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NESCA Notes 2021

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7

Does Scatter Matter? How to Understand Your Child Better

By | NESCA Notes 2021

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

Families often come to testing with questions like these: My child is so smart, why is reading so hard for them? If she can remember the smallest conversation from three years ago, why can’t she remember the two things I sent her upstairs to get? If he can do all of the calculations, why can’t my son solve a word problem? The answer can show itself in the scatter.

Assessment measures are based on statistical conversions, where the number of points a child or teen earns is “translated” into a scaled or standard score. This helps us to understand how your child performs compared to other children their same age. Tests are largely based on the idea that scores should “hang together” – meaning that if your child is average for his or her age on one task (e.g., visual-spatial skills) then they should be average on another (e.g., verbal knowledge). And while this may be true for many people, it certainly it not true for all people. Many people have “scatter,” meaning that there is a statistical difference between their scores.

I will spare you the controversy about scatter in our field, about whether a certain degree of scatter or difference between scores means that you cannot calculate certain other scores. There is also specific knowledge of scatter needed to diagnose specific learning disabilities (e.g., if your child has high average verbal skills, how far apart do their reading scores need to be in order to fit the diagnostic criteria). While those topics are incredibly important to the field, my focus today is to build a little empathy for how scatter can matter.

There are times when this scatter can lead us to a diagnostic decision. For example, a relatively common pattern that I see is that of a very bright teenager whose cognitive and problem-solving are at least above average, while their basic focus and attention is below average. With other evidence that corroborates it, this can mean ADHD. A big difference between a child’s verbal knowledge/language skills and their ability to use their language for social purposes can suggest an Autism Spectrum Disorder. In these instances, the scatter absolutely matters. But, scatter can be meaningful to a child’s daily experience even if it’s not statistically “big enough” to warrant diagnosis.

Imagine being your child for a moment. Perhaps your child has a knack for building complex Lego sets and can spend hours assembling structures that are intricate, detailed, and involve more small pieces that my adult fingers could tolerate (let alone our feet as we step on them!). Perhaps your child’s visual-spatial skills are incredible, scoring in the high average range compared to their friends. Then you place a book in their hands and ask them to read a page aloud, where they struggle to sound out words, track their eyes smoothly across the page, or understand the meaning of anything they are saying. While you are left scratching your head as a parent, imagine the frustration and disappointment your child must feel wondering: why can I work with Legos better than anyone I know, but decoding words is torture?

In my mind, scatter can mean frustration. To feel exceptionally strong and confident in one skill domain and then barely hang on in another can leave your child disappointed, angry, and self-critical. Imagine having a vocabulary and encyclopedia of facts in your mind and your hand simply cannot keep up with your thoughts as you try to take notes or write down ideas for an essay. For an adult, it can be a bit like sitting in front of your computer with too many browser windows open and programs running at once, slowing down the entire operating system to the point that you growl in frustration (anyone else?).

While it can be easy to get lost in the controversy over the technical and statistical nature of scatter, it is important that we all have some empathy for what this must feel like for your child or teen. Empathy for this experience is a critical part of building the roadmap forward: where we can use those strong skills to build up the weaker ones, to grow new and stronger neural connections, and to give ourselves a little grace and patience when those weaker muscles get challenged.

 

About the Author

Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.

 

If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, please fill out and submit our online intake form. 

 

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

4

Speech-Language Pathology at NESCA with Olivia Rogers, MA, CF-SLP

By | NESCA Notes 2021

Speech-Language Pathologist Olivia Rogers, MA, CF-SLP, joined NESCA in June, working with clients in the Newton, Massachusetts office, and is scheduling new clients now. We sat down with Olivia to learn more about her, what her passions in speech and language are and why she joined NESCA.

By Jane Hauser
Director of Marketing & Outreach

How did you initially get interested in Speech-Language Pathology (SLP)?

I started my undergraduate education as a bioengineering major. A project I was assigned to required me to research devices that related to the medical side of bioengineering. After some research, I came upon cochlear implants, which led me to learn more about Audiology and Speech-Language Pathology (SLP). Ultimately, I knew I desired to work with people and make an impact in the healthcare field, but I didn’t feel like bioengineering was where I belonged. After I switched my major to Communication Sciences and Disorders, I knew I had made the right decision.

Additionally, I am the oldest of five children, so was always around kids. Once I stumbled upon this major, I realized it was a great way to combine my desire to work with kids and a career that really fulfilled me.

In what settings have you worked previously?

I’ve done a few clinical rotations in different settings. I spent a semester in a K-8 public school, and a year in pediatric private practice.  Those opportunities allowed me to work with children with various speech and language challenges. I also spent some time in a hospital working with adults in the inpatient acute care unit. All of these experiences strengthened my passion for working with the pediatric population and implementing therapy that is both functional and personal to each individual.

What brought you to NESCA?

Last summer, I was a student intern with NESCA’s Speech-Language Pathologist Abbey Gray, MS, CCC-SLP, as part of my third clinical placement. When the opportunity to work with Abbey and also some of the kids we worked with together again came to my attention, I jumped at the opportunity to work with all of them again.

It’s exciting to work at NESCA in the clinic setting where the Speech-Language team is expanding, and collaboration is so important. Here, I get to be a part of a great team of therapists, clinicians and neuropsychologists. I also appreciate that NESCA is so open to and supportive of its clinicians continuing to learn. For example, I am hoping to gain feeding therapy experience alongside the other feeding therapists here at NESCA.

What part of being a SLP do you enjoy the most?

Being able to communicate is one of the most important life skills, and giving others the tools they need to do so effectively is amazing in itself. However, no two clients are the same and it is up to me to be creative in catering to each individual to make sure that therapy is motivating and beneficial. As a SLP, creativity and play are not only allowed but encouraged. I really enjoy that part of my job.

I really love all of the work I do with children, especially working with kids on receptive and expressive language therapy. With the older children I work with, I enjoy working on the social pragmatic aspects of communication. With the younger kids, I love play-based therapy and working with parents and families to ensure that the language we are targeting is practical.

How do you partner with families when you are working with a child at NESCA?

Integrating real life and therapy is one of the most important aspects of what I do as a SLP. It’s essential for parents or other family members/caregivers to be involved in a child’s therapy to make sure that there is carryover into the home setting. Building functional language skills is a full-time venture involving therapy sessions and practice at home. I strive to have family involved either in the weekly therapy sessions and/or taking notes on what we are working on to further support that child in reaching their goals.

And regarding goals, it’s so important to have parent/caregiver input on the goals we work toward. With the older kids I work with, they are often able to communicate what they’d like to or need to work on. With the younger children, it’s critical for parents and families to help communicate a child’s challenges in order for us to establish the goals we work toward together.

What is one of the most inspiring milestones you have experienced as a Speech-Language Pathologist?

While I was working in the K-8 school, most of the children I worked with were deaf or hard of hearing. There was one 10-year-old boy who was profoundly deaf and utilized cochlear implants. He was essentially nonverbal, and our goal was to help him to auditorily recognize and verbally produce a couple of functional words that could support him in the classroom and at home. In particular, we were trying to get him to interact verbally with his dog; this was a personal goal of his. After months of work, his mom let us know that at home he said, “Sit,” and his dog followed his command! He was so motivated to learn more words since he saw how language could help him to function more easily and successfully. It was such an inspiration and really solidified my strong desire to work with kids to help them in speech and language, and in life.

 

About Speech-Language Pathologist Olivia Rogers

Olivia Rogers received her Master of Arts in Speech-Language Pathology from the University of Maine, after graduating with a Bachelor of Arts in Communication Sciences and Disorders and concentrations in Childhood Development and Disability Studies.

Ms. Rogers has experience working both in the pediatric clinic setting as well as in public schools, evaluating and treating children 2-18 years of age presenting with a wide range of diagnoses (e.g., language delays and disorders, speech sound disorders, childhood apraxia of speech, autism spectrum disorder, social communication disorder, and Down syndrome). Ms. Rogers enjoys making sure therapy is fun and tailored to each client’s interests.

In her free time, she enjoys listening to podcasts and spending times with friends and families.

 

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 Olivia Rogers, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

155

Don’t Let Summertime Chores Deflate Your Vibe

By | NESCA Notes 2021

By: Jessica Hanna MS, OTR/L
Occupational Therapist, NESCA

It’s summertime, and let’s face it, nobody wants to do chores. However, through learning about the benefits of chores in a previous NESCA blog post, we realized all that it can bring to the table to improve child development skills.

Nevertheless, let’s step back. No one ever said chores must be painful or that it is all business and no play. Even when it comes to chores, you can keep it fun! The beauty about chores is that in addition to learning personal responsibility, improved self-care skills, and teamwork, chores help children to incorporate and work on an array of skill sets, such as:

  • Visual perceptional skills
  • Executive functioning skills
  • Bilateral coordination skills
  • Fine motor skills
  • Upper body strength
  • Sensory regulation

Let’s take a closer look at exactly what that can look like:

 Water play chores

Stop what you’re thinking…yes, it can seem messy, but remember the goal: participation, have fun, work on important skills (bilateral coordination, sequencing, crossing midline, integrating sensory input).

  • Cleaning off sandy beach items – Works on a 2-step or 3-step sequence and bilateral coordination skills.
    • 2-step sequence (rinse and dry using a water bucket or water hose)
    • 3-step sequence (rinse/dry/store back in beach bag)
  • Watering plants/flowers outside – Provides heavy work and promotes bilateral coordination to hold a water-hose and use upper body strength to maintain arms lifted above gravity.
  • Rinse dishes in the sink – Works on sequencing steps, crossing midline, upper body strength, and bilateral coordination.
  • Wipe down indoor/outdoor tables – Incorporates motor planning, crossing midline, and promotes upper body strength.
  • Clean reachable outdoor/indoor windows – Remember it is not about the streaks left behind. The task promotes and builds on upper body strength, hand strength, motor planning skills, and bilateral coordination skills.

Chores that work on visual perceptual skills

  • Sorting clean laundry – Play assembly line with clean clothes or turn it into a mini obstacle course. Sorting and putting away laundry can be a group effort for everyone in the family!   
    • Matching socks
    • Color coding clothing
    • Sorting by category (pants/shirts/undergarments)
  • Putting away groceries…what is more fun than playing store? – Have your child follow a pre-made visual or written checklist to make sure and check off all items purchased (e.g., create your shopping list on Prime Now or Peapod where visuals are supplied, and you print a copy for your child to follow and mark up).
  • Loading the dishwasher – When it comes to loading the dishwasher, we all know it can be a game of Tetris, even for adults! When helping your child load the dishwasher safely, make sure you place one item first in a designated area and see if they can sort items accordingly.
  • Cleaning up toys on a floor – When asking your child to pick up toys, reduce visual clutter, and be specific.
    • Place a perimeter (e.g., use a hoola hoop/painter’s tape) around toys that need to be picked up.
    • Use a visual checklist to identify toys to be picked up (e.g., books, Legos, crayons).
    • You can turn it into a scavenger hunt game (e.g., find 10 crayons on the floor).

Chores that promote regulation

Heavy work chores/activities help with sensory regulation through the act of pushing, pulling, and lifting heavy items.

  • Laundry – If you have a front-loading reachable washer and dryer, have your child pull wet clothes out of the washer, or dry clothes from the dryer. Or have your child (depending on size and strength) help carry a basket of clean or dirty clothes to and from the washer and dryer. (To add a fun twist, have them walk over items, around items, spin, bend, etc., with a basket of clothes).
  • Vacuuming/Swiffering – Make sure the size is appropriate. Little ones love handheld vacuum cleaners and dust pans if they cannot manipulate larger sized appliances. Handheld vacuums are fun for kids to use in helping to clean out the car! Turn it into a game to vacuum the treasures your car “ate” during those summer outings can be an adventure for them and a bonus for you!
  • Bed making – Have your child sit in the bed and help pull up those sheets and blankets from the sitting position. It’s fun when it fluffs up and gets tricky when you must sneak or crawl out without pulling the sheets down!

Always keep in mind what you want the goal of a chore to be and remember that they do not have to be done perfectly. When chores are broken down into steps, are provided and paired with a verbal and visual demonstration, and are concrete, your child will be successful in participating in your chore of choice. You must remember to create the just-right challenge regarding your child’s age and pair it with fun!

 

About the Author

Jessica Hanna has over 10 years of pediatric OT experience in conducting assessments and providing treatment of children and adolescents with a broad range of challenges and disabilities, including autism spectrum disorders, sensory processing disorders, visual impairments, cerebral palsy, executive function deficits and developmental disorders of motor function. Prior to joining NESCA, Jessica trained and worked in a variety of settings, including inpatient and outpatient hospital settings, private practice, schools and homes. She has served on interdisciplinary treatment teams and worked closely with schools, medical staff and other service providers in coordinating care. In addition, Jessica provided occupational therapy services at Perkins School for the Blind and Spaulding Rehabilitation Hospital pediatric inpatient unit, where she conducted comprehensive evaluations and interventions for children with a broad range of presentations.

 

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.

 

23

Executive Function Skills in the Outdoors

By | NESCA Notes 2021

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

Executive functioning skills are a “family” of skills that operate in a “top-down” process, controlling and regulating brain regions associated with attention, impulse control, emotion regulation, and meta-cognition or “thinking about thinking.” For more information about executive function skills, please refer to my previous NESCA blog “Teenage Stress and Executive Functioning.” As an evaluator, I often emphasize two key points about executive function skills: (1) Developing executive function skills is a combination of brain development and life experience; and (2) These skills are built through interactions (with others and our world) and practice.

Now with more access to New England summer weather, there are plenty of opportunities for children and teens to grow executive function skills in interaction with the natural world. I recommend a “must-download” if you want to review practical, science-based activities and games for children from the ages of six months old through adolescence, “Enhancing and Practicing Executive Function Skills with Children from Infancy to Adolescence.” This is a wonderful resource that provides a clear list and description of practical activities to strengthen executive function skills based on a child’s age. This resource was developed by The Center on the Developing Child at Harvard University, a multidisciplinary team supporting research, policy, and practice for childhood development. Their website also provides excellent free resources for parents, clinicians, and educators related to topics such as stress, resiliency, play, and brain structure/development.

Here is a short list of outdoor summer executive function activities based on your child’s developmental age:

  1. 6-18 months-old: Peekaboo and Patty-Cake on the grass and other textures, such as dirt, mud, water, or wood (a multi-sensory experience), encourage joint attention and object focus by naming, pointing, and sustaining focus on natural objects at the beach or in the woods.
  2. 18-36 months-old: Match/sort natural objects, such as placing rocks in one bucket and flowers in another bucket, blow bubbles with a variety of wand shapes, pretend play as fishermen, construction workers, or farmers/gardeners.
  3. 3-5 years-old: Pretend to be an outdoor superhero in an obstacle course or race (e.g., running through Hula Hoops or around traffic cones), assist with cooking/preparing an outdoor picnic, or make a nature bracelet.
  4. 5-7 years-old: Play the I-Spy game and participate in scavenger hunts, use strategy board games (e.g., Uno, Concentration) on land or maybe even in the water, go on a sensory walk (name something you see, hear, smell, taste, and touch).
  5. 7-12 years-old: Star-gaze and find/name constellations, create a bird house or other wood structure through woodworking activities, garden one or more plants, play with a super soaker toy or laser/flashlight tag.
  6. Adolescents: Maintain a summer sketching and drawing journal of natural objects, participate in sunrise or sunset yoga or dance classes, outdoor animal-assistant yoga (e.g., Goat Yoga), or sports-oriented camps and activities.

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

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

 

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

 

32

Student Involvement in IEPs: Ten Tips to Help Middle School Students Get Started – Part 1

By | NESCA Notes 2021

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

Federal law requires that students with Individual Education Programs (IEPs) be invited to attend their transition IEP meetings. In Massachusetts, this means that students approaching the age of 14, often 8th graders, should be invited to attend their IEP meetings to start the process of transition planning if this has not already begun. For many, the idea of a middle school student attending an IEP meeting, an activity that can often be intimidating and upsetting for parents, can initially be overwhelming. And historically research has indicated that when students do attend team meetings, they have the lowest level of satisfaction about their IEP meeting of any team member and they feel the least comfortable sharing their thoughts and suggestions in the meeting.[i] However, research across the country has also shown that students can learn skills to actively participate in their IEP meetings, especially when they are directly taught terminology, roles, and how to participate, and when team members expect student participation.[ii] Student participation in IEPs is not only important because it is federally mandated, it is also essential because the IEP is supposed to be based on the student’s strengths, interests, preferences, and needs as well as the student’s post-high school goals—and because it’s the student’s life! For those reasons, I am choosing to focus this blog (and some future blogs) on tips for helping middle school students to become involved in their IEP processes.

  1. Explicitly learn about the IEP document and process—There are clear rules and vocabulary used to govern the IEP process. However, these are wholly unfamiliar and strange to anyone who has not participated in the process before (and even perplexing for those of us who have a lot of experience at team meetings). Therefore, one of the most critical ways to prepare a student to attend transition IEP meetings and to be a self-directed member of their IEP team is to equip them with knowledge of the vocabulary and rules that govern the process. One organization that has created useful materials for helping to teach students about the IEP process is imdetermined.org which has documents designed to assist students in understanding the IEP (https://imdetermined.org/resource/understanding-my-iep-differentiated/) and preparing for the IEP (https://imdetermined.org/resource/understanding-my-iep-differentiated/), but it may also be important to reference and simplify certain sections of the IEP Process Guide (https://www.doe.mass.edu/sped/iep/proguide.pdf). If students are not ready to review their entire IEP (which many students are not), it may be helpful just to think about the present levels of performance, strengths, or accommodations.
  2. Talk about strengths—While it’s critical that students be able to talk about their strengths and challenges, sometimes it’s easiest to start with strengths. People can have all kinds of strengths, such as character strengths, social strengths, language strengths, academic strengths, technical strengths, extracurricular strengths, and more. For kids who have a hard time with open-ended questions, there are checklists that can be found or completed online, such as character strengths inventories, transferable skills checklists, and strengths worksheets. There are also activities that can be useful for documenting strengths over time, such as this Strengths Chain activity (https://www.understood.org/articles/en/strengths-chain-for-kids), keeping a running list or journal of strengths and accomplishments, or building a deck of strength cards. All students need help learning to describe their strengths, especially the first time. Some students may have a hard time identifying the strengths they see in themselves, but may have an easy time sharing what other people say about them or compliment them on. Talking about strengths is not a one-time activity. Make sure that you are talking about and referring to the student’s strengths often while also highlighting how various members of the household or students in the class have different strengths and skills.
  3. Talk about challenges!—While transition planning is a strengths-based process, an IEP is based on a student needing specialized instruction and related services because the student has a disability and would struggle to make effective progress in school or the general education curriculum without special education. If we are going to ask students to be actively involved in a process of goal-setting based principally on their having a disability and related challenges, it is critical that the student has the opportunity to talk about what is hard for them and what they want to get better at… in their own words. At the same time, it is important to normalize the fact that all people have challenges, learn different information at different rates, and need help (and tools) to function successfully. Ultimately, being able to use a diagnostic label and understand the impact of a diagnosis on functioning is important, but what is more important is being able to describe what is hard on a daily basis and what makes those difficult activities easier. For some students, it is helpful to read a book or watch a television show or movie with characters who face similar struggles and to label similarities between the youth and the character. Some of the same checklists mentioned for documenting strengths can be helpful for identifying areas of challenge or undeveloped skills. It may also be helpful to start filling in a worksheet similar to this one-pager (https://imdetermined.org/resource/one-pager/) or this self-awareness worksheet (https://www.understood.org/articles/en/download-self-awareness-worksheet-for-kids). Just as with strengths, it is important to talk about and refer to specific challenges that each person in the household or class faces.
  4.  Complete interest and preference inventories—Learning to engage in self-assessments and talk about those self-assessments is an important part of transition planning and IEP participation. There are so many fun interest and personality quizzes online that can be taken in minutes. Some examples include these personality tests from National Geographic Kids (https://kids.nationalgeographic.com/games/personality-quizzes), this free personality type explorer (https://www.16personalities.com/free-personality-test), or even the O*Net Career Interest Profiler (https://www.mynextmove.org/explore/ip). Have the student take the test—and take these tests yourself—and talk about how your results are similar or different and how well the student thinks the results of the assessment capture them. Think about whether there are strengths or challenges to add to their running lists or worksheets based on their experience taking these inventories.
  5. Talk about the student’s goals for after high school—Students have the right to input as much as possible into their postsecondary vision statement, no matter how realistic or unrealistic their input is. The only way that they can be prepared to provide input at a team meeting is if they have spent some time thinking and talking about their post-high school goals and learning about their choices and options. Just recently, my colleague Becki Lauzon wrote a blog with important discussion points for talking about post-high school goals with students, which can be found here. A robust transition planning process should include helping a student to have detailed goals for their future education or training, employment, independent living, and community engagement; however, initial discussions might just include ruling in or out things like obtaining a high school diploma, continuing learning after high school, having a paid job, driving a car, and living with other people. In middle school, the goal of talking with a student about their postsecondary vision is just to help the student learn to comfortably engage in those discussions and to find out where future work needs to be done in order to help the student build a more complete picture of their adult postsecondary life.

Every student is different and is able to engage in the process in different ways and at different times, but I hope that there is at least one tip in these blogs that is useful for you. Next month, I will be writing a second blog with more tips for engaging middle school students in the IEP process.

If you are interested in having your child work with Kelley Challen or another NESCA transition specialist to plan and prepare to be part of their IEP meeting, please fill out an intake for our transition consultation and planning services or our student coaching services today!

[i] http://www2.ku.edu/~tccop/files/Martins_Perspective.pdf

[ii] http://www2.ku.edu/~tccop/files/Martins_Perspective.pdf

 

About the Author
Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

 

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

10

Rating Scales/Questionnaires – Why Do We Give Them and Why Do They Matter?

By | NESCA Notes 2021

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

When you request a neuropsychological evaluation, you are undoubtably inundated with paperwork. Consent forms, confidentiality forms, COVID forms, and credit card forms. Then, to your surprise, you bring your child to their first appointment, and the neuropsychologist hands you…more forms! Why? What are these forms for, and what will you do with the information? These are great questions, and always feel free to ask your neuropsychologist. Here are some answers I give when I am asked:

Why do you need so many forms?

Our goal in completing a neuropsychological evaluation is to have as comprehensive picture of a child as possible. This means gathering information from many sources, including what you and/or others are noticing that is raising concerns (what we discuss in the intake appointment), prior evaluations and documentation (e.g., their IEP, testing done at school), your child’s performance on our assessment measures (what they do when they come to the office), and important people’s perceptions of your child’s functioning in daily settings – this is what we assess through the rating scales (also called questionnaires). The parent/teacher rating scales are an important source of information because they not only capture your concerns, but also show us how your concerns may be similar to or different from parents (or teachers) of same-age children. For example, concerns with “attention and focus” are common for us to hear. Attentional skills develop gradually over time, and having a standardized rating scale that evaluates your concerns (or your child’s teacher’s concerns) with attention helps us understand how far off your child’s skills are from what is expected for their age.

What do the forms ask about?

This depends on why your child is being referred for a neuropsychological evaluation. For example, if your child is referred for a question around autism, you will likely be given forms that ask about their social functioning, such as how they do at playdates, birthday parties, the playground, or other community spaces with peers. Your child’s teacher would also likely be given forms to evaluate how your child interacts with peers at school, such as how they do during lunch, snack, and recess; how well they work in groups; and if they have been successful in forming strong friendships. If the concerns are more related to mental health, you may be given forms that ask about their symptoms of anxiety, depression, etc.

What will you do with the forms?

We will take your ratings (or your child’s teacher’s ratings) and compare them to normative data. This is a fancy way of saying “we will see how your child compares to kids their age.” Then, we will take that information to help us form a more comprehensive picture of your child’s profile and our recommendations for how to best help and support them. For example, something I see often is a concern with kids following directions, remembering what they are told to do, and finishing all the steps necessary for a task or project (e.g., getting ready for school or bed). This can be (though certainly isn’t always) a difficulty with working memory or, holding information in mind. We assess working memory in many ways during testing. However, we can’t always see the deficits that parents and teachers see, because testing is inherently different from “real life.” So, rating scales serve as an important source of information in understanding what is going on day-to-day, which helps us to make more comprehensive recommendations.

How do I fill these out?

Please, please, please – read the directions carefully! Each form is meant to evaluate something different. For example, some ask you about your child’s emotional state “in general,” others ask about how they have been behaving over the last two weeks, and others ask about how well they can complete tasks independently (i.e., without any help or guidance). Do your best to complete each question – skipping questions that seem “irrelevant” or “inappropriate” may impact how well we can use the information later on. We realize that not every question will apply to every child – we are using the best tools we have, and some are designed to assess a wide range of children. If you have questions about the wording or phrasing, please ask your neuropsychologist – we really don’t mind!

I have a teenager. Why don’t you just ask them about how they are feeling?

If your child is old enough, we will absolutely talk to them about their perceptions of what is going on, what their concerns are, and what has been helpful for them. Many rating scales have a “child” or “self-report” version, and we may have them complete those, in addition to talking more conversationally about how they are doing.

 

About the Author

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.

 

153

Is It Sensory? Or Is It Behavior?

By | NESCA Notes 2021

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

As parents or other caregivers of children with special needs, we can often find ourselves confused between what is a sensory response and what is behavior. Although this is often a complex question, and one without a straightforward answer, there are some tools of the trade that OTs use to help us determine just what is going on with these children. What makes this so complex is that each child is an individual, with their own unique ways of responding to sensory stimuli, to social interactions, and when out in varied settings in their community or with family. Children may also present differently from minute to minute or day to day, depending on sleep, hunger, and fluctuations in mood. But we can often look closely for patterns that may help to guide us in finding the answers.

When working with a child who seems to be in a meltdown, one of the best things you can do is take a quick scan of the environment. Is there a loud or distracting sound in the background? Did someone touch the child unexpectedly? Is the overall environment too busy and overstimulating, such as at party or a restaurant? Sometimes just naming or removing the stimuli, if possible, is enough to help get things back under control. If you know a triggering situation might arise that provokes a meltdown, see if you can give the child a warning and a plan of where to go for comfort. “We will be having a fire drill in 10 minutes, so when it happens you can hold _____’s hand, or we can get you some headphones to cover your ears to make you more comfortable” is one example. Find something soothing from a sensory perspective to help the child settle: a quiet corner with books, some tactile play or fidgets, calming music, a tight squeeze ( but only if tolerated and given permission to do so ). If you know you are entering a highly stimulating environment, it may be best to go in for short periods, with frequent breaks built in for your child every 10 minutes or so to take a walk, use the bathroom, or get a drink.

If you do not see something sensory in your environment creating the discomfort or the meltdown, then behavior and emotions are more likely at play. You child may feel confused about a social interaction, about expectations, or what may be coming next in a transition. Your child may feel a lack of confidence or anxiety in a situation, that although may be seemingly simple and straight forward to you, may not to him or to her. An academic task may feel misunderstood, and not knowing how to start can result in a meltdown for many of our children.

When you see that the child you are caring for is beginning to ramp up, that is the best time to intervene. Once a meltdown has begun, language processing will be limited, and the child may not be reachable for a period of time in order to settle down. The best thing you can do in those moments, is to help the child to stop. I often use a stop sign to hold up in my therapy sessions, that cues the child to take a quick break from interacting with me when I see things starting to spin out of control. I limit my language, provide a calming sensory activity, then we can talk about the upset once I have the child back in my court.

Here are some things to think about and questions you might ask yourself to help guide your interactions and expectations when you, as the adult, are confused about whether this is sensory or behavior:

  1. What are the undesirable behaviors that my child observes when he or she is upset or uncomfortable? Are they different when there is sensory discomfort, in comparison to when he or she is upset with a person or a demand? Notice quality of voice, bodily tension, inability to stay still or focused, aggression, flight or an attempt to get away, shutdown or inability to interact. You may start to see patterns in behavior when you look at them in relation to a sensory event or something that is more emotionally-laden.
  2. What occurred just before this behavior appeared? Was there a sensory distraction or discomfort or was he or she upset with a person or a demand?
  3. How did the child behave during this episode?
  4. How did adults or peers interact with my child during the episode? Did it calm the child, or make him or her more agitated?
  5. List sensations that may have triggered a meltdown: tactile, auditory, visual, smell, taste, movement. Were they loud, distracting, uncomfortable? Was the child in a space that may have been too small or too large? Was the child able to get away from the uncomfortable stimuli, or did he or she feel stuck in the moment?

It will be beneficial for team members to share information and write these things down, perhaps in a format of a journal, so that the team can work together to uncover the patterns, find strategies that are successful, and provide consistency across the board. We all know consistency for these children is one of the most effective tools for learning, and although it may take some extra work up front for caregivers, the pay off on the other side is often so rewarding that it is worth the effort.

If you would like to explore this topic further with NESCA OT Julie Robinson, join us for a free webinar on this topic on September 13, 2021 at 10:30 am ET. Register in advance for this webinar at:

https://nesca-newton.zoom.us/webinar/register/WN_-edHNIwkRBKnjk0gq6-bUw

 

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.

 

14

Summer is Here, but There are Still Chores to Do – The Importance of Chores in a Child’s Development

By | NESCA Notes 2021

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

What a year it’s been! Hopefully with the pandemic restrictions lifted and the start of summer, we are all breathing a sigh of relief. I’m certainly looking forward to traveling, seeing relatives and getting out without masks. The pandemic upturned our lives in so many ways, but now that there is a “sense of normalcy” returning, we may be tempted to kick back and really relax this summer. However, I would caution that in kicking back and relaxing, there are still chores that need to be done. So, why not include your children in taking ownership and helping out around the house? There is research that states that toddlers who are taught to “help out” around the house continue to help out as they age. Many children in indigenous communities grow up asking to help or just help out because it is needed. Wouldn’t it be nice if that were the case in the United States?

Jim Fay, co-founder of the Love and Logic parenting website, says that all of us need to feel needed and know we are making a contribution to those around us or to our world at large – even kids. In many families, chores are a tradition, but in others they have fallen by the wayside. Many upper and middle class families have hired household help, so the need to do chores isn’t as great, and fighting with children to do chores doesn’t seem worth it. Let’s face it, no one likes to do chores, but they have to get done. Psychologist Roger McIntire, author of Raising Good Kids in Tough Times, says, “A child has to have some responsibilities.” The family is a community, and everyone should chip in and help out. Helping out with family responsibilities and doing one’s own personal responsibilities are useful and necessary skills for a child’s development. The American Academy of Child and Adolescent Psychiatry states that, “there are benefits to including chores in a child’s routine as early as age 3. Children who do chores may exhibit higher self-esteem, be more responsible, and be better equipped to deal with frustration, adversity, and delayed gratification. These skills can lead to greater success in school, work, and relationships.” Research also shows that children who grow up contributing to the family responsibilities grow up to be adults who work well in collaborative groups and have a “can-do” attitude.

Helping kids learn that they have to do chores and that they are a part of life teaches them that it’s not just about me and what I need at this moment, but that I’m part of a system. I’m part of a family (I set the table). I’m part of my class at school (I clean up after an art project). I’m part of my sports team (I carry the bat/ball bag). I’m part of the workplace (I do my part). Humans crave a sense of belonging and connection, and helping others out and doing work for the good of the whole helps us understand why connection is important. The more we can do to foster this in our kids, the better off they will be as adults. Chores are a form of selflessness and help children develop a sense of responsibility and awareness of the needs of others. They begin to recognize that when they pick up, they can find their toys and they are grateful for the small things. Parents show gratitude when children do chores. Praise is good! Children feel appreciated and connected, and gratitude helps wire our brains to notice more things to feel thankful for, leading us to feel better overall.

Chores are powerful teachers. They help a child develop a greater sense of responsibility and awareness of the needs of others, and they also contribute to a child’s social and emotional well-being. Chores help children believe that they are competent and capable and help them develop greater self-esteem. Doing chores can also help children learn problem solving skills as well as the consequences of not doing their chores (i.e., not putting your baseball shirt in the laundry so it’s dirty for the next game). Chores are an excellent teacher of life skills. Knowing how to set the table, walk the dog, pick up toys, do laundry, prepare a meal, sweep/vacuum the floor, change a vacuum cleaner bag, etc., all help prepare a child for the responsibilities of adulthood. More involved tasks (i.e., cleaning out the garage) can be used in the development a child’s executive functioning skills, prompting them (perhaps with parent assistance) to figure out how to tackle the task in the most efficient, most systematic manner. And they learn about solutions that may be applied to a host of other life responsibilities.

Being a part of a family and taking responsibility for oneself and contributing to the family by doing chores is a powerful gift to give to children, even if they may not do the chores perfectly, may need to be reminded to do them, or grumble while they are doing them. It’s okay. Over time, these will lessen. Stay with it and help your child recognize and understand that life is work, and they have to be a part of the work of life.

If you aren’t having your child do chores now, consider it while the summer is here. It will help them out in many ways in the long run, helping them to be better functioning and more capable adults. If you need help figuring out which chores are age-appropriate, there are many lists online offering ideas and ways to assist in helping children do chores without too much complaining!

References

https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Chores_and_Children-125.aspx

https://www.loveandlogic.com

https://www.nytimes.com/2018/08/18/opinion/sunday/children-chores-parenting.html

 

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.

 

18

The Joys of Career Counseling

By | NESCA Notes 2021

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

One of my favorite parts of being a Certified Rehabilitation Counselor is career counseling. In an ideal world, work is not just a paycheck. It’s another way for people to find joy and connect to the world and their community in a way that makes sense for them. Whether it is being a young person creating a lemonade stand, going around town to shovel people’s driveways, or getting that first real feel of a work environment and learning the social dynamics of having coworkers and a boss, those early jobs can help a person figure out what they don’t want to do and bring them closer to finding that right job. There is nothing more rewarding than when I get that email from one of my career counseling clients that they rocked their interview and were offered the job.

I’m looking forward to spending the next few months talking about career counseling and the career search process for individuals with disabilities. Career counseling and exploration are a vital part of every teenager and young adult’s life. This is especially true for students with disabilities who are struggling to figure out their next steps. As NESCA’s Director of Transition Services Kelley Challen, Ed.M., CAS, wrote in her last blog, employment in the high school years is an evidence-based method of having better postsecondary outcomes in both college and the workforce.

Career exploration is nothing new. But exploration starts a lot earlier than we think. We have all seen pictures of the first and last day of school that include a board with the student’s favorite color and what they want to do when they grow up. The answers to those questions change over time. If I had the job that I wanted when I was in 5th grade, I would be a zoologist right now! My future dislike of biology notwithstanding, I love the career that I ended up choosing. Still, it is not a career I ever would have thought of when I went off to college.

As we go back to a different world than before the pandemic, we will have to relook at what career exploration means. By the nature of the pandemic, there were lost opportunities for students and young adults to have looked at and tried different careers. So, what can we do instead? One of the best silver linings to come out of the pandemic is the number of YouTube videos and free resources that became available. If a student has never heard of or seen a career, how can they know if they like it or not? So, whether your child is 10, 18, or 25, if they are looking for a new job or a new area to find joy, the first place to start is exploration.

Throughout my summer blog series, I look forward to sharing more about career exploration with the following topics:

  • Career Counseling Services at NESCA
  • Interest Inventories and the benefit of informal career assessments
  • The benefit of informational and practice interviews

 

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.

 

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