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NESCA Notes 2021

Counseling/Therapy: So Many Types and Approaches…Which One Should I Choose?

By | NESCA Notes 2021 | No Comments

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

Many adults, teens and children struggle with a myriad of challenges from everyday stressors, feelings of worthlessness and insecurities to official diagnoses of anxiety, depression, PTSD, eating disorders, OCD, addiction, and more. Deciding how to grow and change and alleviate the pain and suffering can be daunting. There are so many different ways to address psychological pain. Psychological, medical, behavioral, psychopharmacological, complementary (e.g., acupuncture), and educational treatments, among others, are possible choices and can assist in lessening an individual’s anguish. How do I decide which one(s) to try? Usually, treatment involves more than one of these, so the decisions may not be as difficult as you think. The first step is recognizing that you, your child, your marriage or family needs help and taking a step to get help.

Psychological treatments include many options: psychotherapy (i.e., “talk therapy or insight-based therapy”), psychoeducational counseling, biofeedback, social training, behavior therapy, mindfulness, stress management, anger management and so many more. Therapy can be individual, group, family or couples work, and there is no single approach that works for everyone. It often depends on the referral question and complaint. Counseling is typically provided by a psychologist, social worker, mental health counselor, marriage and family counselor, expressive therapist, psychiatrist and/or psychiatric nurse. Many factors go into making psychological treatment decisions (i.e., referring question/complaint, cost, location, approach, etc.). When it comes to therapy, it is most important to have “goodness of fit” between the clinician and the client. The client needs to have a connection with and feel valued, supported and understood by their practitioner. This allows whatever treatment approach or method to be more readily accepted by the client.

Reviewing the differences between treatment approaches may help with the decision-making process beyond “the goodness of fit.” Psychotherapy involves talking with a clinician to address emotional, psychological and behavioral challenges that can be both conscious and unconscious. The client’s past experiences, perceptions and history may play an important role in psychotherapy. The client “tells a story” that helps the clinician understand their life experiences through their eyes, therefore allowing treatment to be tailored to that client’s personal experience. By working through one’s thoughts, past experiences and stressors with a caring clinician, the client is able to gain insight and perspective, reduce symptoms, change behavior, learn strategies to lighten the load and improve quality of life. Often psychotherapy is long-term and involves good communication/language skills as well as higher level of thinking, often abstractly, and insight capacity.

Psychoeducational treatment is somewhat different than psychotherapy. Education is central to treatment and is a more directive approach. It can have very specific goals and may be short-term. The past is not actively addressed; rather, the purpose is to teach the client to acknowledge, accept and understand their disability and/or mental health condition and provide ways to support growth, change and meet goals. Psychoeducational treatment can be provided to individuals, groups, families, couples, employers and others and may include reading informational text, video analysis, homework, data collection, biofeedback, journal writing and more.

Some of the goals of both treatment approaches may be to:

  • connect how thoughts, feelings and behavior are intertwined;
  • improve coping and problem-solving skills to better deal with life’s stressors;
  • increase positive self-regard; and
  • recognize and better deal with strong emotions.

Many clinicians have training in specific techniques and some use a combination of approaches and philosophies. Psychotherapy typically falls into broad categories: Psychoanalysis and psychodynamic, Behavior Therapy, Cognitive Therapy, Humanistic Therapy and Integrative or Holistic Therapy.  Sometimes a specific approach may be the best method of choice given a specific condition or specific goal of the client. Some techniques have been researched on large samples of people and proven to yield positive results with certain diagnoses; while others are newer, less researched (yet are still effective).

In determining what technique is most appropriate, consider the age, diagnosis, goal of treatment, efficacy of the treatment, as well as the personality, cognitive and language capacity, cultural/family background, location, cost, etc. Many treatment approaches share common techniques, but some techniques are better suited with certain conditions/diagnoses. There are upwards of 100 different types of psychotherapeutic approaches, so knowing which one works with what conditions, resonates with you as the client and can meet the needs/goals.

Another option is online treatment. In recent years, many in-person practices and newer standalone online treatment options have emerged. Often these are for mild depression and anxiety. As you search out any treatment, ask for references and reviews and assess treatment efficacy. Some online sites include Talkspace, TeenCounsleing and more. There are also online apps to help with stress management, anxiety, depression and more, such as Moodfit, HeadSpace for Kids, MindShift, Inner Balance, and so many more. Needless to say, online therapy and apps are not the same as in-person therapy but may augment and be helpful in some situations.

Many clients at NESCA present with learning differences, anxiety, OCD, depression, trauma, addiction, ASD, and more. The following partial list includes just some of the treatment approaches recommended by many of NESCA’s neuropsychologists. At NESCA, we currently offer a psychoeducational approach to psychological treatment and short-term pandemic related issues of anxiety and depression. If interested in learning more, please visit: https://nesca-newton.com/integrativetherapeutic/.

  • Acceptance and Commitment Therapy (ACT)
  • Attachment-based Therapy
  • Animal-assisted Therapy
  • Bibliotherapy
  • Biofeedback
  • Cognitive Behavior Therapy (CBT)
  • Dialectic Behavior Therapy (DBT)
  • Exposure & Response Prevention (ERP) Therapy
  • Expressive Therapy (art, music, drama, etc.)
  • Family Systems Therapy
  • Hypnotherapy
  • Mindfulness-Based Cognitive Therapy (MBCT)
  • Motivational Interviewing
  • Narrative Therapy
  • Positive Psychology
  • Parent-Child Interaction Therapy (PCIT)
  • Play Therapy
  • Psychoeducational Counseling
  • Trauma-Focused Cognitive Behavioral Therapy

Additional information about treatment approaches can be found at: https://www.psychologytoday.com/us/types-of-therapy.

https://www.nami.org/learn-more/treatment/psychotherapy

https://apa.org/topics/psychotehrpay/approaches

https://talkspace.com/blog/different-types-therapy-psychotherapy-best/

https://verywellmind.com

 

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.

 

Executive Function Tools: Natural Consequences

By | NESCA Notes 2021

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

In my last blog that focused on executive function tools, I delved into the benefits of using and committing to a digital calendar. The calendar is a concrete tool that can be directly taught to students using traditional methods. Less concrete, but in many ways equally useful, is this next executive function tool – the natural consequence.

When most people think of natural consequences, they think of younger children refusing to do things like eat a meal that their caregiver prepared or put on a coat when it is cold outside. If a child refuses their dinner, the natural consequence is hunger. If a child refuses to wear their coat, the natural consequence is feeling cold. These are consequences that will happen without parents or caregivers explicitly providing a consequence. When it comes to executive function mishaps, the natural consequence is often the need to independently deal with the fallout.

Many of the students I serve directly need scaffolded executive function support with direct instruction and specific opportunities for practice. I am not advocating for removing these services or throwing these students to the proverbial wolves. What I am advocating for is using mistakes or lapses in executive function skill as learning opportunities, as opposed to absolving our students from all responsibility and continuously jumping in to save the day. To demonstrate this difference, here are a few examples of ways I have seen parents successfully use natural consequences as a tool to teach executive function.

Case Studies

  1. Amber is a student who has had consistent difficulty organizing her time after school. While she attends many different afterschool activities, such as recycling club and track, she is often late to practice or misses important changes to the schedule. To help Amber, her parents set up a calendar with notifications and reminders that appear on her phone and her computer directly after school. Recently, Amber started driving lessons with the local driving school. A few weeks ago, Amber had a conversation with her mother in the morning about the fact that she would be picked up for a lesson 10 minutes after the end of the school day. Amber’s notification on her phone went off 15 minutes before the lesson, and she received a pop-up on her computer screen 30 minutes before the end of the school day. Despite these reminders, Amber hopped onto the bus at the end of the day. While this was an honest mistake, Amber was not using her tools or the time management strategies that she has been taught and is expected to use. Amber’s parents decided that as a natural consequence, Amber would need to deal with fixing her mistake. They were there to support her as she called the driving school, apologized to the instructor, and rescheduled her appointment. If she was not willing to take these steps, another natural consequence would have been a delay in getting her license. This caused some heightened anxiety for Amber, but with encouragement from her parents, she practiced the phone call out loud and looked through her calendar to see where she had availability for a make-up appointment. Amber’s parents could have easily called the driving school and fixed these problems for her; however, Amber would have missed out on an opportunity to practice problem solving.
  2. Another student who benefited from natural consequences is Albert. Albert’s parents hired a tutor to meet with him over Zoom twice per week to prepare for the SATs. He was expected to meet with his tutor, Barry, two times per week to start building up his skills. Unfortunately, despite frequent reminders and systems being put in place, Albert often missed or was late to these meetings as he was distracted by playing video games. When Albert’s parents started to receive charges for missed appointments from Barry’s company, they thought carefully about how to impress on Albert the importance of using his strategies and making it to his appointments. Eventually, Albert’s parents informed him that if he missed another session, he would be responsible for the late fee, as the charge was an inevitable consequence. When Albert eventually missed another session, his father drove him to the bank and helped him withdraw the money from his own savings account to pay his parents for the missed session. Unsurprisingly, this was hugely frustrating to Albert in the moment; however, his meetings with Barry became a priority and Albert quickly started making it to tutoring on time. After experiencing the natural consequence himself, Albert began to change his actions.

Both of these examples led to increased buy-in from the adolescents who were actively working on building up their executive functioning skills. As they started to participate in problem solving after they made a mistake, they were more aware of the work that their parents had typically been doing for them. Some language that can be productive includes:

  • “I know it was a mistake and now we just need to figure out how to fix it. What do you think we should do?”
  • “What are the next steps you need to take to solve this problem?”
  • “I can tell you what I think we should do, but I would love to hear your ideas first. Where would you start?”

As adolescents forge toward young adulthood, they will inevitably make mistakes, miss appointments, arrive late, and misplace some of their belongings. If we are constantly picking up the pieces, then they are missing out on the opportunity to learn how to solve their own problems and build an understanding of the consequences.

 

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

 

Looking for Answers? Ask the Right Questions.

By | NESCA Notes 2021

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

Many parents have met with me concerned that, “We had a full evaluation and got a lot of scores and a diagnosis but we still don’t understand why our child has this problem and what we can do about it.” This outcome can be avoided if parents and the evaluator are both clear on why the child is being evaluated, have laid out specific questions to be answered and what kinds of recommendations are being sought. Determining the referral question(s) should be a key goal of the intake session.

During the intake meeting, the evaluator can help the parent to shape their concerns into a specific referral question that can be addressed effectively through the process of neuropsychological evaluation. The evaluator can manage parental expectations in this process so there is not disappointment with evaluation results that don’t answer the parents’ questions. For example, I’ve had parents request an evaluation because they want to know if their fifth grader will get into Harvard or their child with high-functioning ASD (autism spectrum disorder) will get married. These questions can’t be addressed through a neuropsychological evaluation, but they can be re-worked into answerable questions. A neuropsychological evaluation can tell us if a child’s cognitive and academic skills are in the range of students who attend the most competitive colleges. However, there are many other factors that influence the college acceptance process. In this case, the referral question might be revised into “assess the child’s potential for academic success in a rigorous academic setting.” Similarly, it is beyond the scope of a neuropsychologist to determine if anyone will get married, but through the evaluation process we can assess the child’s current social and emotional functioning and offer some predictions about their likely developmental trajectory in the social domain.

While the previous examples of referral questions are too broad or abstract, I am also often confronted with referral questions that are too narrow, such as, “Does this child have ADHD?”.  In this case, I would work with the parents to reframe the referral question to, “Why does this child appear to have difficulty paying attention in school?” This referral question recognizes the fact that there are many reasons that a child may have difficulty concentrating or appear distractible – ADHD being only one of the possibilities.

When I train neuropsychologists, I emphasize the importance of understanding “Why now?”. What is it that motivated the parent or school team to seek evaluation at this point in time as they work to frame the referral question with parents? Common reasons include: concern about how the child will manage an upcoming transition (e.g., to middle school), sudden appearance of a problem, obvious widening of the gap between a child and peers, inability to meet increased developmental demands, lack of response to interventions, change in emotional status, or deterioration in academic performance.

It is extremely helpful when parents and/or school teams prepare for the intake meeting by brainstorming what they are seeking from the evaluation, questions they hope will be answered, issues to be assessed, and specific guidance that is being requested. The evaluator can then work with the parents or school team to fashion these into a referral question that is specific and relevant to the child so that all parties are “on the same page” as they undertake the evaluation process.

 

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

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

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

To book an evaluation with Dr. Helmus, NESCA Founder and Director, or one of our many other expert neuropsychologists or therapists, complete NESCA’s online intake form

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

Resilience, Covid and College Admissions

By | NESCA Notes 2021

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

It’s been a year since schools across the nation closed their doors and moved education to the world wide web. Teachers, many of whom have never received training to teach in a virtual format, were now providing lessons remotely. The challenges of teaching remotely highlighted many of the disparities that affect our students. Students did not always have the technology or literal bandwidth to learn from home. Students with learning differences and disabilities faced even more challenges in receiving their support in a format not conducive to their needs. However, there were some silver linings. Students had more opportunities to practice executive function skills and become more familiar with software programs outside of video games, social media and YouTube videos.

As students – and, well, all of us – adjusted to the pandemic and what that meant for our daily lives, mental health concerns increased. Faced with uncertainty, constant changes and fear, anxiety, stress and depression increased among students. In response, they built coping skills.  Not all coping mechanisms are positive, but our kids survived this past year. As we work our way back to some semblance of normalcy, what does that mean for our students who were planning to move on to postsecondary education? Extracurricular activities are considered a relatively important part of the admissions process, but those weren’t available last spring and are barely available now. What should colleges use instead to find students that would be a good fit?

Resilience.

Resilience, the ability to adjust and adapt to changes and adversity, is an important factor necessary to reach goals, especially once a person faces a challenge. We encourage students to build resilience by setting high expectations of them and assisting them in creating challenging goals. We help students process what to do when they reach a roadblock. As students build coping skills and learning strategies, they are building resilience. How does resilience help in college? College is a different environment than high school. Many students experience challenges as they adjust to their newfound freedom and responsibilities. Students now find themselves responsible for scheduling their classes, getting to those classes and figuring out how to manage their schedules.

As colleges receive applications in a year unlike any in recent history, students may want to consider how they can show the colleges how they persevered. Matthew Pietrafetta of Academic Approach suggests students use the college admission essay as an opportunity to present the college with their stories that demonstrate how they became more resilient. Recommendations may also provide another factor for colleges to consider. Teachers and counselors understand the challenges that the student experienced and can share how they overcame adversity. Our students have already overcome additional challenges than many of their general education peers have not. Their past successes are the reason colleges should consider their admission. Test scores and grades are only one part of the picture. The next generation of college students has already built the resilience that will help them succeed. The past year has only exemplified this point further. Our students have proven that they can adapt and meet whatever challenges come their way. What a better way to prove to the colleges that they have what it takes?

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473764/

https://admissions.usf.edu/blog/do-extracurriculars-matter-in-the-college-admissions-process

https://www.insidehighered.com/admissions/views/2021/02/16/covid-19-era-college-admissions-officers-should-pay-attention-resilience?fbclid=IwAR3MNIb9ABfUJgVMZnyuJqKoF0HhBsOmYTB_ms4JZUbExvG9G_BbDUOn-gw

 

About the Author

Tabitha Monahan, M.A., CRC, is an experienced transition evaluator and vocational counselor. While she is well-versed in supporting a wide range of transition-aged youth, she is especially passionate and knowledgeable in helping clients and their families navigate the complex systems of adult services and benefits as well as medical and mental health systems. She is further adept in working individually with students of all abilities to empower self-advocacy and goal achievement.

 

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

 

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

 

Autism Awareness Month

By | NESCA Notes 2021

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

So what? What does it really mean to have an awareness month and a designated day? April is Autism Awareness month, and this year April 2 was World Autism Awareness Day, established by the United Nations (UN) in 2008. In general, these designations are meant to bring awareness to ”causes.” You will see a lot of blue in April as blue is the color of autism spectrum disorder (ASD) awareness. There will likely be many federal, state and local municipal buildings, private homes, as well as national and international monuments bathed in blue lights. People will wear blue, there will be blue autism products to buy, and our air waves will be flooded with autism awareness commercials. In a typical year, many commemorative and educational events would be held. It is usually a time of celebration for people with autism as well as their families and friends everywhere. For instance, in pre-pandemic years, sports teams, movie theatres, museums, Broadway and other venues would host ASD-friendly days. Autism Speaks has its “Light it Up Blue” initiative and is celebrating this year specifically with its #LightUpWithKindness campaign. The United Nations (UN) has a different theme every year, and this year’s theme is The Transition to Adulthood.

When the United Nations established April 2 as Autism Awareness Day, it had high hopes.

In 2008, the Convention on the Rights of Persons with Disabilities entered into force, reaffirming the fundamental principle of universal human rights for all. Its purpose is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity. It is a vital tool to foster an inclusive and caring society for all and to ensure that all children and adults with autism can lead full and meaningful lives.”

Well said…but far from the reality of many individuals with autism and their families. If only our schools, communities and societies were as inclusive, respectful and welcoming as this statement. If it were today’s reality, many people diagnosed with ASD and their families wouldn’t have to struggle as much as they do on a day to day basis with stigmatization, discrimination and a lack of respect and inclusive opportunities.

Autism is a lifelong neurological condition that originates in childhood, and its presentation changes over time. Autism is a spectrum with social, communication, sensory and behavioral differences manifested uniquely in each individual. While we have come a long way in understanding autism, recognizing the breadth and diversity of those with it; embracing their talents, unique abilities and strengths; and addressing the day to day challenges that autistic people face. The UN’s vision is still far from a reality, and there is still much work to do.

It is my hope that during Autism Awareness Month, you become more aware. If you support the “cause” and buy a shirt, bracelet or puzzle piece and shine a blue light on your porch, that’s great – spread the word.  Take the Autism Speaks #LightUpWithKindness” campaign to heart do something to create a world that is kinder, gentler, more respectful and inclusive of autistic people with autism. Watch a movie about ASD, read a book by an autistic author, take the time to educate yourself and your children. If your child has autism, educate your child’s classmates, neighbors, family members and community members. If a child with autism is in your child’s class or school, connect with them and their parents. You are modeling for your own kids and those around you, so spread kindness, acceptance and inclusiveness. If you are an employer, connect with your local school district and offer to partner with them to provide internships for transition-aged youth with autism and maybe even hire them as employees! While this is a financially challenging time for so many, if you do have the means, donate and give to an ASD agency (whether it be locally-, nationally-, medically- or research-based, etc.) – whatever brings you joy. Donate your time at an autism support center.  There are so many ways to recognize Autism Awareness Month that go beyond the color blue – choose something that resonates with you and be the light! Be the light that goes beyond Autism Awareness to Autism Action, Autism Acceptance, Autism Access and Autism Advancement.

 

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.

 

Mind the Gap: Why You Should Consider Summer OT and Speech Services at NESCA

By | NESCA Notes 2021

By: Julie Robinson, OT
Director of Clinical Services; Occupational Therapist, NESCA

It has been a challenging school year, with ever-changing schedules, routines, and unfortunately with a good deal of inconsistency in the provision of therapeutic services through the schools, due to the many impacts of COVID. Parents, caregivers and students have all experienced differing levels of anxiety about what progress has been and is being made, with many children experiencing some level of regression with regard to behavior, self-regulation, motor skills or language development. In anticipation of many of our children returning to school in-person in April, parents have expressed concerns that their children may be lagging behind or that they have not had ample support throughout the earlier parts of their school year to ensure they can keep up with the other children in their class. Over the months of April, May and June, we will all get to see firsthand where the gaps might arise. And then when school is over, many of us might be concerned that the gains of just a few short months will be lost again over summer. This is why those of us at NESCA perceive that the benefits of summer services will be an important part of ensuring progress and the ability to jump right back into learning – as we hope all school will be in-person again in the fall.

NESCA is available to provide summer services, as we do consistently for our weekly patients. In addition, we are offering short-term services to those children who may not qualify for them through their school systems, or for those families who would simply like to supplement what their children are receiving in-district to give them a boost before school begins again in the fall.

Our occupational therapists (OTs) can work on the following areas of focus with your child:

  • self-regulation and coping skills
  • how best to transition from the quiet of home to the multiple stimuli of a classroom full of children
  • how to cope with longer hours of wearing a mask
  • how to follow social distancing requirements, when they long for a closer physical connection with their peers

We can also help to ease the anxiety some children may have about becoming sick or how NOT to feel fearful of getting back into the classroom when sensory processing issues push them to feel uneasy. Our OTs can continue work on handwriting and motor development work started throughout the school year to ensure there is no regression or to improve the speed and automaticity of written expression and legibility. We can teach organizational and executive functioning skills to encourage kids to be independent, prioritize assignments and manage their time. OTs can address self-care skills of dressing, shoe tying, feeding and hygiene, which are likely to require more independence with social distancing requirements. While it’s summer, we help build outdoor skills, such as bike riding and greater self-confidence on the playground to elicit more social connections with peers. Our OTs are providing services in-person in our Newton and Plainville, Massachusetts clinics, by teletherapy or outdoors in the community as appropriate.

Our speech therapists at NESCA can also help to continue and supplement the hard work children have been putting in throughout the school year. They can work on social pragmatics and help with the skills needed to transition from so much time alone, to being in groups with their peers once again. NESCA’s speech therapists can support children on how to:

  • initiate play
  • find shared interests
  • be flexible thinkers
  • communicate with kindness and an appropriate level of voice
  • read gestures and non-verbal communication (especially while wearing masks, which can impede the ability to properly read another person’s mood, reactions or emotions)

We can continue to work on the established goals from school, regarding both expressive and receptive communication, language articulation and language as it pertains to written communication. Our speech therapists are currently providing all services via teletherapy while we work on a transition back to in-person therapy.

If you are interested in seeking out summer services at NESCA, or any of our assessments and services, please contact NESCA’s Director of Clinical Services Julie A. Robinson. She can be reached at jrobinson@nesca-newton.org and will conduct a phone intake with you to help you best determine your needs.

 

About the Author

Julie Robinson is an occupational therapist with over 25 years of experience as a clinician. The work Julie does is integral to human development, wellness and a solid family unit. She particularly enjoys supporting families through the process of adoption and in working with children who are victims of trauma. Julie has extensive experience working with children diagnosed with an Autism Spectrum Disorder (ASD), or who have learning or emotional disabilities. She provides services that address Sensory Processing Disorder (SPD) and self-regulation challenges, as well as development of motor and executive functioning skills.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services or other clinical therapies, 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.

 

Facilitating Language Growth at Home

By | NESCA Notes 2021

By: Abigael Gray, MS, CCC-SLP
NESCA Speech-Language Pathologist

I recently got to spend time with my 18-month-old nephew, after not having seen him in a year and a half due to the pandemic. It got me thinking about practical ways to help facilitate language throughout the day without feeling like you’re doing anything extra. Play and routines are great times to build language, and you can often find opportunities that are motivating for your child. Motivation and interest are key, because children are much more likely to participate and communicate. Below, I discuss tips to incorporate into your daily routine at home.

Five ways to facilitate language growth at home:

  1. Play!
    • Play the way your child is playing and imitate what they’re doing.
    • Even if you had a plan, don’t be afraid to change it to focus on their interests (i.e., follow their lead, as explained below).
    • Use fun sounds, words and gestures to go with what you’re doing (e.g., “beep beep” when playing with cars, “pop” when popping bubbles, “yummy/mmm” and rubbing your stomach when pretending to eat play food).
  2. Follow your child’s lead
    • Observe what they’re interested in, wait until they initiate or continue interaction, and listen to their words and sounds.
    • Get on their level so they know you are joining in.
    • If they are doing something unsafe, explain why it’s unsafe in simple terms and redirect them to a safe activity.
  3. Get silly
    • Repeat actions they think are funny.
    • Switch up routines in a silly way (e.g., “forget” their favorite bath toy, give them a fork with their yogurt). This encourages language when your child notices and wants to tell you something is different or missing.
    • Change song lyrics or words in stories to be about your child, their interests and/or what is happening around you in the moment.
  4. Pause
    • Slowly sing familiar nursery rhymes and songs and then pause at key words to encourage them to fill in a word or gesture.
    • Pause a familiar activity, such as pushing the swing, and wait for them to ask you to continue using words or gestures (e.g., “more,” “again,” “go”).
    • When looking for a response, stop talking, lean forward and look at them expectantly. You can count slowly to 10 silently, which gives your child time to respond.
  5. Expand
    • When your child uses one to two words, turn it into a short sentence. For example, if they say “up” wanting you to pick them up, you could say, “Ok, I’ll pick you up.”
    • Be sure to use correct grammar when expanding their message, even if your child is still using immature grammar.
    • Use a variety of words (e.g., describing words, action words, words for feelings, location words, etc.). Start with words your child would want to say to talk about the things they are interested in.

Many of these ideas are things you may already be doing throughout the day, but it is good to think about how doing so helps your child learn to understand and use language. If you feel that your child may be behind in their language understanding or production, it is helpful to schedule an evaluation with a speech-language pathologist. If therapy is warranted, your speech-language pathologist can make recommendations specific to your child and family and show you how to best encourage language growth in the home environment.

References:
Weitzman, E. (2017). It takes two to talk: A practical guide for parents of children with language delays (5th ed.). Toronto: Hanen Centre.

 

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.

 

To book an appointment with or to learn more about NESCA’s Speech & Language Therapy, please fill out our online Intake Form, email NESCA’s Director of Clinical Services Julie Robinson or call 617-658-9800.

 

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

 

The Roles of Students, the School and the Family during the Transition Planning Process

By | NESCA Notes 2021

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

The transition process is a complex and ongoing one. Throughout the transition planning process, many individuals often wonder who exactly is responsible for what. While the school system plays a big role during this time, it is also important to make sure that students and their families/guardians have a role in the process as well. Here’s a helpful breakdown of the participants involved in the transition process and what responsibilities fall within each of their roles.

The Role of the School in the Transition Process

  • Provide information on the student’s strengths, past achievements and progress on the current IEP
  • Provide strategies for effectively teaching the student, including appropriate accommodations and/or modifications so the student can successfully access the general curriculum
  • Identify needed related services
  • Coordinate all the people, agencies, services or programs involved in the transition planning
  • Link students and parents to appropriate post-school services, supports or agencies prior to the student leaving high school
  • Suggest courses of interest to the student and educational experiences that relate to the student’s preferences and interests and that provide skills to help the student achieve their desired post-school goals
  • Hold workshops for families on transition planning, post-secondary options, adult service providers, etc.

The Role of the Student in the Transition Process

  • Participate actively in all discussions and decisions (IEP meetings). This could include reading their vision statement, creating a PowerPoint to share at the meeting, etc.
  • Communicate preferences and interests
  • Communicate strengths and areas where help is needed
  • Take part in the IEP development
  • Develop a post-secondary vision statement
  • Identify transition-related skills that can be done in the home environment (i.e., chores)

The Role of the Parent(s)/Guardian in the Transition Process

  • Support the student
  • Reinforce the value of an individualized, appropriate educational program
  • Provide information about the student’s strengths, interests and areas where assistance is needed
  • Provide information about the student’s independent living skills and the help the student may need to achieve the desired post-school goals
  • Be actively engaged as equal partners in all aspects of the IEP planning, discussion and decision-making
  • Work in collaboration with the school to practice transition skills within the home environment

Below are some additional resources on this topic:

http://alabamaparentcenter.com/resources/documents/Transition_v2_Whatschoolscandotoinvolvefamilies.pdf
https://fcsn.org/transition_guide/english.pdf
https://www.communityinclusion.org/pdf/man5.pdf

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.

 

Giftedness – What does it mean, and how do I know if my child is gifted?

By | NESCA Notes 2021

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

All children have learning strengths and weaknesses, and as parents we are proud of all our children. However, there are some children who are precocious and seem to learn many skills early and with ease. According to the National Association of Gifted Children, there are certain characteristics that parents will often notice and wonder if their child is gifted. Some of these characteristics include:

  • Unusual alertness, even in infancy
  • advanced vocabulary
  • heightened sensitivity
  • remarkable memory
  • rapid and constant learning from their environment
  • seeming to know things without the effort required to learn it
  • longer attention spans and intense concentration skills; yet at the same time they can become preoccupied with their own thoughts, often being labeled as “daydreamers”
  • demonstrate a wide range of interests
  • display a highly developed level of curiosity and ask probing questions
  • vivid imaginations (often including imaginary playmates during pre-school years)

However, there are also some challenges for gifted children as they tend to be highly sensitive, and they feel things deeply and respond with intense feelings and reactions. When a child demonstrates advanced cognitive abilities, that does not mean that they are emotionally mature enough to manage the information they are able to access. For example, a young child who can read at an advanced level is not necessarily mature enough to read books intended for older children, as the content is beyond their ability to process emotionally. This discrepancy is referred to as asynchronous development. Often highly gifted children will be advanced in many academic areas but may lag behind their peers in their development of social skills. They can also demonstrate perfectionism and anxiety, often as a result of their asynchronous development.

Unfortunately, at this time, Massachusetts does not have a definition of giftedness and does not collect data on gifted students. However, if you believe that your child is gifted, there are many things you can do to support them. For example,

  • allow them to dive deeply into subjects of interest to them
  • encourage them to take risks and make mistakes, as this will allow them to develop coping strategies as well as improved problem-solving skills
  • provide opportunities outside of school, such as enrichment programs in their areas of interest
  • consider participating in opportunities for activities that occur with like-minded peers, that teach in depth, encourage creative problem-solving and are fun (e.g., those provided by the Massachusetts Association for Gifted Education, MAGE)

Finally, early identification improves the likelihood that a child’s gifts will develop into talents. If you suspect that your child is gifted, consider both objective testing (e.g., IQ testing, academic achievement tests) as well as collecting subjective information (e.g., teacher observation and rating forms, parent reports, examples of child’s work).

NESCA’s comprehensive neuropsychological evaluations provide a highly-detailed description of an individual’s developmental status, thinking patterns and learning style based upon a very careful integration of findings from developmental history, observations by parents, teachers and clinician(s), and data from NESCA’s own testing. These evaluations, which seek to paint a recognizable portrait of the whole person, assess the underlying reasons they may be struggling academically, socially or emotionally and offer parents and teachers a set of tools for supporting the individual’s development.

If you are interested in learning more about NESCA’s Neuropsychological Evaluations, email: info@nesca-newton.com or complete our online intake form.

 

SOURCES

Davidson Institute – (www.davidsongifted.org/)
National Association for Gifted Children (www.nagc.org)

 

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.

Appreciating and Responding to The New York Times article, For Some Teens, It’s Been a Year of Anxiety and Trips to the E.R. by Benedict Carey

By | NESCA Notes 2021

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

As an occupational therapist working almost exclusively with teenagers and young adults over the past year, the title of Benedict Carey’s article jumped out at me like a tired and worn flag, waving frantically for acknowledgement. Our teens are anxious, tired, and dealing with living through the proverbial “unprecedented times” without the developmental capabilities needed to quickly adapt in this era of remote learning, remote social interaction, and remote extracurriculars. Remote everything!

It is important for me to note that I really enjoy working with teenagers. I find myself in constant awe of their resiliency, their willingness to confront hard truths that many of us shy away from, and their ability to push forward despite having huge questions about who they truly are. All of these things are tough and require immense emotional fortitude, but this year many of these challenges feel impossible.

Carey has taken the time to gather perspectives from multiple stakeholders. He provides a platform for parents, educators, professors, therapists, pediatricians, and directors of hospital programs to explain the struggles of supporting these kids without adequate resources. Parents describe the fear of supporting their children as they struggle with mental health. Doctors discuss the frustration of having inadequate resources and support in emergency rooms around the country. Carey highlights that, according to the Centers for Disease Control and Prevention (CDC), the proportion of adolescent emergency admissions for mental problems, like panic and anxiety, is up 31 percent. Some of my clients add to this statistic and are navigating their own path through chaotic hospitalizations and overwhelmed support systems. Carey’s article is absolutely worth taking the time to read, if only to see the ubiquity of these issues and how they are happening all around our country. Simply put, we have a clear problem. Less clear, is the solution.

When meeting with adolescents and young adults themselves, I hear three main fears popping up week after week. Here are a few thoughts and suggestions on how to support these specific fears or feelings.

  1. “I can’t get this done, (and therefore) I am going to completely ruin my future.”

When looking at future success through a transition lens, we consider the areas of independent living, community participation, post-secondary education, and employment. In the school setting, most students’ curricula are focused solely on academic success. Sometimes, we do a poor job of teaching students about multiple intelligences or emphasizing the importance of hard work. While grades are important, they are not everything, and while standardized testing is returning to students’ schedules, they should not serve as students’ measure of self-worth. We know this, but do they? We have to teach our children that if they are hardworking, kind, and truly doing their best, the threat of “ruining their future” is much less likely than they fear. Let’s highlight the undeniably true narrative that everyone’s path can look different and still lead to success.

  1. “I’m so tired. All of the time.”

Many of my clients tell me they are not sleeping. If they are sleeping, they fall asleep late with a phone in their hand, constantly refreshing apps or trying to maintain communication with their peers. In our current remote world, the phone can feel like a lifeline. Sleep is a foundational need for mental and physical health. Students who are 15 or 16 years old often have a limited understanding of how holistic the effects of decreased sleep can be. Sleep is not their priority. Recently, I have seen parents disable the internet or have their teenagers put their phones into a lockbox from midnight until 6:00am. This new boundary is often met with anger or frustration at the beginning, but then these students start to sleep. They are better able to manage their emotions. They have more energy. They start to see the benefits despite their skepticism. If a tech break doesn’t feel quite right for your family, it is still worth opening up a conversation about the need for strong sleep hygiene and modeling a routine that promotes calming down by limiting screens before bed, which can have hugely positive effects.

  1. “This is never going to end.”

In many ways, a year feels much longer to a 17 year-old than it does to an older adult. Working at a job for four years never feels as long or as formative as the four years of high school. And objectively, a year to a 17 year-old is over five percent of their life, while it’s only two percent of 50 year old’s life. Let’s acknowledge that. Let’s verbalize the fact that teenage years are also full of milestones that have been constantly cancelled or changed to fit social distancing recommendations and safety precautions. There is a sense of loss and grief surrounding many events that these students have been looking forward to since elementary school. Encourage students to do their own research into what the next six months may look like as we start to open back up. Help them to understand the vaccine rollout and the pitfalls and successes that we have had as a nation tackling a novel disease.

Adolescent mental health is going to be an on-going challenge that we tackle as a community. As we slowly forge out of isolation, let’s center our conversations around the mental health of our teens and honestly acknowledge the unique position that they have found themselves in.

References

Carey, B. (2021, February 23). For some teens, it’s been a year of anxiety and trips to the e.r. The New York Times. https://www.nytimes.com/2021/02/23/health/coronavirus-mental-health-teens.html

Leeb, R.T., Radhakrishnan, L., Martinez, P., Njaj, R., Holland, K.M. (2020, October 27). Mental health-related emergency department visits among children aged <18 during the covid-19 pandemic. MMWR Morbidity and Mortality Weekly Report 2020:1675-1680. DOI: http://dx.doi.org/10.15585/mmwr.mm6945a3

 

About the Author

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