NESCA is currently accepting therapy and executive function coaching clients from middle school-age through adulthood with Therapist, Executive Function Coach, and Parent Coach Carly Loureiro, MSW, LICSW. Carly specializes in therapy for individuals with Autism Spectrum Disorders and individuals who are highly anxious, depressed, suffer with low self-esteem, etc. She also offers parent coaching and family sessions when needed. For more information or to schedule appointments, please complete our Intake Form.

Category

Nesca Notes 2023

1

Educational Assessment – Measuring What We See and Understanding What Underlies

By | Nesca Notes 2023

By Angela Currie, Ph.D.
Pediatric Neuropsychologist; Londonderry, NH Director, NESCA

At NESCA, all neuropsychological evaluations from ages pre-k through young adult include assessment of academic skills, in addition to assessment of other domains, including intellectual, language, memory, attention, executive function, social, and emotional skills. Because learning is a primary “job” for any individual in this age range, it is important to understand how their unique profile of skills impacts their learning process as well as consider whether underlying learning issues may be impacting observed challenges with stress, inattention, etc.

Just because all evaluations include educational assessment, it does not mean that the battery of tests always looks the same. If that is so, what tests might you expect your child’s neuropsychologist to include?

First and foremost, when an evaluator is selecting tests, it is important to first consider whether learning is a specific area of concern. When caregivers and/or teachers are specifically concerned about reading, writing, and/or math, it is important to assess both the child’s achievement level as well as assess underlying reasons for any observed challenges. This can be thought of as assessing both functional (i.e., actual academic performance) and foundational (i.e., the underlying problems) skills. While understanding a student’s functional academic skills is critically important, giving insight into their day-to-day performance in school, if the foundational skills are not examined, then interventions are likely to be misinformed and ultimately less effective.

For example, a child may be referred for evaluation due to difficulties with reading, and perhaps there is a family history of dyslexia. For this child, the educational portion of the evaluation would consider four functional skill domains, including:

  • Decoding – ability to sound and blend together unfamiliar words
  • Sight word reading – ability to recognize whole words
  • Fluency – reading efficiency, or speed
  • Comprehension – understanding of written material

While information about the above functional reading skills may tell us a lot about how the child’s reading skills are presenting, the scores alone do not elucidate the underlying neurocognitive pattern that contributes to these scores. So, in addition to assessment of cognition, processing, and memory, the evaluation will also examine the following foundational skills for each domain:

This graph demonstrates that these skills build directionally – without having the underlying ability to hear sounds in words, appreciate what words look like “in your head,” quickly access information from memory, or understand meaning within language, then individual, functional reading skills will not develop as expected, and overall reading will be behind. Similar analysis can be done for writing, such as examining skills for language expression and retrieval, mechanics, grammar, and word forms. For those with math concerns, examination of applied problem solving, calculations, and fluency as functional skills is important, but so is examination of the foundational skills of orthography, retrieval, visual-motor integration, visual processing and imagery, and quantitative reasoning.

Even for those who are referred for neuropsychological evaluation for concerns that are not directly academic, it is still critical to assess reading, writing, and math achievement and efficiency (i.e., fluency) as key skills on which they rely for their “full time job” of learning. This is also important because many individuals with ADHD, anxiety, mood challenges, or other neurodivergence often experience challenges with executive function. Executive function is a set of cognitive and regulator skills that allow for efficient, goal-oriented problem solving and task completion. This includes skills such as planning, organizing, managing time, self-monitoring work process, and controlling impulses. With this, it is very common for individuals with such challenges to experience slow academic fluency or efficiency, despite strong achievement. Academic achievement scores are thus critical for informing the appropriateness of various academic accommodations, such as extended time for tests or accessing teacher notes.

Children, teens, and young adults spend much of their time learning – both in and out of the classroom. It is for this reason that, at NESCA, full consideration of their educational profile is considered to be a critical component of any neuropsychological assessment. We aim to understand what we see – the functional skills, or achievement ­– but we also aim to see the foundational needs so that interventions and accommodations can truly meet the student’s needs. More information about NESCA’s approach to neuropsychological assessment can be found on our website at https://nesca-newton.com/neuro_eval/.

 

About the Author

Dr. Currie specializes in evaluating children, teens, and young adults with complex profiles, working to tease apart the various factors lending to their challenges, such as underlying learning, attentional, social, or emotional difficulties. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

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

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and staff in greater Burlington, Vermont and Brooklyn, New York, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

11

How to Make the Holidays Less Stressful

By | Nesca Notes 2023

By: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

Are the holidays the “most magical time of the year?” Maybe, but they can also be the most stressful. In fact, a recent survey by the American Psychological Association found that 41% of U.S. adults experience increased stress levels around the holidays, while 52% find their stress levels remain the same, and only 7% feel less stressed this time of year. A whopping 43% of American adults acknowledge that the stress that accompanies the holidays compromises their ability to enjoy them (and that number includes only the people willing to admit it!).

As an adult reading this, you may be thinking this information comes as no surprise and you’re all too aware of the stress that comes with the holidays. What you may not realize as fully is that this time of year can be stressful for children as well. While the holidays can bring excitement and fun, they can also present challenges, particularly for our kids and teens who struggle with underlying mental health issues (such as anxiety or depression) or neurodevelopmental conditions (such as Autism, Attention-Deficit/Hyperactivity Disorder, or Sensory Processing Disorder). For the next few weeks, many of us will be attempting to navigate our own holiday-related stress and manage the stress our children may feel and express in a variety of ways. So, if you’re feeling less overwhelmed with excitement and joy and instead simply overwhelmed, you’re not alone. Here are some strategies for making the holidays work for you:

Notice and recognize the impact of expectations. It all starts here. From Hallmark movies to the pictures posted by mom-fluencers on Instagram, we are bombarded with unrealistic images of what the holidays “should” look like. Social media is particularly insidious, as it tends to contribute to a sense that the everyday, real people around us (not just those celebrities in magazines) are living what we see reflected in their carefully edited and curated photos. It’s important to remind ourselves that these images don’t reflect the reality of life and that we don’t see 99% of what happens in the daily lives of those we follow on social media. We may see the images of perfectly decorated Christmas cookies but not the kitchen counters covered in flour, eggs, and frosting (or the parent yelling) in the background. We click on the beautiful photo of three kids all smiling at the camera from Santa’s lap but don’t see the 25 outtakes featuring those same children in tears, sticking out their tongues, or bolting out of the frame. Realizing this and taking a step back is key for ourselves and our children, who may also need explicit information about what they can expect (for instance, regarding the number of and type of gifts they will get based on your family’s budget versus what they envision).

Realize we also all harbor implicit ideas about what the holidays “should” look like based on our experiences growing up and the way our families did things, which we take for granted. If you’re in a relationship, you may have encountered your own hidden expectations if they ever come into conflict with those of your significant other. Even if you celebrate the same holiday(s), you may do so in very different ways. Some of you may be familiar with conversations, such as, “What do you mean your family decorates the tree Christmas Eve? Christmas trees go up as soon as we put our jack-o-lanterns in the compost on November 1st!” If you and your partner celebrate different holidays or your kids split their time between your home and that of another parent, all of this becomes much more complicated. So, talk about it openly and together. As a family, re-evaluate your expectations and traditions, and start with a blank slate. Sit down together, make your expectations explicit, then assess them together.

Ask some questions, such as:

  • What does each family member, kids included, envision the holidays will look like? This might be general and abstract (maybe Mom wants to ensure there’s downtime for rest and relaxation) or concrete (maybe the kids want to go ice skating over winter break, and Dad wants to make sure the family goes to midnight mass on Christmas Eve). How will you make this work both logistically and in terms of balancing different needs?
  • What traditions do you automatically take part in, and do they work for your family at this particular moment in time? Although traditions are important and meaningful, blind and rigid adherence to rituals and routines that don’t work for us don’t benefit anyone. We often take part in traditions without questioning whether they add to our lives or why we started doing them in the first place.

Once you’ve had these discussions, consider that you don’t have to “do” the holidays the same way ever single year. There’s no rule that says every holiday season has to look the same. Do you always go take photos with Santa at the mall even though your kids inevitably resist the idea, become anxious and overwhelmed, and you end up frustrated? Open up to the possibility of forgoing that tradition even if it’s just for the time being. Do you make an elaborate holiday dinner each year but aren’t up to it this year? Consider finding an alternative for now that takes the stress off of you and still aligns with your priorities. If what’s important to you is enjoying a meal with your family, maybe you can still do that while letting go of the need to do it all yourself.

Modify your expectations and make accommodations for your children given their unique personalities and potential challenges. This might mean forgoing busy and crowded events, such as parties, for children and teens who struggle with anxiety in social settings or become easily overwhelmed by sensory input. Or maybe you still attend, but you have a pre-established plan for leaving by a certain time and/or managing distress that may arise. These days, many public spaces that host events (e.g., museums, theaters) hold modified sensory-friendly versions of events at specified times. For many children, building in predictable routines, and previewing special plans or changes to their usual schedules can be very helpful. For kids or adolescents with significant “picky” eating or Avoidant-Restrictive Food Intake Disorder (ARFID), you might consider hosting a holiday dinner at your house so you have control over the menu or bringing food you know your child will eat if you’re visiting others. Many kids with ADHD will need movement breaks, so think ahead about how you’ll work those in depending on your plans. It helps to think ahead and have a flexible plan for meeting your kids’ needs in different scenarios.

Now for the twist. Remember that APA study I quoted at the start of this blog? Well, even though so many people reported significant stress, it also found that 69% of adults feel the stress of the holidays is “worth it,” and many endorse positive outcomes related to the holidays, including an increased sense of togetherness. No matter what or how you celebrate, the holidays can be a wonderful and meaningful time of the year, and the odds of finding joy, connection, and calm will be higher if you take a step back and figure out how to make the holidays fit into your life and work for your family.

References:
https://www.apa.org/news/press/releases/2023/11/holiday-season-stress

 

About the Author

Maggie Rodriguez, Psy.D., provides comprehensive evaluation services for children, adolescents, and young adults with often complex presentations. She particularly enjoys working with individuals who have concerns about attention and executive functioning, language-based learning disorders, and those with overlapping cognitive and social/emotional difficulties.

Prior to joining NESCA, Dr. Rodriguez worked in private practice, where she completed assessments with high-functioning students presenting with complex cognitive profiles whose areas of weakness may have gone previously undiagnosed. Dr. Rodriguez’s experience also includes pre- and post-doctoral training in the Learning Disability Clinic at Boston Children’s Hospital and the Neurodevelopmental Center at MassGeneral for Children/North Shore Medical Center. Dr. Rodriguez has spent significant time working with students in academic settings, including k-12 public and charter school systems and private academic programs, such as the Threshold Program at Lesley University.

Dr. Rodriguez earned her Psy.D. from William James College in 2012, where her coursework and practicum training focused on clinical work with children and adolescents and on assessment. Her doctoral thesis centered on cultural issues related to evaluation.

Dr. Rodriguez lives north of Boston with her husband and three young children.  She enjoys spending time outdoors hiking and bike riding with her family, practicing yoga, and reading.

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

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

8

The Impacts of Handwriting Challenges

By | Nesca Notes 2023

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

After recently participating in the virtual conference of the International Dyslexia Association, two presentations that particularly sparked my interest were, “How Handwriting Impacts Literacy Development,” presented by Carol Armann OTR/L and Kathleen S. Wright of The Handwriting Collaborative LLC, and, “Dysgraphia – Recognize, Diagnose, and Remediate,” by Debi Buchanan, Ed.D. and Sheryl Frierson, M.D., M.Ed.

Within those webinars, research was presented that demonstrated the importance of handwriting and fine motor skills development, as those skills resulted in not only improved literacy skills, such as letter writing, but also kindergarten math performance, and these skills are associated with ongoing reading and math achievement as late as 5th grade (Dinehart et al 2013). Additionally, identifying early handwriting challenges and providing systematic handwriting instruction can reduce the number of children who ultimately will require special education services (Beringer, V& Wolf, B 2016).

Some fine motor skills necessary for the development of handwriting include in-hand manipulation (e.g., precisely picking up, manipulating, and releasing objects), graphomotor (e.g., handwriting strokes, lines used in forming letters), and visual-motor integration. Dysgraphia is an impairment in handwriting, characterized by deficits in legibility and/or fluency. However, it is not exclusively a motor impairment, but is a disruption in the coordination of the mental image (e.g., which letter, which way does it go? Where does it go in the word?) and motor output (e.g., motor sequencing, motor planning) that are required for legible and fluent handwriting.

As students move through the grades, handwriting becomes an essential component in gaining reading and writing skills. Handwriting fluency is particularly important as non-proficient hand writers cannot keep up with their ideas (Graham, 2010). While, positively, there are programs that can help students with graphomotor output challenges, such as speech-to-text programs, teaching early writing skills is essential to building literacy skills, as effective handwriting instruction has been linked to improved letter recognition, letter formation, spelling, and written composition (Berringer et al 2002, Graham Harris, &Herbert, 2011).

Depending on your child’s age, you can encourage fine motor skills development through fun activities. As examples, some good resources are https://napacenter.org/fine-motor-activities/ and https://www.understood.org/en/articles/6-fine-motor-activities-for-young-kids. If you are concerned that your child is not reaching outlined milestones in their development of the underlying skills necessary for writing accuracy and efficiency, consider asking Early Intervention (for children under 3 years of age) or your school district for an occupational therapy evaluation to determine if your child would benefit from specialized supports. For school age children, an occupational therapy evaluation to determine the functional level of your child’s writing skills would also be appropriate.

 

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 college-aged daughter.

 

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

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.
11

Navigating Screen Time: Understanding the Impact on Child Development

By | Nesca Notes 2023

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

At school, we have had increasing difficulty with children refusing to leave their car at drop-off because they are on their tablets and do not want to stop what they are doing to go to school. Screen time has long been discussed regarding how much is too much and recommendations offered for limiting screen time. Now, with mobile devices, screens can be taken anywhere. Furthermore, there is never a shortage of entertaining options to engage with, from games like Minecraft, Roblox, and Fortnite to YouTube, all of which draw children in and make it difficult to stop. This article aims to provide a nuanced exploration of the impact of screen time on child development. While screen time is not inherently negative, it requires thoughtful management and consideration, particularly in the context of the developmental needs of children.

Screens are pervasive in daily life and have become integrated into the fabric of 21st century family dynamics, mostly due to the numerous ways of engaging with screens. According to the American Academy of Child and Adolescent Psychiatry (AACAP), children between the ages of eight to 12 spend at least four to six hours a day watching or using screens. According to Common Sense Media, children between birth and eight spend an average of two and one-half hours per day, with children two and under spending approximately 49 minutes on average. While screens can teach and entertain, too much may lead to problems.

Excessive screen time can have a variety of effects on child development. These effects can be physical, cognitive, emotional, and social, and vary depending on the content and purpose of screen time. The is largely due to what children are not doing when they are using screens. Extended periods of screen time can lead to a sedentary lifestyle, which can lead to obesity, poor posture, and disrupted sleep patterns. In terms of cognitive development, overuse of screens with fast-paced and visually stimulating content can overwhelm a child’s developing brain and potentially affect attention span, impulse control, and the ability to concentrate.  It can also impede the development of language and communication skills. When children spend too much time in front of screens, they may have fewer opportunities to engage in real-life conversations and interactions, which are crucial for language development. And, while educational content can have benefits, excessive screen time can still disrupt the learning process. It may lead to reduced engagement with traditional forms of learning and limit a child’s ability to exercise critical thinking and problem-solving skills.

It is important to note that not all screen time is detrimental. Age-appropriate and high-quality content, as well as supervised and interactive screen time, can have educational and social benefits. Additionally, technology can be a valuable tool for learning and creativity when used in moderation and with parental guidance. Parent and caregivers can help mitigate the potential negative effects of screen time by setting limits, monitoring content, and encouraging a balanced lifestyle that includes a variety of activities, such as physical play, reading, and face-to-face interactions. Sometimes the best conversations happen in the car.

References:

 

About the Author

Dr. Cynthia (Cindy) Hess conducts neuropsychological evaluations as a pediatric neuropsychologist at NESCA. Dr. Hess enjoys working with children and young adults with complex emotional and behavioral profiles. She is skilled at evaluating social and emotional challenges as well as a range of learning profiles. Her experience allows her to guide families in understanding the supports and services their child requires to be successful in school.

 

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

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

3

The ABCs of Challenging Behavior

By | Nesca Notes 2023

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

When a child or adolescent is exhibiting challenging behaviors, it is helpful to understand why the behaviors are occurring. The first step is to analyze the situational factors surrounding the behaviors:

A: Antecedent. What is happening right before the behavior occurred?
B: Behavior. What is the specific behavior that the child/adolescent exhibited?
C: Consequence. What happened right after the behavior occurred?

By looking at the ABCs of a particular behavior, we can start to understand the function of the behavior. That is to say, why is the child/adolescent engaging in the behavior? How is the behavior being reinforced?

Let’s look at an example:
Tom is in 6th grade. He arrives to math class, and the teacher distributes a worksheet. Tom rips up the math sheet and throws it on the floor. The teacher sends him to principal’s office.

A: Math class, being given a worksheet
B: Ripping up the paper
C: Being sent to the principal/leaving the class

In this example, the aversive situation might be math class itself, it could be the worksheet, or it could be the specific concept being worked on (e.g., multiplication is hard for Tom). Alternatively, something might have happened right before math class that upset him.

The consequence is that Tom is allowed to avoid the problematic situation. Thus, the teacher is inadvertently reinforcing the behavior. Tom has learned that if he refuses to do the work, he gets to leave class.

The more effective intervention would be to understand why he refused the work. In this case, it would be important to have a conversation with Tom. Was the work too hard? Does he need extra explanation of the concepts being covered in the worksheet? Did something happen before math class that Tom was still upset about? If the teacher is not able to engage him in this type of conversation, perhaps it would be better to send him to the school counselor as opposed to the principal.

As you think about your own children, it might be helpful to consider the ABCs of any challenging behaviors that are occurring. What was happening right before? If you can identify antecedents, you might be able to make some concrete environmental changes in order to avoid the behavior. What happened right afterward? Did your reaction to the behavior somehow reinforce it? Could you do something different next time the behavior occurs that would be more effective?

Resources
The Explosive Child by Ross Greene
How to Talk So Kids Will Listen & Listen So Kids Will Talk by Adele Faber and Elaine Mazlish
The Behavior Code Companion by Jessica Minahan

 

About the Author

Erin Gibbons, Ph.D., evaluates children presenting with a range of attentional, learning, and developmental disabilities. She has a particular interest in children with autism spectrum disorders, intellectual disabilities, and those with complex medical histories.

If you are interested in booking an evaluation with a NESCA neuropsychologist/clinician, please fill out and submit our online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

11

Why Teletherapy?

By | Nesca Notes 2023

By: Carly Edelstein, MSW, LCSW
Licensed Clinical Social Worker and Executive Function Coach

During the pandemic, providers all over the world implemented virtual services. While some therapy clients preferred and/or needed to shift back to in-person once deemed safe, others grew fond of meeting with their therapist virtually. Given the effectiveness, convenience, and flexibility, teletherapy is here to stay. Unlike medical doctors, most therapists don’t need to check your temperature or blood pressure when they see you. Rather, therapists aim to create a physical space where their clients feel safe and comfortable. That said, what if you feel the most comfortable being vulnerable in your home? While not everyone sees the appeal in teletherapy, having the option increases accessibility, and studies show clients attend teletherapy more consistently than in-person, yielding more desired outcomes.

Feeling emotionally and physically comfortable at home during teletherapy is just as important as its convenience. Perhaps you’re a college student or working parent with limited free time in your busy schedule. Teletherapy offers flexibility by removing transportation and wait times. With rates of anxiety, depression, and other mental health conditions rapidly rising, teletherapy is an option to consider if you’re seeking support.

Tips for preparing for your first teletherapy session:

  1. Consider privacy; place yourself in a room or space where you can discuss confidential information without others overhearing your conversation. Sound machines that make white noise can help to prevent sound waves from escaping the room.
  2. Limit any distractions; sign into the teletherapy platform in a brand new window versus a tab, so you’re not tempted to browse the web or check emails during your session. You want to set yourself up for success when it comes to being focused and staying present.
  3. Notice what’s in your background; in order to feel as comfortable as possible, make note of what your therapist may see behind you while on video.
  4. Sit back, relax, and trust the process!

Sources:

https://www.forbes.com/health/mind/teletherapy-for-mental-health-treatment/

How well is telepsychology working? (apa.org)

 

About the Author

Carly Edelstein is a Licensed Clinical Social Worker practicing in Massachusetts and Rhode Island. Having worked both in private practice and schools, she has extensive experience supporting students, families and educational teams to make positive changes. Ms. Edelstein provides executive function coaching and psychotherapy to clients ranging from middle school through adulthood. She also offers consultation to schools and families in order to support her clients across home and community environments.

To schedule an appointment with one of NESCA’s counselors, coaches, or other experts, please complete our online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

11

Building Gratitude in our Kids

By | Nesca Notes 2023

By: Tabitha Monahan, MA, CAGS, CRC
NESCA Transition Specialist/Counselor

Would it be November without a blog post about gratitude? Gratitude feels both more important and harder to come by this year with the slew of events bombarding people’s daily lives and something different appearing what feels like every news cycle. But there must be something to all this gratitude if everyone from Forbes Magazine to Psychology Today is writing about it?

So what does the science say?

Basically, gratitude makes us happier and healthier. Being grateful and expressing gratitude can increase our social circle and have others be more willing to seek you out. Gratitude also seems to improve not only mental health but physical health as well. Studies show that grateful people take care of themselves better. They are more likely to exercise and more likely to follow up with medical personal. Studies show that writing in a gratitude journal before bed can even help you sleep better! (Morin, n.d.)

How can I help my child build gratitude?

Young people with disabilities, especially speech and language challenges, may have a hard time sharing their experiences at the end of the school day. Before my students left for the day, I would always ask them to go around the room and share one thing they enjoyed during their day. This way, no matter how challenging the day was, they ended it on a good note. Over time, the students began to look forward to sharing a positive experience from their day. Whether it was getting a compliment at their worksite or overcoming a challenge, they began to go looking for the positives.

Another wonderful way to build gratitude is to turn it into a scavenger hunt. Give each day a topic and share your gratitude topic at dinner. 

While we often think of a gratitude journal as something written, it doesn’t have to be. Have fun with it! Instead of writing down what you are thankful for today, take a picture with your phone or have your child make a drawing relating to the topic. Pinterest is full of great ideas, like the image below. Doing this for a month may turn you and your child a little more gleeful and find a brighter outlook on tomorrow.

Image Credit: Woman of Purpose (thepurposedwomanmag.com)

What are you grateful for today?

 

About the Author

Tabitha Monahan, MA, CAGS, 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. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

6

Loving Individuals with Executive Function Challenges: Real-world Examples of Flexibility and Adaptability

By | Nesca Notes 2023

By Jasmine Badamo, MA
Educational Counselor; Executive Function Tutor

Last week I discussed how being flexible and adaptable is a great way to support individuals with executive function struggles. Today I’d like to give you a few examples of how that would look in real life!

Scenario #1
You are the parent from the nighttime routine debacle from last week. Instead of bedtime being relaxing, it fills you with anticipatory dread. Bedtime is in 15 minutes, and you are scrambling to get your child ready. After prompting your child for the 27th time to pick a pair of pajamas and put them on – something they have to do literally every night and should come as no surprise to them, you walk into your child’s room to see the contents of their backpack strewn all over the floor as they look for their favorite plushie to pack for school tomorrow. Pajamas are not on, teeth are not brushed, and now there is a room to clean. You feel your frustration boil over as you realize that it will be yet another night of everyone going to bed late and stressed out. You think to yourself, “This shouldn’t be this difficult! My kid should be able to do a simple nighttime routine and get to bed on time!”

→ Examples of Flexibility and Adaptability: You stop constantly prompting (or as your child calls it, “nagging”) and start providing external supports that help them foster more independence. After sitting down together and learning that visual reminders are helpful, you posted a nighttime routine checklist on the wall. In your discussion, you also realized that your little one runs out of steam about 15 minutes in, so you simplified the nighttime routine to the bare minimum. You even started shuffling some of the nighttime tasks to earlier in the day when everyone has more energy. It’s a little unconventional to put on pajamas before dinner, but it’s one less task to do later, and it makes dinner fun.

Scenario #2
You love your partner dearly, but for the life of them, they are incapable of arriving to any family event even remotely on time. The lead-up to walking out the door and into the car is always filled with shouting and frustration, and while you arrive together, you arrive late and grumpy.

→ Examples of Flexibility and Adaptability: You started traveling separately to family events. Yeah, it confuses some of your relatives, you’re using double the gas, and your partner shows up way later than they would if you drove together, BUT you both arrive at the family gathering in great moods and enjoy your time with everyone, which is your actual priority. It’s also helped your relationship because it’s removed a lot of the push-pull dynamic that was created by rushing to get somewhere together on time. You also notice how it has opened the door to more conversations around your spouse’s neurodiversity and ways to support them. But really, the best part of this new flexible arrangement is that you can get there on time before all the tasty food runs out, and when you’re feeling generous, you even save your partner a plate!

Scenario #3
No matter how hard you try, your fridge is a warzone. Vegetables rot before you can cook them; you have multiple bottles of hot sauce because you keep forgetting you already have some; and a pack of mushrooms stares judgingly at you every time you pass over it because you still haven’t bought the other ingredients for the mushroom soup you plan(ned) to make.

→ Examples of Flexibility and Adaptability: You let go of how you thought a fridge needed to look, and organized it in a way that makes sense for your brain and eating habits. Vegetables now go in the fridge door where you’ll have a visual reminder to eat them before they go bad. Condiments are on a lazy Susan so you can quickly check what you have and don’t have. You also started shopping for only 1-2 dishes at a time, and now keep all the ingredients needed for a dish together in bins so they’re ready to go when you cook. Yes, you know pasta doesn’t need to be in the fridge, but you know what, this is your life, and this makes sense for you. And while it’s true that this new organization system is suboptimal in terms of space usage, you’ve noticed that you’re actually using more of what you do have in the fridge, which is your priority.

Want to explore this topic more?
Here are a few social media accounts that are modeling a more flexible and adaptable approach to executive function demands:
@thecenteredlifeco
@strugglecare (along with her Podcast “Struggle Care”)
@divergentcoachkelly
@adriabarich

And, if you would like to explore additional solutions to executive function challenges, NESCA’s team of expert executive function coaches is available to work with you and/or your family. We have coaches who can work in-person or remotely. Let us know how we can support you.

 

About the Author

Jasmine Badamo, MA, is an educational counselor and executive function coach who works full-time at NESCA supporting students ranging from elementary school through young adulthood. In addition to direct client work, Ms. Badamo provides consultation and support to parents and families in order to help change dynamics within the household and/or support the special education processes for students struggling with executive dysfunction. She also provides expert consultation to educators, special educators and related professionals.

Ms. Badamo is a New York State Certified ENL and Special Education teacher. She has more than 10 years of teaching experience across three countries and has worked with students and clients ranging in age from 7 to adulthood. She earned her bachelor’s degree in Biological Sciences from Cornell University and her master’s degree in TESOL from CUNY Hunter College. She has also participated in graduate coursework focusing on academic strategies and executive function supports for students with LD, ADHD, and autism as part of the Learning Differences and Neurodiversity (LDN) certification at Landmark College’s Institute for Research and Training. In addition to being a native English speaker, Ms. Badamo is also conversationally fluent in verbal and written Spanish.

Having worked in three different New York City public schools, Ms. Badamo has seen firsthand the importance of executive function skills in facilitating student confidence and success. Her coaching and consultation work focuses on creating individualized supports based on the specific needs and strengths of each client and supporting the development of metacognition (thinking about one’s own thought processes and patterns), executive function skills, and independence. She will guide clients to generate their own goals, identify the barriers to their goals, brainstorm potential strategies, advocate for support when needed, and reflect on the effectiveness of their applied strategies.

Ms. Badamo is a highly relational coach. Building an authentic connection with each client is a top priority and allows her to provide the best support possible. Additionally, as a teacher and coach, Ms. Badamo believes in fostering strong collaborations with anyone who supports her clients including service providers, classroom teachers, parents, administrators, and community providers.

To book executive function coaching with Jasmine Badamo or another EF or Real-life Skills Coach at NESCA, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

6

Reduce Your Frustrations: How Being Flexible and Adaptable Helps You and Your Loved One with Executive Function Challenges

By | Nesca Notes 2023

By Jasmine Badamo, MA
Educational Counselor; Executive Function Tutor

The Dreaded Nighttime Routine
Hey parents, tell me if this rings a bell. Instead of bedtime being relaxing, it fills you with anticipatory dread. Bedtime is in 15 minutes, and you are scrambling to get your child ready. After prompting your child for the 27th time to pick a pair of pajamas and put them on – something they have to do literally every night and should come as no surprise to them – you walk into your child’s room to see the contents of their toy bin strewn all over the floor as they look for their favorite plushie to pack for school tomorrow. Pajamas are not on, teeth are not brushed, and now there is a room to clean. You feel your frustration boil over as you realize that it will be yet another night of everyone going to bed late and stressed out. You think to yourself, “This shouldn’t be this difficult! My kid should be able to do a simple nighttime routine and get to bed on time!”

In my experience, so many of us have found ourselves in a similar situation with a child, a partner, or even ourselves. While you might like for me to launch into tips and tricks for achieving a seamless nighttime routine for your family (does that exist?!), instead I’d like to explore the idea of challenging our “shoulds,” and discuss how being more flexible with ourselves and others can help reduce our frustrations.

Yep, I’m Talking about Letting Go!…Again!
If you or a loved one struggle with executive function demands, it’s important to get more comfortable letting go of how things “should” be, and start being flexible around how things could be. I really love Dr. Russell Barkley’s shepherd analogy for parenting a child with ADHD, as it can be applied to a wide range of relationships and situations involving individuals with executive functioning challenges. He tells us that parents are not engineers, and they do not get to design their children to be the way they’d like them to be. Instead, he pushes parents to accept that they are “a shepherd to a unique individual,” and while “no shepherd is gonna turn a sheep into a dog,” parents do have the power to “pick the pastures in which the sheep will graze and develop and grow.”

Whether you are shepherding a child, a loved one, or yourself, this approach helps us let go of who a person “should” be, how the routines of daily life “should” go, or what tasks “should” be easy. Trying to turn a sheep into a dog (aka trying to shove a round peg into a square hole) only leads to frustration, and worse yet, often sets neurodivergent people – and those who love them – up to fail. Instead, start focusing on how daily life could be, and channel your efforts into shaping your environment and tasks accordingly.

Flexibility and Adaptability are the Tools for Letting Go
The best way to start shaping the environment to better suit the needs of an individual with executive function struggles is to be flexible and adaptive. Below is a list of strategies for being more flexible and adaptive:

Adaptivity Killers Adaptivity Enhancers
-All-or-nothing thinking

-100% optimization and productivity

-Shaming in order to motivate action

-Rejection or deprivation of needs

 -Growth mindset (progress over perfection)

-Selective effort and investment

-Positive self-talk and celebrating small successes

-Self-reflection and compassion

Notice how the Adaptivity Enhancers above align with practices that will dissipate frustrations or at least help you weather them with more ease. Take a look at how each would play out in real life:

  • “I may not be the most athletic human in the world, but I’m really interested in doing more physical movement. I bet if I practiced, I could increase my athletic ability and start to enjoy physical activity more.” (growth mindset).
  • “I know I can’t go from 0 to 100, and that I only have so much expendable energy in the day. I’m going to focus my efforts on lifting weights: starting with small weights and lifting just twice a week.” (selective effort & investment).
  • “Today I lifted for less than my target time, but I’m really proud of myself for coming all the way to the gym after I had such a crummy day at work. I’m also proud that I lifted weights for as long as I did.” (positive self-talk; celebrating small successes).
  • “I notice that I’m usually cranky on Wednesdays after work, and it’s a drag to get myself to the gym – which is totally understandable. Maybe I can better support myself by going on Tuesdays when I tend to have more energy.” (self-reflection and compassion).

Stay tuned for next week’s blog for more real-life examples of how being flexible and adaptable can help you navigate everyday executive function demands.

 

About the Author

Jasmine Badamo, MA, is an educational counselor and executive function coach who works full-time at NESCA supporting students ranging from elementary school through young adulthood. In addition to direct client work, Ms. Badamo provides consultation and support to parents and families in order to help change dynamics within the household and/or support the special education processes for students struggling with executive dysfunction. She also provides expert consultation to educators, special educators and related professionals.

Ms. Badamo is a New York State Certified ENL and Special Education teacher. She has more than 10 years of teaching experience across three countries and has worked with students and clients ranging in age from 7 to adulthood. She earned her bachelor’s degree in Biological Sciences from Cornell University and her master’s degree in TESOL from CUNY Hunter College. She has also participated in graduate coursework focusing on academic strategies and executive function supports for students with LD, ADHD, and autism as part of the Learning Differences and Neurodiversity (LDN) certification at Landmark College’s Institute for Research and Training. In addition to being a native English speaker, Ms. Badamo is also conversationally fluent in verbal and written Spanish.

Having worked in three different New York City public schools, Ms. Badamo has seen firsthand the importance of executive function skills in facilitating student confidence and success. Her coaching and consultation work focuses on creating individualized supports based on the specific needs and strengths of each client and supporting the development of metacognition (thinking about one’s own thought processes and patterns), executive function skills, and independence. She will guide clients to generate their own goals, identify the barriers to their goals, brainstorm potential strategies, advocate for support when needed, and reflect on the effectiveness of their applied strategies.

Ms. Badamo is a highly relational coach. Building an authentic connection with each client is a top priority and allows her to provide the best support possible. Additionally, as a teacher and coach, Ms. Badamo believes in fostering strong collaborations with anyone who supports her clients including service providers, classroom teachers, parents, administrators, and community providers.

To book executive function coaching with Jasmine Badamo or another EF or Real-life Skills Coach at NESCA, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

5

Neurodevelopmental Evaluations for Children under Age 5

By | Nesca Notes 2023

By: Lauren Halladay, Ph.D.
Pediatric Neuropsychologist, NESCA

Many families are curious about neurodevelopmental testing. Neuropsychologists who specialize in working with young children are often asked about when it is appropriate to pursue an evaluation, what the evaluation process entails, and where to go.

Why Would a Young Child Need an Evaluation?

There are developmental milestones across several domains that children are expected to achieve within certain timeframes. When children are showing delays in achieving those milestones within expected age ranges, seeking an evaluation may be warranted. From birth to 5 years of age, the areas of development that are especially important to monitor include:

  • Speech and Language (e.g., use of single words/phrases, following directions)
  • Social Skills (e.g., eye contact, social smile, interest in others, imaginative play skills)
  • Motor Skills (e.g., crawling, walking, using a pincer grasp)
  • Cognition/Early Problem Solving Skills (e.g., matching shapes and objects, completing simple puzzles)

If delays in any of the areas listed above are observed, pursing an evaluation sooner rather than later is recommended, as research has shown that early diagnosis and intensive treatment are the most important factors in determining rapid progress and long-term prognosis.

What Does a Neurodevelopmental Evaluation Entail?

Within a comprehensive neurodevelopmental evaluation, the child is administered tests that look at the developmental areas listed above. Information should also be collected from parents, teachers, and other caregivers who know the child well. These evaluations help to provide a better understanding of the child’s developmental profile, including areas of relative strength and weakness. In other words, the evaluation can provide more information about where the child’s skills currently fall when compared to their same age peers. Such information can provide diagnostic clarification, as well as help to inform recommendations for services if needed.

Where to Go

There are several options for where families can pursue evaluations, each with their benefits and drawbacks:

  • Early Intervention (EI): EI is meant to support families of children birth to three years of age who have developmental delays or are at risk of developmental delays. The goal of the Massachusetts EI program is to collaboratively promote skill acquisition based on the family’s priorities and child’s individual needs. Evaluations are typically conducted within the home setting to determine the child’s eligibility for EI services. While these evaluations can provide valuable information about the child’s strengths and weaknesses, a diagnosis will not be provided.
  • Hospital-based Setting: These evaluations are structured differently depending on the hospital system. In most cases, these evaluations are interdisciplinary, meaning that they involve a team of providers from different disciplines (i.e., psychologist, medical provider (pediatrician, nurse practitioner) speech and language pathologist, occupational therapist, etc.). While outcomes of these evaluations can include diagnosis and recommendations for services when appropriate, waitlists are often long, and reports tend to be brief.
  • Independent Setting/Private Practice: Independent evaluations usually involve several visits with a pediatric psychologist or neuropsychologist, rather than with a team of providers. Similar to the hospital-based evaluations, independent evaluations can result in diagnosis when appropriate. Specific recommendations based on the child’s individual profile are offered. These evaluations tend to be more detailed and comprehensive than those conducted by EI and within hospital-based settings. Clinicians also have the option to observe the child in other settings (e.g., daycare, preschool, elementary school), as well as attend school-based meetings.

Relatedly, NESCA is currently providing evaluations for children 12 months to 3 years of age who are showing early signs of an autism spectrum disorder (ASD). The wait time is 1 month or less – by design –  so children who meet criteria for an ASD diagnosis can access the appropriate interventions for them. If you are interested in learning more about ASD Diagnostic Testing through NESCA’s ASD Diagnostic Clinic, please visit our website at https://nesca-newton.com/asd-diagnostic-clinic-2/ and/or complete our online Intake Form.

Related resources and links to help track developmental milestones:

 

About Lauren Halladay, Ph.D.

Dr. Halladay conducts comprehensive evaluations of toddlers, preschoolers, and school-aged children with a wide range of developmental, behavioral, and emotional concerns. She particularly enjoys working with individuals with Autism Spectrum Disorder, Intellectual and Developmental Disabilities, and complex medical conditions. She has experience working in schools, as well as outpatient and inpatient hospital settings. She is passionate about optimizing outcomes for children with neurodevelopmental disabilities by providing evidence-based, family-oriented care.

 

If you are interested in booking an appointment for an evaluation with a Dr. Halladay or another NESCA neuropsychologist/clinician, please fill out and submit our online intake form. 

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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