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NESCA Notes 2020

Growing in a Fog: The Impact of Sleep Loss on Children’s Development

By | NESCA Notes 2020

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

A recent study conducted at the University of Warwick, in the United Kingdom, supported the long-held belief that reduced sleep in children has a significant negative effect on their cognitive and emotional functioning. Findings were recently published in the journal Molecular Psychiatry, in an article, titled “Sleep duration, brain structure, and psychiatric and cognitive problems in children.”

When examining children ages nine to 11, reduced sleep was associated with higher levels of depression, anxiety and impulsive behavior, as well as poorer cognitive performance. Findings showed that, on average, behavior problems were 53% higher in children who got less than seven hours of sleep, compared to those who got nine to 11 hours. Additionally, on average, total cognitive scores were 7.8% lower in the children with reduced sleep.

Negative effects of sleep loss were not only observed through children’s behavior and task performance, but there were table differences within brain structure as well. Shorter sleep duration was related to lower volume in brain structures that are responsible for decision making, learning, emotion regulation, memory, executive function, sensory regulation, language function and spatial perception, among other skills. Because sleep is a highly active process, during which children’s brain circuitry reorganizes, it is thought that sleep loss can interfere with actual physical brain maturation, not just emotional, behavioral and cognitive functioning.

This study conducted by the University of Warwick is not the first to demonstrate how a lack of sleep negatively impacts children’s and adolescent’s functioning. In addition to better emotional and cognitive health, adequate sleep is also related to better physical health, including reduced injuries, heart disease and obesity (www.aap.org).

The American Academy of Pediatrics recommends that preschoolers get 10 to 13 hours of sleep per day; grade school children get 9 to 12 hours of sleep; and teenagers get eight to 10 hours of sleep. While this is so, children are often chronically sleep deprived due to excessive school, social and extracurricular demands. Increasing screen time and access to social media is also problematic, not only because these distract children and teens from sleeping, but technology use interferes with the release of melatonin, reduces REM sleep and activates the wake center of the brain. It is thus not surprising that a 2015 analysis of data from the Youth Risk Behavior Surveys found that approximately 57.8% of middle schoolers and 72.7% percent of high schoolers are not getting enough sleep. In spite of this, school start times remain early, expectations for extracurricular involvement remain high, and blue-light-filled technology is increasingly necessary for the completion of late-night homework assignments. This occurs alongside a steady rise of stress and anxiety within pediatric populations, pointing to the importance of re-evaluating the demands and conditions under which our children are expected to grow and learn.

Sleep is a foundational necessity on which cognition, emotion regulation, attention and learning build. The negative effects of sleep loss can be felt at any age, but they are particularly concerning in childhood, a time when the brain is rapidly developing. The American Academy of Pediatrics has provided some tips on how to support healthy sleep in a child of any age. These can be accessed at www.healthychildren.org, at the below link.

References

University of Warwick. (2020, February 4). Children’s mental health is affected by sleep duration. Retrieved on February 24, 2020 from www.sciencedaily.com/releases/2020/02/200204094726.htm

Wheaton AG, Jones SE, Cooper AC, Croft JB 2018, ‘Short Sleep Duration Among Middle School and High School Students — United States, 2015’, MMWR Morb Mortal Wkly Rep., vol. 67, pp. 85–90.

American Academy of Pediatrics (2016). American Academy of Pediatrics Supports Childhood Sleep Guidelines, June 13, 2016. Retrieved on February 24, 2020 from https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/American-Academy-of-Pediatrics-Supports-Childhood-Sleep-Guidelines.aspx

American Academy of Pediatrics (2018). Healthy Sleep Habits: How Many Hours Does Your Child Need? Retrieved on February 24, 2020 from https://www.healthychildren.org/English/healthy-living/sleep/Pages/Healthy-Sleep-Habits-How-Many-Hours-Does-Your-Child-Need.aspx

 

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.

ADHD: Setting Up A Successful Environment

By | NESCA Notes 2020

Co-authored by: Lauren Zeitler, MSOT, OTR/L, NESCA Occupational Therapist; Feeding Specialist, and Lindsay Delling, OTS, Occupational Therapy Graduate Student

Before any assessments, treatment planning, or suggestions of adaptations take place, we must first understand what attention-deficit/hyperactivity disorder (ADHD) in childhood means, and how it may present and affect each individual child. The American Psychiatric Association defines ADHD as one of the most common neurodevelopmental disorders affecting children, with symptoms including, “inattention (not being able to keep focus), hyperactivity (excess movement that is not fitting to the setting) and impulsivity (hasty acts that occur in the moment without thought)” (2017). There are three different types of ADHD: inattentive type, hyperactive/impulsive type, or combined type, that come with specific criteria within each to provide a diagnosis. While some symptoms of ADHD are common amongst young children, such as difficulty sitting still or limited attention spans, the difference in children with ADHD is the inability to control it without external forces providing regulation for them. This blog post will outline the sensory systems and will provide environmental suggestions and adaptations for children with ADHD to help them succeed and increase focus!

It is estimated that 8.4% of children have ADHD; so, that being said, what can we as occupational therapists recommend to enhance attention and regulatory strategies in children with ADHD using the sensory systems as a guide?

  1. Touch – Children with ADHD may actually scientifically benefit from utilizing fidget toys to increase their attention to a task. This thought process comes from the fact that using a fidget toy, such as a fidget spinner or some putty, allows children to exert some energy while also keeping their hands busy. This then makes them more likely to attend to another task, such as listening to a teacher speak, because they have sustained alertness while working with the fidget toy and can therefore sustain attention to the overarching task. We have seen this in most people on a smaller scale as they twirl their hair or tap a pen while attending to a task; they are essentially using these items as fidget toys to enhance their alertness and sustain attention to the task at hand (CHADD, 2021). The same can be said for a wiggle seat cushion or chair to promote seated movement so the child can gain that sensory input of movement, while staying seated and attending to the task.
  2. Sight – Because children with ADHD exhibit hyperactive tendencies, this means that they are likely hypersensitive to lighting and types of lighting within environments, such as fluorescent lighting which is prevalent in many school systems. Providing children with ADHD breaks from this harsh light and allowing time for their eyes to relax is a great way to promote improved attention throughout the school day. Hypersensitivity in sight is also important to be aware of regarding any schoolwork a child may be doing. If there is a lot going on within the page, a child with ADHD can become easily overwhelmed and may be quick to abandon the activity due to overstimulation. Covering portions of the page so that the child can only see one activity at time may be helpful in keeping them focused and on track and will likely decrease frustration.
  3. Hearing – Due to the hypersensitive nature of children with ADHD, sounds can be very distracting for them when they are trying to focus on a task. One solution would, of course, be to find a quiet space for them to complete schoolwork and other activities. This, however, may not always be readily available or even an option. In that case, providing these children with other adaptations, such as noise cancelling headphones, while they complete their work or even just frequent noise breaks and allowing them to take a walk or play with a preferred item can be great alternatives in promoting sustained attention in a noisy environment!
  4. Smell – Just like the other senses, certain smells can also become overwhelming and even distracting for some children with ADHD. This can happen for many reasons, such as smells of food reminding them how hungry they are at school, smells that make them think of a certain memory that promotes daydreaming, or even simply gross smells that the child cannot seem to get their mind off of. To promote sustained attention and a calming effect with children with ADHD, essential oils can be a good option to trial! While they are not scientifically proven to directly help with symptoms of ADHD, they are proven to ease anxiety and stress, which can occur with ADHD. Scents such as lavender, vetiver, and chamomile are known for their stress-relieving abilities that promote relaxation and serenity within the body.
  5. Taste – Snacks…a fun way to wrap up this post! Similar to fidget toys, crunchy snacks can also provide attention-enhancing qualities when eaten during a time where sustained attention is necessary. The child will be focused on the task of chewing the crunchy item, such as carrot sticks, an apple, or some chips, and will therefore be present in the moment and better able to attend to the task going on around them. This strategy can be used in a variety of settings where eating is appropriate – school, home, tutoring, etc. And, it’s a fun contribution to the repertoire of strategies to enhance attention and self-regulation strategies!

As always, we recommend reaching out to your occupational therapist or getting an occupational therapy evaluation. Contact NESCA’s Director of Clinical Services Julie Robinson, OT, to learn more at: jrobinson@nesca-newton.com.

References

https://chadd.org/adhd-weekly/fidget-toys-and-adhd-still-paying-attention/#:~:text=Putty%2C%20squeeze%20toys%2C%20fidget%20cubes,classroom%20without%20becoming%20a%20distraction.

https://www.psychiatry.org/patients-families/adhd/what-is-adhd

 

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

 

Lindsay Delling is a graduate student at Regis College working toward obtaining her master’s degree in occupational therapy. She previously completed fieldwork at Spaulding Rehabilitation Hospital in Charlestown and many school-based settings before coming to finish her fieldwork with NESCA. Prior to graduate school, Lindsay worked with children with disabilities in the Boston Public School system, as well as in a special education preschool setting in her hometown. Lindsay is open to working with many different populations once she completes her degree.

 

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.

 

Understanding Empathy

By | NESCA Notes 2020

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

Our children are growing up in a social environment that is too often flavored by fear; fear of inexplicable violence, fear of people who look different than us, whose politics are contrary to what we hold dear, people who seem to despise us as much as we discount them. At the same time, we are realizing that in order to help our children learn, we must pay attention to their emotional and social states as well as their intellectual development.

In the context of these paradoxes, the concept of empathy has become a topic of considerable interest. The fact of the matter is that empathy may be at play in the divisiveness of our communities as well as in the efforts to include all children in our schools. Empathy is critical in forming close and supportive relationships, but at the same time, it is also responsible for a built-in bias toward people with whom one feels a connection. Further, being empathetic towards others does not ensure that one will follow that feeling of concern with acts of kindness. Finally, too much empathy for those in pain is very painful and can cause the empathizer to pull back or avoid the situation or person  in order to protect themselves. The research of the past 15 years has deepened our understanding of empathy and has helped to explain some of these contradictions. In an article in the Scientific American (December 13, 2017), Science Writer Lydia Denworth summarized the general consensus of the scientific community to describe three different but interactive aspects of empathy:

  • Emotional empathy refers to the experience of sharing one’s feelings and matching that person’s behavioral states; for example, feeling afraid when watching a movie in which someone is being attacked by a lion. This form of empathy is a biological response that is seen in a variety of animals as well as children as young as one year old.
  • Cognitive empathy is the capacity to think about and understand other people’s feelings. It is often referred to as perspective taking or theory of mind. While aspects of this ability can be seen in very young children, it is not fully developed until adulthood.
  • Empathetic concern, or compassion is the feeling of concern that motivates one to help in some way. This capacity can also be seen in young children.

True empathy requires the engagement of all three capacities. Consider, for instance, the experience of many people on the Autism Spectrum. They may be fully capable of feeling emotional empathy; in fact, they are often overwhelmed by the sharing of pain. However, they struggle with the cognitive task of  perspective taking, or appreciating that the other person may not see things in the same way that they do. On the other hand, people with antisocial tendencies may be very good at understanding how someone feels, but do not have any interest in helping them. Finally, it is extremely difficult for people who live in a homogeneous cultural area to be able to extend the same kind of care and consideration to others who look and sound different and whose views may run counter to their own.

Gwen DeWar is a biological anthropologist who edits the Parenting Science website. In one of her articles, she describes 10 steps parents can take to encourage the development of empathy in their children. These include tasks such as, providing the support needed to develop strong self-regulation skills, the modeling of empathic behavior, the avoidance of reward or punishment in favor of thinking through the impact of one’s actions on others, the fostering of cognitive empathy through literature and role-playing, and the education of children to avoid the “empathy gap” that occurs when people forget what it is like to be in the grip of pain, discomfort or fear. It is worth reading.

About the Author:

Formerly 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. She is a member of the Trauma and Learning Policy Initiative (TLPI) associated with Massachusetts Advocates for Children and the Harvard Law Clinic, and is working with that group on an interdisciplinary guide to trauma sensitive evaluations.

To book an evaluation with Dr. Monaghan-Blout 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.

Why Kids Need to Outdoor Free Play

By | NESCA Notes 2020

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

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

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

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

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

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

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

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

 

About the Author

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.

Daily Journaling While Social Distancing

By | NESCA Notes 2020

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

*This post was originally published almost a year ago. While we slowly start to emerge from our quarantine and begin to safely re-engage in some of the activities and duties from our pre-pandemic lives, it is important to remember to participate in activities to better ourselves and others on a daily basis.

This is such a unique time that we are living in, but one day it will be a distant memory. Get a special journal book, make it from scratch or create one online. It will give you something to look back on and remember how you achieved something every day, smiled and made it through a very surreal time in history. Keep your journal to share with future generations. While we are practicing social distancing or being asked to stay home, challenge yourself to do something out of every category below on a daily basis. Do something for your brain, your mental health, your body, your home, your community, your creativity, your family, the environment and your friends/neighbors. Adults and kids can do this.

 

While Physically Distancing, Do Something For:

Your Brain

❏     Do a puzzle

❏     Listen to a podcast

❏     Tour a Virtual Museum

❏     READ

❏     Challenge yourself with a game, crossword puzzle, Sudoku, etc.

Your Mental Health

❏     Try a meditation app, like “stop, breathe, think” or www.calm.com

❏     Find an example of someone giving back or helping others

❏     Laugh out loud at least twice a day, tell a joke, watch a funny movie

❏     Turn off the news

❏     Record how you are feeling using the Yale Mood Meter

Your Body

❏     Take a walk, go for a run, ride a bike

❏     Create a dance play list and dance, dance, dance – We Are Family!

❏     GoNoodle Indoor Recess

❏     YouTube: workouts, yoga or dance

Your Home

❏     Do a chore – vacuum, dishes, laundry

❏     Clean your room

❏     Put your things away

Your Creativity

❏     Learn something new

❏     Draw/paint

❏     Build with LEGO

❏     Learn Calligraphy or Hand Lettering

❏     Play an instrument

❏     Search Pinterest for “DIY” or “upcycle”

Your Community

❏     Follow CDC Guidelines – stay home and wash your hands

❏     Go through clothing and toys to donate

❏     Check out your community website for what is needed

❏     Make cards to send to a local nursing home, nurses, doctors

The Earth

❏     Go for walks and enjoy nature

❏     Plant something

❏     Pick up litter – wear gloves

❏     Find another use for something before you recycle it

Family, Friends, Neighbors

❏     Stay in touch with each other

❏     Connect on FaceTime calls

❏     Have dinners together over FaceTime, Skype, Zoom

❏     Call people instead of text, write a letter, draw a picture

❏     Make a photo book of memories with a service like shutterfly

❏     Cook something for your family, neighbors

❏     Ask if someone needs help

 

About the Author

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

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

 

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

 

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

 

The Uncertainty, Stress and Anxiety About What School Will Look Like

By | NESCA Notes 2020

*This blog post was originally published prior to the start of in-person school last fall for some. While many students have returned to their school buildings, many others are just now returning or will be in the coming weeks. 

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

Much of adjusting to the world in the midst of a global pandemic has been learning to live with nearly constant uncertainty. Undoubtedly, this pandemic and ensuing uncertainty has caused significant stress for youth and their families. The experience of persistent stress can result in increased vulnerability to anxiety and depression. Symptoms may become magnified in those who already faced mental health challenges. There is little doubt that there will be increases in mental and behavior health problems for children and families both in anticipating the re-opening of schools, and when schools reopen their physical buildings.

We all wonder what school will look like in the fall. The anticipation of returning to school can be especially stressful, and will likely be so for most youth. Given that students will not have been in schools with their peers for several months, it can be anticipated that they might feel a heighted sense of insecurity and uncertainty. Even in “normal times,” returning to the complex social and educational environment of school can be worrisome for many children and adolescents.

Each individual child will have had their own experiences while schools were closed. Some children and/or staff members may have been impacted by COVID-19 and some families and/or staff may be experiencing financial hardship due to parental unemployment or loss of household income. It is important to realize that regardless of their experience, each individual will have a unique response. It is helpful to recognize the signs of stress and help children learn positive ways of coping with it.

Signs of stress in preschool children include, but are not limited to, anger, nervousness, eating and sleeping problems (including nightmares), fear of being alone, irritability and uncontrollable crying.

In elementary age children, stress may manifest as increased complaining of headaches and stomachaches, feeling insecure, reduced appetite and difficulty sleeping, withdrawal and worrying about the future.

Signs of stress in pre-teens and teens may include anger, disillusionment, distrust of the world, low self-esteem, stomachaches and headaches, panic attacks and rebellious behavior.

As each person works through this very challenging situation, it is more important than ever to adopt a position of acceptance, as we never truly know what another person is experiencing or has experienced. The following are offered as suggestions on how to help children and teens cope with stress.

  • Help them identify how they are feeling and acknowledge and validate those feelings.
  • Encourage them to talk about what is bothering them.
  • Share strategies you use to cope with stress.
  • Talk openly and, as appropriate, share stories about stress in your day.
  • Find a physical activity and/or hobby that they enjoy and encourage them to participate.
  • Encourage them to eat healthy foods and emphasize the importance of a healthy lifestyle, especially as it relates to stress.
  • Make sure they get plenty of sleep.
  • Set clear expectations, without being overly rigid, and allow for “down” time.
  • Spend time outdoors, encourage them to do something they love – read a book, ride their bike, bake, etc.
  • Learn and teach your children relaxation skills, such as breathing exercises, muscle relaxation exercises, meditating, yoga, drawing or writing.

Our world will have changed by the time children re-enter their classrooms. No matter what happens in the fall, when it is time for school to start, it will inevitably be stressful. Learning to cope with and manage stress is important for physical and emotional health. However, if you are concerned about your child or are struggling yourself, seek help and support for yourself, your child or anyone in your family who is struggling.

Below are some helpful resources:

https://www.apa.org/topics/children-teens-stress

https://nesca-newton.com/helping-your-anxious-child-through-covid-19/

https://childmind.org/article/how-to-ask-what-kids-are-feeling-during-stressful-times/

https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.stress-in-children-and-teens.ug1832

 

About the Author

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

 

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

 

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

 

Helping Your Anxious Child through COVID-19

By | NESCA Notes 2020

 

Almost a year into Covid-19, many of us can use this blog as a reminder when our children exhibit signs of anxiety from learning of new developments with the pandemic; friends, family or others testing positive for Covid-19; or returning to school. The guidance shared in this blog still holds true, nearly one year since many of us went into lockdown and schools shuttered. 

 

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

A recent New York Times article by Jessica Grose discusses ways to support your child, specifically helping them to feel less anxious, during the COVID-19 situation. Their “top 4” suggestions are great ones – validate their feelings, manage your own anxiety, aim for some kind of predictable routine and try mindfulness or progressive muscle relaxation activities.

The larger consideration in this case is this: anxiety, particularly in the current situation, is normal. We can label it with clinical words, give you our best clinical tools and recommend that you seek help (and please do!). At the same time, if we take a large step back, being anxious right now is exactly how we are meant to feel. We are social beings, designed to live in the community and support one another through face-to-face social interactions. When something threatens our safety, or the safety of our families, it is normal to respond with fear, worry and hypervigilance. Everyday interactions that would typically result in no response, like hearing someone nearby cough or sneeze, all of a sudden have become indicators of a threat. Even having others in close proximity to us is now a threat, meaning that the social communities in which we are supposed to thrive have now become potentially dangerous places. In this new environment, our bodies, well-attuned and primed to handle threats, are doing what they should do – they are putting us on “hyper-alert mode,” keeping us exceedingly sensitive to these threats so that we can avoid them and preserve our safety.

Children are in this mode, too, albeit with far fewer resources to help mitigate their fear and worry. As adults, we have far more lived experience with threats, anxiety, fear and worry, and we can use this experience to manage our responses to this novel situation. For children, this may be the first time they are struggling with persistent worry and fear. Or, they may have struggled to cope with other fears and worries for a long time, and this new stressor has overwhelmed their system. In either case, it is important to normalize fear and anxiety, in addition to the myriad of other emotions that children may be experiencing.

The key is balance. We have to balance validating and normalizing feelings with reinforcing unhealthy habits. What does that look like? One dimension to consider is time – validating and normalizing feelings is a short acknowledgement that the child is heard, understood and believed. On the other hand, repeatedly discussing the same questions or topics, engaging in persistent conversations about the threats and explaining “adult” information to children (especially dire predictions, long-term impacts, etc.) is not healthy. These behaviors may appear to decrease anxiety in the short-term, but over time, can be detrimental.

Another important consideration is space – focusing on what is happening in the present is important to help children process and understand the radical changes that are impacting their day-to-day lives. However, if you find that your conversations linger on the past or the future, try to shift back to the present. Your mind may be filled with regrets from the past (e.g., “I knew we should have stocked up on their favorite snack last time we were at the store”) or fears for the future (e.g., “My parents are elderly and at high risk”), and these thoughts are entirely normal. At the same time, when talking with children, it is important to try as much as possible to focus on the here and now. Of course, it is important to give children the space to express their fears for the future, and we can and should acknowledge and validate these fears. We can also, simultaneously, bring children’s focus back to the present and back to tangible, concrete things that they can do (e.g., “I know you are really worried about grandma, and it’s sad that we can’t see her right now. Everyone is working hard to keep her safe, and we are going to call and talk to her later today”).

For some children, advanced intellectual abilities may allow them to understand (at least, in some sense) a great deal of the information that is portrayed on the television and news media. However, it is important to remember that, while their cognitive abilities are years ahead of their peers, their emotional development is not. It may be necessary to closely monitor their online activity, as they may be seeking out information (which is a normal response to fears, especially fear of the unknown) without having the critical thinking abilities to understand the source or potential biases in the way the information is presented. On the other hand, some children may struggle to understand the situation, either because of their young age, learning disability or other developmental delays. If this describes your child, consider putting together a story, with pictures and words, to help them understand some basic information (e.g., why we can’t go to school right now, why we can’t go play with friends). This is often referred to as a “social story,” and clinicians at NESCA can help you create one specifically for your child.

Last, and most certainly not least, seek help and support for yourself, your child or anyone in your family who is struggling. While experiencing anxiety during these times is normal, when these thoughts and feelings are taking over your child’s daily life (or your own), it may be time to look for assistance. Many clinicians, including here at NESCA, are available via phone or videoconferencing, and we can assist with a range of concerns. Whether you want a brief consultation to help you respond to persistent questions from your child or whether your child has a pre-existing anxiety disorder that is exacerbated by these challenging times, we are here to help.

 

About Pediatric Neuropsychologist Dr. Yvonne Asher:

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

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

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

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

 

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

 

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

 

Generalizing Skills from the Classroom to Home and Community – Part 1

By | NESCA Notes 2020

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

“How do I get my student to transfer the skills they are learning in school to the home environment?” This is a question that almost every parent thinks about and asks for suggestions on. I wish I had a simple answer and something that could solve this for each and every student that I have worked with over the years. As you know, every student and home environment are different, so the first step is to individualize the process and see what works best for both the student and the family. Below are some suggestions for two transition areas that have worked, including some resources.

Domestic Skills

Cooking

  • If your student uses a visual recipe in the classroom to learn how to cook, ask the teacher for copies of the exact recipe after it has been mastered in the classroom.
  • Try to have similar cooking tools in the home kitchen that your student uses at school.
  • Start with something basic and that your student likes. It is more of an incentive if they will enjoy eating the end product!
  • Some families choose one night a week that their student cooks with the family or by themselves. This will help build a routine, as well as having your student contribute as an active member of the household.
  • Another motivator for some students is to have a family member take a short video or photo of them cooking (or the final product) so it can be shared with their teacher or other family members. I can’t tell you how much of a confidence booster this has been for students who I have worked with!
  • Other helpful resources:

 

About the Author

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

 

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

 

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

 

Meet Abigael Gray, NESCA’s Speech-Language Pathologist & Feeding Specialist

By | NESCA Notes 2020

This Fall, NESCA debuted its new feeding, speech and language and direct sensory/motor occupational therapy services. Leading NESCA’s feeding and speech and language therapy is Abigael Gray, MS, CCC-SLP. In today’s blog, we sat down with Abbey to learn about her role as a Feeding Specialist; Speech-Language Pathologist.

What led you to your interest in speech and language and feeding, in particular?

I received an undergraduate degree in psychology from Syracuse University. After graduating, I worked in a preschool for children with autism and developmental delays. This is really what made me interested in speech and language pathology (SLP), since all of the children there were receiving speech-language therapy. While I was working there, I observed quite a bit and decided I wanted to learn and do more in this area. After five years of working there, I enrolled at Emerson College to earn my Master’s in Communications Sciences and Disorders. While there, I discovered that Emerson has a great program for feeding. Many schools don’t have a focus on swallowing and feeding in pediatrics, like Emerson does. I had a placement with one of my professors at her practice in Needham. I eventually took a position with this clinic and received great training in pediatric feeding therapy there during my clinical fellowship. This is where I became passionate about feeding therapy. I eventually moved into a multidisciplinary practice for two more years and then joined the team at NESCA.

Why were you attracted to NESCA?

I saw this as a great opportunity to bring speech-language pathology and feeding therapy to NESCA. I loved the  multidisciplinary aspect to the practice and thought I could strengthen what NESCA already offers by adding feeding and SLP to it. I like how all of the various services are built into one practice right here. Many of the  kids being seen at NESCA can also benefit from the therapies that I offer. Having those services available to parents and children right in the same location is a huge plus for them.

After meeting Ann Helmus, Ph.D., NESCA’s founder and director, I knew that it was the right cultural fit for me, being so collaborative. It also gave me the opportunity to continue to work with Julie Robinson, OT, who oversees this new clinical offering. It’s great to be able to continue with my working relationships with the occupational therapists who also joined when I did. The seamless communication between all of us in the clinical therapy practice makes for really well-rounded therapy for the children we treat as well as more convenient for their parents/caregivers.

What are the most exciting and the most challenging parts of your role?

The most exciting part of my new role at NESCA is being able to offer speech-language and feeding  services in-house. Often the recommendations from neuropsychologists through their assessment is to have some SLP support, whether it’s having to do with reading, writing, social skills, expression or comprehension. Being able to offer that right in the same practice allows for continuity of care among clinicians on behalf of the child. It’s exciting for me because I can go back to the neuropsychologist or other clinician at NESCA who referred the client with any new observations or questions I may have. This makes the process much smoother for the parents and our clinicians. There’s just a lot less “red tape” to go through to be able to communicate and collaborate.

It’s also exciting to build this service offering from the ground up. I can take all of the experiences I have had and knowledge I’ve gained through my years in various positions and make our services our own at NESCA.

As far as challenges go, right now as we build out this new service, I am currently the only SLP on board. While that is the case for now, I have a great network of past colleagues and friends who are SLPs to bounce thoughts off of. Our plan is to have other SLPs join our team as we grow the practice.

What are your clinical interests?

Feeding is my big passion area. Within feeding, I am currently completing a lactation counseling training to become a certified lactation counselor. Babies can struggle with breast feeding, then can have even more difficulties transitioning from the breast to solid foods. I love working with infants and toddlers, and having this certification will round out my knowledge about feeding for this age range.

Within speech, I love working on articulation with kids who have speech sound disorders, phonological disorders and childhood apraxia of speech. Within language, I really enjoy working on social pragmatic communication with kids who are on the higher functioning side of the autism spectrum, or Asperger’s, or those who have social pragmatics difficulties.

I also really enjoy working on early literacy skills, sound letters, identification, rhyming and phonological awareness. When it comes to kids who may be in their older elementary school or early middle school years, I love to work on writing skills with them.

One characteristic among NESCA clinicians is that they are all lifelong learners. In what ways are you a lifelong learner?

I loved that having the curiosity to continue to learn is a draw here at NESCA! That’s really important to me. Right now, I’m currently working my way through three different courses:

  • The lactation counseling certification that I mentioned previously
  • A “Feed the Peds” course, which is a refresher course on feeding therapy with some new approaches in the areas of tethered oral tissues (i.e., tongue ties, lip ties) and how those impact feeding. The course covers how to assess and treat these issues. What’s interesting is that these new approaches are appropriate for people across the lifespan – not just for young children. There is also a module on treating those with medical complexities. Often times, medically complex patients have issues with feeding and/or are tube-fed, and can then go on to have challenges progressing through age-appropriate feeding skills or transitioning off of tube-feeding.
  • The third area I am currently in training for is with orofacial myofunctional disorders, including tethered oral tissues and the impact on speech and feeding. This covers anything that structurally or functionally impairs speech, the airway or feeding. This is a growing area in our field, so it’s important to be current and well-informed on this topic.

How has Covid-19 impacted the way you treat patients and families?

Right now, we are delivering speech-language and feeding therapy via teletherapy. While it’s always great to work with a child and/or family in-person, the plus side of teletherapy is that we get to see the child in their natural home environment as well as how the child communicates with family members. Sometimes, when we see the child in this setting, we can detect and observe a feeding or speech-language issue as the family sees it on a regular basis. It’s also nice to be able to work with parents in their own setting. We can better understand their priorities for therapy since we are talking directly with them. It also allows the child to generalize the skills they would normally learn in the clinic setting right into their home. As therapists, we can see what a typical meal at home looks like, which is obviously a more natural setting than the clinic. We used to have to ask parents to send us videos of mealtimes. Now, it’s like we are at a meal with them over Zoom!

Covid-19 was the catalyst for us to offer teletherapy, which has helped parents who work and have to travel to get to therapy tremendously. They are now able to be more hands-on in the therapy sessions. Also, for some medically complex kids, it’s just hard to get out of the house and drive to therapy. And, parents don’t have to cancel appointments if a sibling is home sick or even quarantining. And, we can stay on track with therapy via telehealth even in inclement weather that makes it challenging to drive to the clinic.

Covid-19 has certainly had its drawbacks, but we’re seeing some of the upsides in teletherapy as well.

 

About the Author

Abigael Gray has over six years of experience in assessment and treatment of a variety of disorders, including dysphagia, childhood apraxia of speech, speech sound disorder, receptive and expressive language disorder, autism spectrum disorder and attention deficit hyperactivity disorder. She has a special interest and experience in working with children with feeding and swallowing disorders, including transitioning infants to solid foods, weaning from tube feeding, improving sensory tolerance, developing chewing skills, increasing variety and volume of nutritional intake and reducing avoidance behaviors during mealtimes.

 

 

 

 

If you are interested in learning more about NESCA’s speech-language therapy or feeding therapy, please complete our online intake form, or email NESCA’s Director of Clinical Services Julie Robinson at jrobinson@nesca-newton.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.

 

Digital Literacy, Executive Function and Remote Learning

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L

Occupational Therapist; Real-life Skills Program Manager and Coach, NESCA

The experience of watching a small child who is only two or three years old pick up a smartphone, quickly type in a passcode (as they have memorized the pattern) and open up their favorite game can be jarring for adults who remember the days of dial-up internet and who learned to use technology as it staggeringly evolved. For many of today’s children, handheld electronics have always been a fundamental part of their world. Flipping between apps, using their pointer finger to manipulate games and opening a screen using facial recognition all feel like second nature to many in the current generation of school age children. We assume that children have higher digital literacy than we do and intrinsically understand technology in a way that many of us never will. But what do our children actually know? And, are they missing out on vastly important direct instruction when adults make an assumption that they are already tiny experts in the digital field?

Over the past six months, a time fraught with a monumental shift in education, I have worked one-on-one with a widely diverse group of learners. If I had to pinpoint one theme that comes up over and over, across ages, levels of ability and school systems, it is frustration, confusion and lack of problem-solving strategies as they relate to technology. Statements I have heard during this period of remote learning include:

  • “I don’t turn off my Chromebook. I lose everything, and I’m actually not quite sure that I know how to turn it back on.” – High school honors student
  • “I didn’t know that Google Slide and PowerPoint were different things. I lost so much trying to switch between them.” – High school senior
  • “Hardware or software? I didn’t realize there was a difference.” – Middle school student
  • “I just save my document with whatever my computer suggests as a title. I guess it does make it tricky to find things later.” – High school junior

As an occupational therapist focused on making sure our students can access their curriculum, comments like these teach me a few incredibly important lessons.

  1. Students are lacking information on the basics. The same student who is not sure how to turn off his Chromebook can quickly navigate Google Classroom without any support, both uploading files and opening modules with ease. We need to focus on teaching the fundamentals of technology. What are hardware and software and how to they interact? What options exist within the system preferences of a particular device? How is an iPad different from a Chromebook, a Windows laptop or a MacBook? Why do we need to power down devices sometimes? What are the downsides to never restarting a computer or updating an operating system?
  2. Successful digital organization does not come naturally. Students are typically taught specific systems for organizing physical space and materials, such as color-coded folders, binders and labels. Teaching students to organize their digital space and their digital materials is equally, if not even more, important. Learning to create folders for each class and systematic ways of labeling documents saves students time and energy, and this often decreases frustration in the moment.
  3. Academic and professional tools are not particularly intuitive (a stark contrast to entertainment tools). There are incredible programs designed to help students create presentations, synthesize data and put documents together. These include, but are not limited to, the Microsoft Suite and Google Workspace. These tools can be tricky to manipulate and many middle and high school students would benefit from taking an introductory course, watching online tutorials or working directly with teachers to explore their functionality before layering on assignments requiring competent use of the tools.
  4. Students are often completely unaware of their gaps in knowledge. This is potentially due to the fact that today’s students are so impressive when it comes to using technology for leisure purposes. They seamlessly transition from an iPad, to a Chromebook, to a Samsung phone and can access games or social media without difficulty on each device. Unfortunately, very few schools have programs focused on teaching computing skills or digital literacy in the academic context. Our students piece together enough information to get by for a short while, but often come up against challenges later. Students also may believe they have built competency because they have some exposure to a tool. For instance, I have worked with students who are building resumes and including claims such as, “Proficient in Excel, PowerPoint and Word” but score poorly when tested on these computer abilities.

So, what do can we do?

The first step towards ensuring that a child or adolescent has adequate digital literacy skills is to actually assess how much they already know. Some students do have these skills mastered and others will have unexpected deficits or gaps. This assessment can be done formally or informally. A starting point I often use is to sit down with a student at a computer and ask how they organize, how they navigate, how they save files, etc. I also like using online assessment resources, such as TypingClub.com and Northstar Digital Literacy.

Once the skills that a student needs to grow are identified, there are many opportunities available to teach them. A few options include:

  • Online courses in specific software programs. Sites, such as Coursera, LinkedIn and Udemy, have comprehensive courses focused on specific programs for all different levels of learners.
  • Free online videos. A quick search on YouTube often leads to short, accurate videos and tutorials filmed by teachers or professionals. If your student learns well through video format, these can be a great tool.
  • Ask your school for support. Often, students learn better with direct instruction. If a student’s team is aware of their lack of knowledge regarding technology, there are many professionals at school who may be able to teach these skills during a free period, study hall or meeting.

 

About the Author

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

 

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

 

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