settings, these students often do, despite parent misgivings, have satisfying social lives.

I find it useful to think about socializers as lying in one of two camps: Jazz and Classical.  Jazz socializers are all about improv.  They’ll head downtown with a friend and see where the afternoon takes them, invite a friend over with no particular plan or agenda, or wander the mall in a herd.  They care little about predictability and in fact relish spontaneity and surprise.  Classical socializers, by contrast, are most comfortable with structure.  They crave predictability, wanting to know the specific parameters of a social activity, including the start and end times, the purpose, and the rules of engagement.  Classical socializers, then, tend to do best with organized social activities.

It’s important to note that one type of socializing is not better than the other; it’s about match.  I say that as many parents of Classical socializing children worry that their children will grow up to be friendless and alone.  To those concerns, I observe that there are plenty of socially-satisfied Classical socializing adults: they have their book club the first Monday of every month, poker night every other Thursday, weekly chorus practice, and bar trivia on Wednesdays.

Thus, rather than trying cram to their Classical socializing child into a Jazz paradigm – which in fact runs the risk of leading to more social isolation due to anxiety stemming from the mismatch – I encourage parents to embrace the kind of socializer that their child is.  For parents of Classical socializers, that means supporting their child’s social satisfaction and growth through encouragement of their participation in a variety of structured after school activities (of course without over-scheduling).  In addition to giving their children a chance for a rich and rewarding social life now, participation in such activities serves as important practice and preparation for adult life, as in college and as adults in the working world, that is how Classical socializers will be most socially satisfied.

 

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.

 

Community-Based Skills Coaching: What is it? Is it the right intervention for my child?

By | NESCA Notes 2017

By Kathleen Pignone, M.Ed., CRC

Transition Specialist

What is Community-Based Skills Coaching?

Community-Based Skills Coaching is an individualized service delivered by seasoned professionals to support the needs of transition-aged youth and young adults. It is an intensive 1:1 coaching model provided in the young person’s community. It can include any area of need and is tailored to the young person’s age and stage of development.

Community-Based Skills Coaching is empowering to the young person because the coach meets them where they are at emotionally, socially and developmentally. It allows the individual to learn practical living skills across multiple real-life environments. The first step in Community-Based Skills Coaching is an evaluation period where the young person works with the coach to identify strengths and areas for improvement. Through a collaborative process, the coach and young person tailor each session to allow for direct in-vivo teaching. This can include, but is not limited to, independent living skills, career planning and work readiness skills, financial literacy skills, travel skills, social pragmatic skills and self-advocacy skills.

Coaches meet with individuals in their home communities in order to determine how to best problem solve around any barriers or obstacles that the young person may encounter. It allows for the individual to develop and generalize learned and new skills across settings and in real-time. With frequent opportunities to practice skills in authentic environments, the individual begins to develop a level of confidence and automaticity that can only be learned outside of a classroom or office.

Many transition-aged young adults are at a developmental stage of individuating away from parental support. Community-Based Skills Coaching provides an experienced and trained adult to serve as a coach and mentor in order to guide the young person. This coach becomes an important “expert” and a qualified and trusted team member who can support the individual through the lengthy process of transitioning from high school to post-secondary adult life including learning, working, daily living, and community-based leisure activities.

How do I know if this is the right support for my teen, young adult, or myself?

Coaches work with young people aged 12-26 with varying skill levels. Coaches most often work with transition-aged youth who have a diagnosed learning, emotional, and/or developmental disability and transition related skill development needs. However, our coaches are also experienced in working with young people who are struggling with forward progress unrelated to a specific learning or medical diagnosis. Coaching utilizes a strength-based approach and supports youth and young adults to learn about themselves while experiencing life outside of school and home.

The student or young adult drives the process by choosing an area of interest and need. The coach provides guidance and immediate feedback and support to practice and improve upon skill areas. The coach builds rapport with the individual and is able to re-frame and teach in the moment. An inquiry based approach is used to allow the young person autonomy over the mastery of the skill. The coaching can occur weekly or more often, if necessary. Feedback to parents and designated team members typically occurs on a weekly or monthly basis, often beginning with student input.

To learn more about our Community Coaching at NESCA, please feel free to contact Kathleen Pignone, M.Ed., CRC at (617) 658-9800 or email at kpignone@nesca-newton.com

Who provides coaching at NESCA?

Kathleen Pigone, M.Ed., CRC, brings a wealth of knowledge and experience to her role as a Transition Specialist at NESCA. She received her undergraduate degree in Sociology from Boston College and her master of education in Rehabilitation Counseling from the University of Massachusetts Boston.

Ms. Pignone was the Career Development Director at Bay Cove Academy for 15 years, providing students with classroom and real-world employment skills training, community job placement and on the job employment-training. She supervised the Career Development Program, developed individualized transition plans for students, created innovative programming for tracking and assessing long-term employability and career success for students. She also trained staff in the areas of career development and transition services.

Ms. Pignone joined NESCA in March 2016, bringing her unique expertise supporting vocational assessment and employment planning for adolescents and young adults as well as local school programs. In addition to supporting NESCA’s premier transition assessment services, Ms. Pignone engages in person-centered planning with teens and young adults, consultation and training for parents, providers and schools, and community-based skills coaching.

Dina Karlon, M.A., is a seasoned counselor specialized in transition issues. She has worked in public schools as a guidance counselor, GED program coordinator, career center coordinator, vocational assessment specialist, and school counselor. At NESCA, She offers community-based skills coaching services in New Hampshire as well as postsecondary planning consultation to students and families throughout New England.

In addition to her work at NESCA, Ms. Karlon is a Program Specialist for the New Hampshire Department of Education, specializing in development of employability skills and job readiness skills for at risk youth. She has recent experience as a Rehabilitation Counselor for New Hampshire Voc Rehab, working with students and adults with a range of developmental, learning, and social-emotional disabilities and helping to guide and coach them through transitions toward independence in both college and the working world. Prior to that, Ms. Karlon worked for more than two decades as a school counselor in local high schools.

She has provided transition services including personal, career, and college counseling to hundreds of students and their families and has also worked as an adjunct professor at Nashua Community College teaching both traditional and online classes for nearly 20 years. Ms. Karlon brings extensive experience supporting clients with career and college planning and she is able to shift fluidly with clients along their paths in each of these domains.

Sophie Bellenis, OTD, OTR/L, is Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. For the past five years her work has primarily been split between children and adolescents with ASD and related profiles in the United States, and marginalized youth in Tanzania, East Africa.

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.

Dr. Bellenis works as a school-based occupational therapist for the city of Salem Public Schools and believes that individual sensory needs, and visual motor skills must be taken into account to create comprehensive educational programming. She is joining NESCA in order to offer community-based skills coaching services as well as social skills coaching to students and young adults.

Kelley Challen, Ed.M., CAS, is Director of Transition Services at NESCA and oversees Community-Based Skills Coaching as well as transition assessment, planning, consultation, case management, program development, college supports, trainings, and professional development offerings.

Ms. Challen received her Master’s Degree and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard University Graduate School of Education. Initially trained as a school guidance counselor, she completed her practicum work at Boston Latin School focusing on competitive college counseling. She began facilitating social, life, and career skill development programs for transition-aged youth in 2004.

Prior to joining NESCA, Ms. Challen founded an array of programs for teens and young adults at MGH Aspire, and spent time as Program Director of the Northeast Arc’s Spotlight Program, where she often collaborated with schools to develop in-district social skill and transition programming. She is also co-author of the chapter “Technologies to Support Interventions for Social-Emotional Intelligence, Self-Awareness, Personal Style, and Self-Regulation” for the book Technology Tools for Students with Autism.

While Ms. Challen has special expertise in working with students with Asperger’s Syndrome and related profiles, she provides transition assessment, consultation, planning, and programming support for individuals with a wide range of learning and developmental needs.

Sophie Bellenis, OTD, OTR/L joins NESCA

By | NESCA Notes 2017

 

 

Dr. Sophie Bellenis is a Licensed Occupational Therapist specializing in pediatric treatment as well as occupational therapy in the developing world. She is joining NESCA in order to offer community-based skills coaching services as well as social skills coaching as part of NESCA’s transition team.

We are pleased to announce the newest member of the NESCA transition team, Dr. Sophie Bellenis!

Meet Dr. Bellenis:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. For the past five years her work has primarily been split between children and adolescents on the Autism Spectrum in the United States, and marginalized children in Tanzania, East Africa.

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.

Dr. Bellenis has worked for the Northshore Education Consortium at the Kevin O’Grady School providing occupational therapy services and also at the Spaulding Cambridge Outpatient Center. She also has extensive experience working at the Northeast ARC Spotlight Program using a drama-based method to teach social skills to children, adolescents, and young adults with autism, Asperger’s Syndrome, and related social cognitive challenges.

Internationally, Dr. Bellenis has done extensive work with the Tanzanian Children’s Fund providing educational enrichment and support. She has also spent time working with The Plaster House, a post-surgical, pediatric rehabilitation center in Ngaramtoni, Tanzania.

Dr. Bellenis currently works as a school-based occupational therapist for the city of Salem Public Schools and believes that individual sensory needs, and visual motor skills must be taken into account to create comprehensive educational programming.

 

If you are interested in a consultation or individualized skill coaching with Dr. Bellenis, please complete NESCA’s intake form today.

 

 

 

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 Great Masquerader: Anxiety and School Refusal

By | NESCA Notes 2017

 

By:  Ryan Conway, Psy.D.
NESCA Clinical Psychologist

Everyone experiences anxiety at some point in life. It is a normal, adaptive human emotion that helps us prepare for important events and optimizes performance – think upcoming tests, ballet recitals, sports playoff games – and alerts us to danger in situations that threaten our safety. However, some individuals experience anxiety so intensely and so frequently that it becomes impairing, hindering their daily functioning. In fact, according to the National Institute of Mental Health (NIMH), it is the most common mental health disorder in the United States among adults and children. In my work with children and teens, I have seen anxiety become such a powerful force that it gets in the way of having sleepovers at friend’s houses, limits social engagement, results in marked physical discomfort, impairs concentration in class, and even contributes to flat-out refusal of school.

Anxiety is an inward-focused feeling, meaning that we experience it internally. As a result, it is often unrecognizable to parents and teachers and can go easily undetected for a long time until it becomes a problem. Children might be ashamed to talk about it, try to push it away to avoid distress or be limited in their ability to fully articulate what is happening. Behaviorally, anxiety causes a fight-flight-freeze reaction. It leads to acting out and aggressive behaviors (i.e., “fight”) as well as running away and escaping (i.e., “flight”). Anxiety can also be an underlying source of noncompliance, disguised as an unwillingness to engage and shutting down in overwhelming situations (i.e., “freeze”).

In a recent New York Times Magazine article (see link below), writer Benoit Denizet-Lewis takes a closer look at the increasing prevalence of adolescent anxiety as well as a residential program, Mountain Valley Treatment Center, that provides services for more severe cases. In an information age, many teens, parents, educators and mental health professionals are citing social media as partly to blame for the uptick in anxiety. The constant comparing to peers through social media is problematic in that it makes teens feel like they aren’t good enough, which can greatly impact their self-esteem. In my clinical work I see an overreliance on smartphones due to the reinforcing function they serve – whether it be a text back to hang out or a “like” on an Instagram post – and I will often work with youth on self-reinforcement and finding alternatives that are intrinsically rewarding to them.

Many of the students interviewed for the New York Times Magazine article who attended Mountain Valley had histories of significant difficulty attending their regular school due to severe anxiety and/or depression, a presentation known as school refusal. School refusing behaviors exist on a spectrum, from the mild (e.g., missing gym class every now and then due to fears of changing in front of classmates) to the more severe (e.g., missing entire weeks of school due to persistent worries about having panic attacks). Early intervention is key. The longer the child or adolescent is out of school, the more pressure they feel about “catching up” academically. The more they feel like they are falling behind, the more depressed and anxious they become. The more upset and stressed they are, the more difficult it is to get back to school. And the cycle continues.

Understanding this cycle, NESCA offers a special program for youth who refuse school because of emotional distress, called Back to School (BTS). In this program, clinicians use a comprehensive evidence-based treatment approach and work closely with parents and school faculty to figure out the most effective plan that will help the student reenter school.

Given the importance of catching school refusal early, here are some warning signs to look out for:

  • Test-taking anxiety
  • Peer bullying
  • Ongoing visits to the nurse despite no apparent signs of illness
  • Frequent requests to phone or go home during the school day
  • Somatic complaints without a medical explanation (e.g., stomachaches, headaches, etc.)
  • Absences on significant days (e.g., tests, speeches)
  • Sleep problems or resistance to leaving the bed in the morning
  • Changes in mood – anxiety, irritability, sadness

If you have any questions about the BTS Program or NESCA’s therapy program in general, please contact Dr. Ryan Ruth Conway at rconway@nesca-newton.com or 617-658-9831. Dr. Conway will additionally be speaking at several workshops this fall on the subject of School Anxiety, School Phobia, and School Refusal. Information regarding upcoming NESCA events can be found on our website at http://www.nesca-newton.com/events.html.

Article: 

Denizet-Lewis, B. (2017). Why Are More American Teenagers Than Ever Suffering From Severe Anxiety? The New York Times Magazine. Retrieved from https://www.nytimes.com/2017/10/11/magazine/why-are-more-american-teenagers-than-ever-suffering-from-severe-anxiety.html.

 

About the Author:

Conway

Ryan Ruth Conway, Psy.D., is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.

 

If you are interested in working with Dr. Conway or have any additional questions about NESCA’s therapy services, please 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.

 

Catch Them When They’re Good!

By | NESCA Notes 2017

 

By:  Ryan Conway, Psy.D.
NESCA Clinical Psychologist

If your child’s go-to response to your requests is typically “no,” then keep reading…

Children who tend to disobey rules, become easily agitated, experience temper outbursts and argue with authority figures are known to display a pattern of behaviors called disruptive behaviors. These behaviors can cause significant family turmoil and become quite challenging for schools to manage. Children who have trouble regulating their emotions and behaviors may be pinned as “the bad kids.” This is unhelpful because it does not explain what exactly is underlying the acting out. This type of reputation can also impact a child’s self-esteem, resulting in feelings of inadequacy and self-doubt. Disruptive behaviors could be masking other issues that are not obvious to teachers and parents. Consider the possibility that the kindergarten student who shuts down and refuses to engage in class is not oppositional, but instead experiencing anxiety about being away from his mother or father. Maybe the second grader obtains his parents’ attention most often at home when she lashes out. In trying to control disruptive behaviors, children get a lot of attention from adults for what they are doing wrong, often times unintentionally.

One of the hallmarks in teaching caregivers how to effectively manage these kinds of behaviors is positive parenting, which comes from a behavior therapy approach. Among positive parenting techniques is “catching them when they’re good,” which shifts the focus away from what is problematic and towards the appropriate behaviors parents want to see continue. With this technique, parents become more mindful about the behaviors they attend to and seek out opportunities to let their child know when he or she is on the mark. It feels good for both the giver and the receiver, and can bring you closer to your child!

Positive feedback is a powerful tool at any age. For children, it comes in many forms – a sticker for helping to set the dinner table, a praise statement (“I’m so pleased that you are using gentle hands with your brother”), even a hug! As your child starts to recognize that you are giving more attention to appropriate behaviors, they will similarly shift from negative actions (e.g., sassing off, whining, crying, etc.) to positive ones.

Behavioral parent training empowers caregivers by teaching them specific skills to not only manage their children’s behavior at home, but also to improve communication, build warmth within the parent-child relationship and create a calmer household. The Society of Clinical Child and Adolescent Psychology (SCCAP), a group dedicated to disseminating information about evidence-based therapies for youth mental health problems, sites behavior therapy (individual parent and groups of parents with or without child participation) as the most efficacious treatment for disruptive behaviors in children. The SCCAP website, www.effectivechildtherapy.org, was recently updated and is a helpful resource for parents seeking information and guidance about treatment for children and teens.

NESCA is excited to be offering a new group for parents and children ages 7-10 who exhibit disruptive behaviors and/or ADHD symptoms. This group will have separate parent and child sections – with opportunities for combined parent-child sessions – and utilize both behavioral and cognitive-behavioral techniques. For additional information, visit http://www.nesca-newton.com/events.html.

Or visit our previous article about behavioral parent training and the research backing this approach: http://www.nesca-news.com/2017/04/parent-training-programs-101.html.

 

About the Author:

Conway

Ryan Ruth Conway, Psy.D., is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.

 

If you are interested in working with Dr. Conway or have any additional questions about NESCA’s therapy services, please 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.

 

Is Acupuncture Right for You?

By | NESCA Notes 2017

 

By:  Holly Pelletier, La.C.
Licensed Acupuncturist

One of the most common questions I receive as an acupuncturist is “Can it help with (insert any condition or ailment here)?”   And the answer is most emphatically “Yes”.  This is because the majority of us suffer from something we wish we didn’t have to. The reason is that we have been taught only to receive medicine and health care as a means of fixing something which is already broken. We do not think about creating and maintaining a healthy body before these malfunctions begin to occur. But what if we could change our way of thinking?

As a society in general, we tend to be hyper-focused on fixing problems. When we shift our focus back a bit, we can usually see that problems come from preventable causes. It is these precipitants or causes that need to be addressed. When it comes to the human body, we all ought to be able to recognize ourselves in the following scenario:

Imagine a time where you had an injury or felt pain somewhere in the body. You may have noticed that you quickly developed a very intuitive way to relieve the pain; perhaps you shifted your bodyweight to avoid an achy foot, or used your non-dominant hand to pick up something heavy, or placed a pillow below a sore hip in the car. Whatever the situation, I’m sure you instinctively and creatively found a way to lessen your pain.

At first, these adjustments may have been just what you needed to allow some part of your body to rest and heal. Sometimes, however, circumventing pain can cause prolonged unnatural use of your body in other areas; and when you strain one part of your body in order to avoid strain on another part of your body every day for a week or a month, or in many cases even years, you will without a doubt begin to feel pain somewhere else. The body has a way it is supposed to move, and when you move in a way that is contradictory to it, you incite a domino effect.

The entire body is interconnected. Every system, every organ, and every cell that is out of balance has to pull from reserves somewhere else. Simply put, the sick robs from the healthy. This is how imbalance forms in the body, and it is the reason unpleasant symptoms begin to manifest.

Symptoms of imbalance can be subtle–they may show up in the form of dry mouth, a slightly aching head, or difficulty sleeping. Every person has a different chemical makeup, and therefore these imbalances will show up differently in everyone. It takes an in-tune and aware individual to begin noticing these changes in their body, and an even more proactive and intelligent person to decide to do something about them when the first signs arise.

At last, we come to acupuncture and its role. Acupuncture is part of a holistic medicine system that originated in China and dates back thousands of years. Its entire motivation is to restore balance anywhere in the body. That means that, in a roundabout way, acupuncture can work with any ailment, although its strength is with preventative and early-onset illness.

This is why acupuncture is a phenomenal modality for children and adolescents. Their imbalances are fresh and new, still close to their root cause, and relatively easy to reverse. It becomes more difficult as we age.

When explaining this to those who are new to acupuncture, I often get follow-up questions about whether or not acupuncture can cure things such as cancer, diabetes, Alzheimer’s, and other extreme ailments. Without a doubt, there are some very debilitating diseases that are best managed with a combination of pharmacological treatments and acupuncture.

Until you begin getting treated with acupuncture and seeing how your body responds, it is nearly impossible to determine the level of imbalance in the body. What I can say with clarity and assertion is that acupuncture will most definitely help in some areas of a person’s life. When dealing with chronic illness, there is such a deep imbalance in the body that the person’s main concern may not be transformed in the way that they hope. In these individuals, although their illness may not be cured, their quality of life will almost certainly improve and many symptoms will be managed with acupuncture included in their care.

Because acupuncture works with such a variety of individuals with drastically differently manifesting symptoms, it is challenging to specifically say what changes you will see after beginning your course of treatments. Following are a list of benefits I have found to show up in almost everyone I treat, regardless of primary concern:

  • Improved and more stable mood
  • Stress reduction and the body’s ability to handle difficult situations
  • Better and more sustainable energy throughout the day
  • Deeper and more quality sleep
  • Appetite regulation – more or less depending on what the individual needs
  • Overall increased feeling of well being
  • Decrease in pain and inflammation in the body

There are many lists out that there have been approved by the FDA detailing specific ailments that “acupuncture treats” and they can be helpful, but looking at the benefits of acupuncture in that way minimizes the vast comprehensive approach that it actually has on the body.

It is a much more holistic medicine that can positively affect many individuals.

For any questions involving acupuncture, or to set up a free consult or appointment please contact Holly at hpelletier@nesca-newton.com.

 

 

About the Author:

Holly Pelletier, L.Ac. is a licensed acupuncturist who practices part-time at NESCA. Holly Pelletier has been working with children of varying ages, in many different capacities since 2004. Prior to treating kids with acupuncture, she worked as a teacher, coach, and mentor. She exceptionally enjoys working with children and acupuncture because of their speedy response time and genuine excitement about this form of medicine. Holly has a very gentle technique and has specific training in non-insertive acupuncture styles, which does not require needling directly into the skin. In additions to working with children, Holly is also very passionate about working with issues involving women’s health, nutrition/herbs, neurological disease, and psychological challenges such as anxiety and depression. For more information on our acupuncturist, Holly visit: http://www.hpelletieracu.com/

 

 

 

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.