NESCA Notes 2024 Archives - Page 6 of 8

10

Supporting Teens: Helping Them Engage in Treatment

By | NESCA Notes 2024

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

I was fortunate to join my colleague, Kelley Challen, Ed.M., CAS, in a recent presentation about fostering self-advocacy and self-determination for young adults. The focus of our conversation was around encouraging teens to participate in the special education process as active members of their IEP team. It got me thinking: what are other ways that teens should be included in decision making? How do we ensure that teens are included in vital treatment decisions? And what do we do about those teens who are reluctant to engage?

There is a robust body of empirical evidence to suggest that the combination of medications and therapy is most effective at reducing symptom severity for emotional health disorders including anxiety and mood disorders. While adults on a treatment team may be well aware of this evidence, teens may look elsewhere to gather information – turning to the less than reliable sources of anecdotal conversations and social media. If we want teens to participate in the treatment planning process armed with greater information, there are a few steps we can follow to support their treatment engagement.

First, when the question relates to medications, I always encourage teens to have very open discussions with their parents and providers about the risks and side effects of medications. It’s incredibly helpful to open conversations by asking teens what they already know or what they have already heard or read about different types of medications. This helps to eliminate any confusion or misperceptions, either about negative side effects or about their unrealistic expectations that things will be “magically cured” in a very short period of time. It is important for teens to understand how long medications may work in their system, how long they need to take the medication to reach the therapeutic dosing, and the risks of not taking it or experimenting with other substances which may interfere with the mechanisms of action. For anxious kids who may not feel comfortable speaking up within an appointment, I encourage families to make a list of their teen’s questions and a plan for who will read the list of questions in the appointment. There are valuable supports that can help with the executive functioning demands needed to remember medications (e.g., daily pill boxes, setting alarms, or reminders on their phone, etc.).

When it comes to therapy, it is relatively common for me to hear a parent state that a child is reluctant or unwilling to attend therapy. There may be many very valid reasons why a teen may feel this way, and it is a sign that they are engaging in the developmental task of individuation when they push back on this recommendation. We don’t need to fear this struggle, and we can use it as an opportunity to invite a conversation. For teens who struggle to explain why they are reluctant about treatment, I might share a few common explanations to see if they resonate with the teen: “Some teens think it’s boring, or it’s too hard, or it’s a waste of time. Some worry their parents will know each thing they say, or feel like they are not in control of the treatment goals.” It may also be as simple as finding virtual sessions to be frustrating and impersonal, or finding the commute to an office for an in-person session to be time consuming. Many of these logistic concerns can be addressed with scheduling. It is also important for teens to know that therapy is not “one size fits all.” There are different forms of therapeutic treatment, and it is important to find a provider with experience delivering evidence-based treatments for the specific diagnosis that your teen carries.

One of the most important factors in treatment adherence is a trusting therapeutic relationship. Those relationships take time to build. If a teen is not feeling well connected to their therapeutic provider, I encourage them to have a discussion either directly with their provider about this or to explore other treatment providers. The same way someone may not wish to be friends with every person they meet, there are certain connections that just “feel right.” Skilled providers also use techniques, such as Motivational Interviewing, to encourage teens to develop their own goals for treatment. This can help to diffuse the argument that a teen is only engaging in a treatment to appease their parent or caregiver. These powerful tactics include important elements of empathy, highlighting discrepancies in thinking (or in conflicting actions and behaviors), accepting (and even expecting) resistance, and promoting self-efficacy.

In helping teens to find their own voice in the treatment process, a power struggle or a demand for engagement from a parent is unlikely to get us very far. Bringing in the support of other trusted people in a teen’s life (e.g., teacher, school counselor, coach, uncle or aunt, older cousin) may also be a useful way to open the discussion about why therapy feels stressful. While teens may wish for things to get better on their own, ignored or avoided struggles do not just go away magically. Treatment can be hard as it does involve facing anxiety-provoking material. However, teens will be facing this content with a trusted adult and armed with new tools to master these triggers. It is important to acknowledge that therapy can be hard work, and they will not be doing it alone. Engaging in special self-care routines after a therapy session, particularly if parents can acknowledge and create space for these, can be a powerful way to encourage commitment to treatment. When teens feel more control in engaging with their treatment, they are far more likely to persist.

For more information on enhancing motivation for treatment engagement, consider the following resources:

Child Mind Institute’s Rachel Ehmke’s article “Helping Resistant Teens into Treatment https://childmind.org/article/helping-resistant-teens-into-treatment/#:~:text=What%20are%20they%20looking%20for,their%20motivation%20for%20getting%20better.
Motivational Interviewing with Adolescents and Young Adults (2010) by Naar-King and Suarez.
How To Talk So Kids Will Listen And Listen So Kids Will Talk (2012) by Faber and Mazlish.

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.

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

14

You’ve Got a Friend – The Importance of a Mentoring Relationship in ASD

By | NESCA Notes 2024

By: Renee Cutiongco Folsom, Ph.D.
Pediatric Neuropsychologist

It is graduation time again. Graduation speeches usually include a portion where the graduates thank their parents, siblings, friends, and teachers for their success. Most of the time they also thank coaches, mentors, and counselors for their accomplishments. Listening to them takes me back to my own graduation experience where I credited part of my success to people who came alongside me to mentor and support me through the various stages of my development. The encouragement and feedback provided by these mentors shaped me in ways that I would not have gotten simply by sitting in the classroom or reading books. The role of mentors is also important, and I should say more so, for children and adolescents who are on the autism spectrum.

Autism Spectrum Disorder (ASD) is a developmental disorder that manifests in problems with social communication and interaction, and in the presence of repetitive, restricted behaviors that significantly impact functioning. Children and young people with ASD usually have problems with what are called social pragmatic skills – those skills that are necessary for knowing how to act in social situations, reading social cues, and conducting back-and-forth conversation with others. Some persons with ASD have a hard time appreciating the unwritten “rules” of social engagement, for example, that you should look at a person you are talking to, smile, and nod occasionally to signify that you are paying attention and interested in what other people are saying. It is difficult for persons with ASD to read subtle cues and “feel” the room to know how to react to certain dynamics. Appreciating sarcasm or humor could be difficult for them. These skills are often the hardest to “teach” a child or adolescent with ASD because of the complex and dynamic nature of social interactions. Also, these are skills that come naturally or instinctively for many of us, so it is hard to break down interactions and make subtle behaviors (e.g., eye contact, nonverbal cues, gestures) more salient. This is where an older sibling or a mentor – a camp counselor, a coach, or a tutor – could be a wonderful resource for teaching these skills to a young person with ASD. Have you ever had a camp counselor model for you how to react when you are introduced to a new person? Maybe you had a coach hang out with you after a game to model how to engage in back-and-forth conversation and listen to other people’s interests. These mentoring relationships are a good venue for practicing skills that may have been taught to the person with ASD in the context of a formal speech/language therapy session or in the classroom. Indeed, I have found over the years that children and adolescents with autism and have older siblings or mentors do better in these social pragmatic skills than those without this kind of guidance.

Beyond teaching social pragmatic skills, mentors also provide guidance about practical everyday decisions. Has an older sibling ever given you feedback about how your top does not match your pants? Or that you should slow down eating that burger because you are such a messy eater? You may have had an older friend who has shared with you how they navigated dating. Teenagers, not only those with autism, are usually more open to receiving such feedback or information from those who are a little older than they are as opposed to older adults or parents because of wanting to develop their own personalities apart from parents. Therefore, for these young people I usually recommend having a mentor who is a little older than they are who can serve as a friend/mentor/model.

Many skills that are crucial in navigating social situations – how to behave appropriately, how to make friends, how to be a good team member – are usually learned in the context of organic relationships, such as a mentoring relationship, as opposed to a classroom lesson because the interaction itself is the “content” of the instruction. The mentor must be reminded, though, to be more intentional in modeling/teaching these social pragmatic skills to the client.

There is no better way of learning how to be a good and caring friend than to experience having a friend come alongside you to show you how it is done. As my favorite singer, James Taylor, sings, “Ain’t it good to know you’ve got a friend?”

About the Author

Dr. Renee Cutiongco Folsom, Ph.D. has been working with families in the greater Boston area since 2015. Prior to this, she was on staff at Johns Hopkins University and trained at the University of California, Los Angeles (UCLA). She provides comprehensive neuropsychological evaluations of children, adolescents, and young adults who have learning, behavioral, and socio-emotional challenges. Her areas of expertise include Autism Spectrum Disorder and other conditions that usually co-occur with this diagnosis; Attention-Deficit/Hyperactivity Disorder; Dyslexia and other Specific Learning Disabilities; and Anxiety/Depression. She thinks that the best part of being a pediatric neuropsychologist is helping change the trajectory of children’s lives.

To schedule an appointment with one of NESCA’s pediatric 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; the greater Burlington, Vermont region, and Brooklyn, NY, 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

Allow Them to be Challenged! (Examples of Balancing Support with Challenge): Part 2

By | NESCA Notes 2024

By Jasmine Badamo, MA
Educational Counselor; Executive Function Coach

Last week’s blog discussed the “zone of proximal development” and the importance of providing young people with calculated challenges in order to facilitate their executive function development (https://nesca-newton.com/allow-them-to-be-challenged-building-childrens-executive-functions-part-1/). Because the balance between providing support and allowing challenge is highly individual, I wanted to write a follow-up blog providing some examples of how this balance can be implemented:

EXAMPLE 1: A middle schooler is struggling to turn in their assignments on time, even when they already have them completed.

EXAMPLE 2: An elementary-aged child is struggling to keep their work desk clean, and it’s causing a lot of conflict and stress during homework time.

EXAMPLE 3: A high school student wants to find a summer job so they can earn some money and build their resume.

Remember that every child and family is unique, and there is no one right answer. It may take time to find the right balance for your child, but it is well worth the effort!

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Did you know that NESCA offers parent coaching tailored to helping parents facilitate their child’s executive function growth? While many families take advantage of the opportunity to have their student’s work directly with our executive function coach and utilize parent coaching as a support for generalizing the strategies the students are learning, this has also been an invaluable service on its own for many parents.

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; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) 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

Allow Them to be Challenged! (Building Children’s Executive Functions): Part 1

By | NESCA Notes 2024

By Jasmine Badamo, MA
Educational Counselor; Executive Function Coach

Executive function – the ability to engage in goal-directed behaviors, such as planning, organization, focus, and self-regulation – is a set of cognitive skills that all individuals possess and use on a daily basis.

Like any skill, each person’s executive function is at varying stages of proficiency and development. Furthermore, a person’s day-to-day capacity for executive functioning can fluctuate based on a variety of factors, including age, cognitive profile, environment demands, emotional state, physical illness, stress, mental health, etc.

As the role of executive function in learning, working, and general life tasks is becoming more widely acknowledged and understood, it is also becoming more common to make accommodations for young people to support their executive function challenges. It is exciting to see more of this consideration and inclusion; however, I often find myself in conversations with families, educators, and related professionals regarding the difficulty of balancing executive function support and accommodation with allowing space and opportunities for growth and skill development.

How can we resist the temptation to completely alleviate a young person’s struggle, especially when we know that the individual needs opportunities to practice the executive function skills they are attempting to master? It comes down to exposing young people to calculated challenges.

Facing challenges is an important part of learning and developing independence. It is also important to be thoughtful about the level of challenge we present to an individual. In my coaching, I like to think of Lev Vygotsky’s theory of learning in which every person has a “zone of proximal development” that encompasses the skills or tasks that they cannot yet do on their own, but that they can achieve with guidance or assistance (often referred to as “scaffolding”). When a learner receives support attempting a task that is just beyond their individual reach or capacity, it allows them to stretch their skills and current knowledge. With guidance and repeated practice, the learner develops the ability to utilize the skills and knowledge independently; their zone of proximal development shifts, and they can tackle more complex and challenging skills (citation).

Challenge is essential to growth. But finding a person’s zone of proximal development is not an exact science – it’s individual, shifts with time and circumstances, and it can be difficult in the moment to know if you’ve struck the right balance between supporting your child while simultaneously allowing for sufficient challenge.

You may be thinking, “What’s too little challenge? What’s too much? Is my child facing an overwhelming amount of executive function demands, or are these challenges good growing and learning opportunities for them?” Next week’s blog will give a few examples of how parents and caretakers may be able to balance support vs. calculated challenge. And, in the meantime, consider collaborating with an executive function coach! It’s a great way to answer these questions and learn how to independently identify the appropriate level of challenge for your child.

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Did you know that NESCA offers parent coaching tailored to helping parents facilitate their child’s executive function growth? While many families take advantage of the opportunity to have their student’s work directly with our executive function coach and utilize parent coaching as a support for generalizing the strategies the students are learning, this has also been an invaluable service on its own for many parents.

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; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

13

Building Executive Function Skills over the Summer

By | NESCA Notes 2024

By: Kristen Simon, M.Ed, Ed.S
Transition Specialist; Psychoeducational Counselor

As the countdown to Summer begins post April vacation, teens are getting excited for this season of rest, with more time to socialize and spend their days doing the things they want to do. While the first two weeks tend to be filled with high energy and plans, as the summer continues, the energy starts to slow down and boredom sets in. This part of the summer is a great time for adolescents to lean into building executive functioning skills that they may not have had time to practice fully during the school year. And the planning to do so should begin now, prior to the summer, instead of introducing this when they already feel unmotivated.

Executive dysfunction is supported through the school year with structure, routines, consistent visual schedules, online calendars, reminders, and many other external supports. As noted in previous blog posts for students with executive functioning challenges, the focus during the school year can easily fall into a pattern of “putting out fires” or providing intense support to catch up on never-ending assignments, instead of proactive skill building. The summer offers a low-pressure environment for students to practice planning, organizing, following through, and self-monitoring.

Some ways to practice and build these skills might include:

Manage their own schedule. Have your adolescent practice keeping a weekly schedule. Teens can print off a blank weekly schedule or utilize a digital version to list what needs to be accomplished each week (work, appointments, chores, exercise, social, hobbies, small goals) and plug these into a weekly checklist or visual calendar. At the end of each week, teens can reflect on how much they were able to follow the system they tried and what obstacles got in the way of anything they didn’t accomplish.
Practice setting alarms. Even if it’s for 10:15 AM (or later) and actually waking up at the time they needed to is important all year long. Allow them to troubleshoot if they sleep in, including what routine can they shift from the night before to meet this?
Set their own appointments. Is there a dentist appointment that needs to be made or a car service that family needs completed? Have your teen take ownership of calling or going online to make the appointment, tracking the appointment, and following through with going to the appointment.
Household chores. Ask your teen to take ownership of one part of the home (e.g., mowing the lawn). Work to schedule out how often throughout the summer this job needs to be completed and set a plan for how to follow through with this responsibility.
Make a meal for the family. Following through with all the steps included (finding a recipe, budgeting, food shopping, prepping, managing the timing of each item that needs to be cooked) is a great way to practice executive functioning skills.
Get a summer job. Working is a great way to build many executive functioning and self-determination skills for teens. Not only does it add structure to the week, it also helps with regulation and provides social opportunities.

Summer is a great time to build executive functioning skills for school but also life. If you’re interested in hearing more about NESCA’s executive functioning coaching session or real-life skills coaching, visit: https://nesca-newton.com/coaching-services/ or complete our Intake Form at: www.nesca-newton.com/intake.

About the Author

Kristen Simon, M.Ed, Ed.S, has worked with transition-aged youth as a licensed School Psychologist for more than a decade. She has extensive experience working with children and adolescents with a range of learning and social/emotional abilities. Kristen’s strengths lie in her communication and advocacy skills as well as her strengths-based approach. She is passionate about developing students’ self-awareness, goal-setting abilities, and vision through student-centered counseling, psychoeducation, social skills instruction, and executive functioning coaching. Mrs. Simon has particular interests working with children and adolescents on the Autism spectrum as well as individuals working to manage stress or anxiety-related challenges.

Mrs. Simon is an expert evaluator and observer who has extensive working knowledge of the special education process and school-based special education services, particularly in Massachusetts. She has been an integral part of hundreds of IEP teams and has helped to coordinate care, develop goals, and guide students and their families through the transition planning process. Mrs. Simon further has special expertise helping students to learn about their diagnoses and testing and the IEP process in general. She enjoys assisting students, families, and educators in understanding a student’s disability-related needs as well as the strategies that can help the student to be successful in both academic and nonacademic settings. Mrs. Simon has often been a part of teams in the years when students are initially participating in transition services, and she has helped countless students to build the skills necessary to be part of their first team meetings. She is committed to teaching students—as well as parents and educators—how to participate in student-centered team meetings and the IEP processes.

At NESCA, Mrs. Simon works as a transition specialist and psychoeducational counselor. She works with adolescents, their families, and their school communities to identify and build the skills necessary to achieve their postsecondary goals. Mrs. Simon provides transition assessment (including testing, functional evaluations, and observations), program observations and evaluations, case management and consultation, and individualized counseling and skills coaching.

To schedule an appointment with one of NESCA’s transition specialists, 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 staff in the greater Burlington, Vermont region 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.

16

Working to Make Traffic Stops for Autistic Drivers Less Stressful

By | NESCA Notes 2024

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

Any driver who has ever cruised down a highway and suddenly sees flashing blue lights and hears the siren of a police car pulling up behind them knows that feeling of panic and dread – that immediate stress response that runs through your body. The internal questioning begins…What did I do wrong?, Was I speeding?, Did I not use my turn signal?, etc. The flight and fight response courses through our body. We pull over and wait while the officer gets out of their car and approaches. We know to keep our hands visible, wait patiently, and wait to be spoken to. These “unwritten rules” may not be specifically taught, but we just know to do them. Now, imagine for a moment that you are autistic and unwritten rules are difficult for you in general – never mind in this stressful situation. This situation is exacerbated in intensity by the very nature of their Autism Spectrum Disorder (ASD) diagnosis, which may lead to the driver experiencing difficulty with communicating, their ability to manage the stress of the situation, interacting as expected socially, and managing the total flooding of their sensory systems. If the driver is a minority and autistic, the stress may be further compounded.

Recently in Massachusetts, The Blue Envelope initiative was unanimously passed by both the House and Senate. This initiative assists autistic drivers in auto accident situations and traffic stops. While it is voluntary for police departments and autistic individuals to participate, the hope is that both groups will avail themselves of this potential to support and be supported in driving situations that arise. It is designed to make experiences like the one outlined above safer, and to ease communication between autistic drivers and police officers. The program began through a collaborative effort among autistic individuals, their parents, and multiple agencies and organizations, including the Massachusetts Chiefs of Police Association, Massachusetts State Police, Advocates for Autism of Massachusetts, and The Arc of Massachusetts.

The Blue Envelope Program is literally based on a blue envelope that autistic drivers keep in their vehicle with their important papers inside (i.e., driver’s license, registration, insurance card, and a contact card). The Blue Envelope isn’t just an ordinary envelope to keep things organized. Rather, it’s meant to be a “life saver and game changer,” as it is specially designed to provide critical communication guidelines and support as well as other important information about ASD. The communication information is printed on the outside of the envelope, thus alerting the officer that they are interacting with an autistic person. Along with general information about ASD, the information in the envelope can be personalized – since we know that each person’s strengths and challenges are never the same from one individual with autism to the next. Also included on the outside of the envelope are “instructions/guidelines” for the individual. The intent of this program, by alerting officers that they are interacting with an autistic individual, is so they may potentially modify their interaction approach and style; possibly averting the individual becoming escalated, leading to more serious encounter. The Blue Envelope Program is available in many states, including RI, CT, ME, NJ, PA, AZ, and CA. It is currently in use by the Massachusetts State Police and some local communities. The program also includes training for law enforcement officers on how to approach and interact with individuals should they have a Blue Envelope.

The Blue Envelope Program hopes to, “enhance understanding, reduce anxiety, streamline communication and encourage preparedness,” and create a “positive outcome” for all. There are tips for officers that include things like, “use simple, direct language, avoid idioms, be observant, allow drivers longer time to respond, and clearly tell the driver when the stop is done.” If signs of distress are visible, try to reduce sensory inputs (turning off flashlights, sirens, etc.). Tips for drivers include handing the officers the Blue Envelope and telling them you’re autistic, following instructions, and asking for clarification if they do not understand something the officer is saying. The general guidance remains to always keep your hands visible – on the steering wheel; and if you need to reach for anything, tell the officer what you are doing before doing it.

The goal of the Blue Envelope Program is to create an outcome that is safe, respectful, and positive for all parties involved in a traffic stop, whether it be an accident or a traffic violation. Its aim is that autistic drivers will feel safer, calmer, more secure, and less stressed during traffic stops and that the officer training will help them be more aware of whom they are interacting with, be more prepared, exhibit greater empathy, and be more patient when interacting with an autistic driver. It has the potential to be a win-win program for all involved.

If you would like to apply for a Blue Envelope in Massachusetts, visit: https://www.mass.gov/info-details/blue-envelope-program#tips-for-a-safe-traffic-stop-

Additional Resources:

WGBH All Things Considered’s interview with Dr. Chris Keary, psychiatrist at the MGH/Lurie Center, 4/17/2024 – https://www.wgbh.org/news/local/2024-04-17/a-new-program-for-mass-drivers-on-the-autism-spectrum-looks-to-make-traffic-stops-safer
NBC News broadcast, 3/9/2024 – https://www.nbcboston.com/news/local/blue-envelope-program-aims-to-help-police-better-connect-with-drivers-with-autism/3303434/
WBUR, 4/10/2014 – https://www.wbur.org/news/2024/04/10/blue-envelope-autism-police-traffic-stops

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 clinicians, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician/consultant/service 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; the greater Burlington, Vermont region; and Brooklyn, NY, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

47

If My Child Attends a Residential School, Will the State Pay for Housing When They Graduate?

By | NESCA Notes 2024

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

The goal of transition services is to help students who are on IEPs to progress toward their measurable postsecondary goals. This includes planning for future learning and work situations, and also planning for future living—as independently as possible. An enormous challenge that comes up in this planning process is that families (and sometimes the professionals supporting them) do not fully understand the realities of housing for adults who have exited public education.

There is a common misconception that if your child has qualified for residential special education programming, that will mean that your child will qualify for residential support as an adult. However, adult human service supports are not an entitlement like special education—these services are voted on by state legislature. The truth is that adult services and benefits are built to fill in the gaps of what you cannot physically or financially do to support your child. If you are alive and you can reasonably take care of your child, even with support, that is what you will be expected to do. If, instead, you want your child to be able to live in their own home or a shared home, then you and your child will be responsible for figuring out how to find and fund that living situation.

Hopefully, this data, shared by Cathy Boyle of Autism Housing Pathways in a January presentation, titled “Thinking About Housing,” will help to hammer home this point. Cathy shared numbers from fiscal year 2021 which quantified some of the residential supports awarded to young adults in Massachusetts who turned 22 during that fiscal year. Specifically, there were 1,233 students turning 22 who were served by the Department of Developmental Services (DDS) in Massachusetts. Of that number, only 263 received “residential supports.” However, the majority of those “residential supports” were provided in shared living situations where the housing was not being funded by DDS. It was only about 100 individuals statewide who turned 22 and entered into brick-and-mortar homes funded by DDS.

Regarding who is able to secure DDS housing in Massachusetts, it is typically only available to individuals who have an intellectual disability that was diagnosed before age 18 and (1) are a danger to themselves, and/or (2) are a danger to others, and/or (3) have pica (a condition in which a person eats items not usually considered food). There are some other criteria considered, including whether the caregiver can keep the individual healthy and safe (based on caregiver criteria, such as age, health, employment) and the judgment of the evaluator from the state. But, as previously described, housing is reserved for individuals with the most significant needs. Also, while there is funding through DDS for day services for adults with autism in Massachusetts, this budget explicitly does not cover residential services or housing. Only individuals with autism who also meet the intellectual disability criteria are eligible for housing under standard criteria.

If your child has a mental health condition, you may wonder about housing through Department of Mental Health (DMH). While it’s difficult to find current statistics on the number of young adults turning 22 and receiving group home services, there is a limited number of beds, and eligibility criteria for DMH services specifies that you can only be eligible for services if they are actually available. Also, the criterion for housing is quite similar to DDS in that an individual has to be entirely unable to live at home even with intensive in-home support. This often equates to the same variable of whether your child is actively at risk of harming themselves or another person.

While I’m providing data from Massachusetts in order to exemplify these housing challenges, the struggles are similar, if not more difficult, across the United States. The reality is that if you have a child with a disability, you and your child are more than likely going to have to plan for and figure out how to pay for their housing in adulthood. This is one of the ways that our children are treated 100% similarly to nondisabled adults. Although having a disability may help your child to qualify for accommodations in adulthood, living accommodations are most often not part of that right.

Resources:

To learn more about housing in adulthood in Massachusetts, check out Autism Housing Pathways (which is not just for adults with autism): https://autismhousingpathways.org/the-current-housing-situation/
To find your local public housing agency in any state, visit the U.S. Department of Housing and Urban Development – https://www.hud.gov/program_offices/public_indian_housing/pha/contacts
Your local Independent Living Center is another great resource to learn about housing and resources for living in your local community: https://www.ilru.org/projects/cil-net/cil-center-and-association-directory

NESCA offers many services designed to help students bridge the transition from high school to college including executive function coaching, pre-college coaching, transition planning, and neuropsychological evaluation. To learn more specifically about our transition planning services, visit https://nesca-newton.com/transition/. To learn about other coaching services, visit: https://nesca-newton.com/coaching-services/. To schedule an appointment with one of our expert clinicians or coaches, please complete our intake at: https://nesca-newton.com/intake/.

About the Author
Kelley Challen, Ed.M., CAS, is an expert transition specialist and national speaker who has been engaged in evaluation, development, and direction of transition-focused programming for teenagers and young adults with a wide array of developmental and learning abilities since 2004. While Ms. Challen has special expertise in working with youth with autism, she enjoys working with students with a range of cognitive, learning, communication, social, emotional and/or behavioral needs.

Ms. Challen joined NESCA as Director of Transition Services in 2013. She believes that the transition to postsecondary adulthood activities such as learning, living, and working is an ongoing process–and that there is no age too early or too late to begin planning. Moreover, any transition plan should be person-centered, individualized and include steps beyond the completion of secondary school.

Through her role at NESCA, Ms. Challen provides a wide array of services including individualized transition assessment, planning, consultation, training, and program development services, as well as pre-college coaching. She is particularly skilled in providing transition assessment and consultation aimed at determining optimal timing for a student’s transition to college, technical training, adult learning, and/or employment as well as identifying and developing appropriate programs and services necessary for minimizing critical skill gaps.

Ms. Challen is one of the only professionals in New England who specializes in assisting families in selecting or developing programming as a steppingstone between special education and college participation and has a unique understanding of local postgraduate, pre-college, college support, college transition, postsecondary transition, and 18-22 programs. She is additionally familiar with a great number of approved high school and postsecondary special education placements for students from Massachusetts including public, collaborative, and private programs.

Ms. Challen enjoys the creative and collaborative problem-solving process necessary for successfully transitioning students with complex profiles toward independent adulthood. As such, she is regularly engaged in IEP Team Meetings, program consultations, and case management or student coaching as part of individualized post-12th grade programming. Moreover, she continually works to enhance and expand NESCA’s service offerings in order to meet the growing needs of the families, schools and communities we serve.

When appropriate, Ms. Challen has additionally provided expert witness testimony for families and school districts engaged in due process hearings or engaged in legal proceedings centering on transition assessment, services and/or programming—locally and nationally.

Nearly two decades ago, Ms. Challen began her work with youth with special needs working as a counselor for children and adolescents at Camp Good Times, a former program of Milestones Day School. She then spent several years at the Aspire Program (a Mass General for Children program; formerly YouthCare) 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. Also, she 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 skill and transition programs.

Ms. Challen received her Master’s Degree and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard University Graduate School of Education. While training and obtaining certification as a school guidance counselor, she completed her practicum work at Boston Latin School focusing on competitive college counseling.

Ms. Challen has worked on multiple committees involved in the Massachusetts DESE IEP Improvement Project, served as a Mentor for the Transition Leadership Program at UMass Boston, participated as a member of B-SET Boston Workforce Development Task Force, been an ongoing member of the Program Committee for the Association for Autism and Neurodiversity (AANE), and is a member of the New Hampshire Transition State Community of Practice (COP).

She is also 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: Innovations that Enhance Independence and Learning.

To schedule an appointment with one of NESCA’s transition specialists, 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; the greater Burlington, Vermont region; and Brooklyn, NY (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

12

How the Pandemic Changed In-Person Learning

By | NESCA Notes 2024

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

Among the parts of my job that I find most meaningful are the conversations I get to have with parents during intake and feedback sessions. During an intake, much of the emphasis is on history taking. Some of it isn’t very exciting; trust me, I get that it can be tedious to review information like how much your child weighed at birth, how many ear infections they had, and when they learned to walk. Yet so often the information parents are able to share about a child’s history is crucial. There’s a quote attributed to Michael Ventura that says, “Without context, a piece of information is just a dot. It floats in your brain with a lot of other dots and doesn’t mean a damn thing. Knowledge is information-in-context… connecting the dots.” The history parents share provides essential context that helps us piece together and make sense of the data we get from doing an assessment in the office.

In recent years, we’ve added questions about COVID-19 to help us understand how that experience has impacted the children and teens we work with. I regularly ask parents, “How old was your child when COVID-19 hit? What grade were they in and how long did remote learning go on? When did they return to in-person instruction?” During a recent intake with a parent, I got an answer I wasn’t expecting. A very thoughtful and perceptive mom gave me some dates and ages then paused for a moment and added, “But even though they’re back in school, I don’t think learning has ever been the same since COVID.” I asked her to tell me more, and we had a wonderfully thought-provoking conversation. As so often happens, I learned a great deal from a parent. Since that time, I’ve extended the discussion to include some of my very insightful colleagues, who have also shared their thoughts. The consensus is that “in-person learning” in 2024 doesn’t mean the same thing it did in 2019. So, what’s changed?

Yes, students are, for the most part, sitting at desks inside classrooms rather than connecting remotely from their desks (or kitchen tables or couches) at home, but what happens in the classroom and beyond is different in some important ways.

Technology: In speaking with parents and colleagues in different fields, I’ve repeatedly heard that pandemic-related school closures “accelerated the use of technology” and “online learning platforms” in education. There was certainly a need to use online learning platforms during the pandemic, and the extent to which schools incorporated technology speaks to ingenuity and flexibility in the face of an unexpected and incredibly challenging situation. Moreover, technology is a wonderful tool that can be used to enhance learning in many ways. That being said, many parents and colleagues have observed that schools never went back to “how information and tasks were managed pre-COVID.” That is, technology and online platforms have remained a part of the learning experience. The challenge for some students is that even within the same school system, there can be a great deal of variability between the specific platforms individual teachers use and how they make use of them. Especially for students who struggle with anxiety or executive functioning weaknesses, keeping track of and switching between different platforms and applications for different classes can be overwhelming.
Different Teaching Methods: One of the trends I’ve observed directly and have gotten feedback on from others has to do with how teachers provide instruction in the classroom. Compared to “the before times,” the post-pandemic years have seen a rise in independent learning, even within the context of the classroom. More often, teachers have students work independently, whether that means reading through Google slides at their desks or completing worksheets and tasks on their own. There seems to be less direct teacher-led instruction and an increased reliance on independent learning, which often incorporates use of technology, such as Chromebooks, in the classroom. While some students thrive when given the freedom and flexibility to learn on their own, many students learn best when provided with instruction using more direct, structured, and an interactive approach.
The Boundaries are Blurred: Working adults will relate to this phenomenon. Back before COVID-19, many of us had pretty clear boundaries separating our work lives from our personal lives. We commuted to an office or other workplace, worked for a set time period, then went home. That all changed when many non-essential employees pivoted to working from home at the start of the COVID-19 lockdown. Suddenly our kitchens or bedrooms were transformed from private living areas to undefined spaces that housed both our personal lives and our work lives. And our work and home lives bled into each other as we tried to fit in work when we could, especially if we were also home-schooling or caring for children all day. Though many employees are back to the office at least to some extent, the boundaries remain somewhat blurred. The same phenomenon has happened for students. There is a “24-7 connectedness” that technology enables, which has both pros and cons. Because a lot of schools still use online platforms for assigning, submitting, and grading homework, teachers can post assignments at any time. One parent described a sense of assignments popping up online “like Jenga blocks, one layered in after another.” Similarly, students can turn in assignments at any hour of the day or night. One of my colleagues has observed that this has negatively impacted sleep habits for some students. Another colleague astutely pointed out that, not only can this be overwhelming for students, but it may also be contributing to some of the burn-out many teachers are experiencing.

Education has been perhaps permanently altered by the pandemic, just as many of us have been. The changes that have occurred bring benefits and challenges that our students and teachers are still adjusting to. I don’t have answers or solutions, but I know that I’m going to be adding to the questions I ask parents about COVID-19, education, and the impact on their student. It’s still important for me to learn when a student resumed “in-person learning,” but I’m no longer going to assume that phrase means the same thing it’s always meant. Instead, I’ll be asking parents to tell me what in-person learning looks like now, because the reality is that none of us has gone back to life circa 2019. Just like all of us, our students are living in the “new normal,” and we need to understand it so that we can support them in benefiting from the opportunities it brings and in navigating the challenges it poses.

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; the greater Burlington, Vermont region; and Brooklyn, NY, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

46

Preparing for a College Visit

By | NESCA Notes 2024

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

With vacation weeks coming up in Massachusetts and New Hampshire, many local families—especially those with juniors in high school—are contemplating visits to college campuses. School vacation weeks in the spring are a great time to visit colleges because you can tour the campus at a point in time when students are engaged in a typical flurry of academic and extracurricular activities. Summer may allow for more convenient or peaceful tours, but it is not a time of year when the happenings on campus accurately reflect student life (unless there is a very active summer session). Instead, spring and fall are often considered the optimal seasons for campus visits. For those of you planning upcoming visits, here are a few tips to consider—especially if you are a student with a learning disability, autism, or a mental health diagnosis.

Sign up ahead of time for the tour through the college’s web site. Even if a college does not require registration, potential students should go ahead and register for the college tour so that they get “credit” for their visit. There are lots of metrics that count as part of the college admissions process, and one of these important variables is literally the number of times that a potential student makes contact with the college. Things like registering for a tour, emailing admissions, following the college on social media, visiting with college representatives at college fairs, and signing up to receive materials by mail or email can all be considered “points of contact” with the college and may help students to ultimately be accepted.
Be prepared to answer a few questions about yourself. Most college information sessions or tours will start with the admissions staff and/or tour guide introducing themself and asking a few questions about the students in the group. Students should be prepared to share things like their name, hometown, grade, potential major, and clubs or activities they might want to participate in during college. Not all of this information will be requested outright, but some will typically be part of introductions and more may be asked during a presentation or tour. For students who have a hard time answering questions on the spot, they will feel much more comfortable if they have thought about—and practiced—answering these questions before the tour. They can also be more actively involved. Terms like undergraduate, graduate, first-year, and transfer may also come up when visiting colleges, and it can be helpful to review some college vocabulary ahead of time so that students are not flustered in the moment.
Ask questions of your own! (But make sure you are asking the right people your questions.) Information sessions and college tours are typically facilitated by admissions staff and college students. These are the times when you are learning about the college in general and getting a sense of campus culture, facilities, and services available to all students on the campus. For legal reasons, college admissions and college disability supports are notably separate entities. This means that college information sessions and tours are not typically the time and place for accommodation- and disability-specific questions. So, what questions should you ask? Well, there are plenty of web-based resources that you can look to in order to create your own personal list of tour questions. Here are just a few you might find interesting:
- 60 Questions to Ask on Your College Tour – https://www.princetonreview.com/college-advice/questions-to-ask-on-a-college-tour
- 16 Must-Ask Questions on Your Next College Tour – https://www.highpoint.edu/admissions/16-must-ask-questions-on-your-next-college-tour/
- Don’t Waste Your College Visit, Ask the Right Questions – https://www.forbes.com/sites/brennanbarnard/2023/02/06/dont-waste-your-college-visit-ask-the-right-questions/

Even if you have done online research about a college, it’s a good idea to ask a few questions about items that are important to you to see if things on campus are really as described. Also, if you are a student with a disability, you might ask some of the questions that get at culture and inclusion: What’s it like to be a new student on campus? How do you see the college demonstrate commitment to diversity and inclusion? What controversial issues have come up on campus?

Don’t panic if you don’t see yourself or your student in the tour guide. College tour guides are typically some of the highest performing, actively involved students at the college and are usually representative of an extreme rather than the “average” student. While these students are certainly a part of the campus and culture, it is important to get a sense of who else is on the campus. Take time to observe and talk with other students you see walking around on campus. If you can, circle back to an academic building in an area of interest and find a student to talk to there. Or just stop a few students around campus and ask informal questions (e.g., Why did you pick this college? What do you wish you could change? What do you do like about being a student here? What do you wish you knew before you started college here?).
Take time to eat on campus. Make time before or after your tour to eat in a main cafeteria or campus center. If you are going to be eating three meals a day on campus, its important to know what that experience will be like. Certainly, the food is important. You need to know if there are a variety of food options and that there is something you would be comfortable eating for all meals. Also, you want to get a sense of the atmosphere, including how crowded it is and how easy it is to find a table.
If you are just getting started on your college search process and do not have a set list of schools yet, don’t worry. You can still get out and visit schools. I often suggest starting with different college archetypes (e.g., big school, little school, school spread out in a city, school with more defined campus, private, public, community, etc.). It can be good to just pick a few different school types, visit the colleges, and then do some real downloading of information and preferences immediately after the visits. I often ask students to do some ratings of colleges as they leave the schools so that they can quantify their “gut feeling” about a school and use that for comparison even if they aren’t sure exactly what it was that they liked or disliked. Even a bad college visit can help to determine some of the things that are most important about the college search process!

Embarking on college campus visits is a bit of a house hunting process—you are looking at potential academic homes. It can definitely be overwhelming, especially when it’s a process that you have not been through before and you may not know exactly what you want or what’s worth looking at. But you have to start somewhere. Following these suggestions should allow you to get a true sense of campus life and culture while also learning about yourself and your own preferences and values. Be prepared, but also trust yourself, and let each experience help you learn who you want to be as a future college student.

NESCA offers many services designed to help students bridge the transition from high school to college, work, and more independent adult life. Such services include executive function coaching, pre-college coaching, transition planning, and neuropsychological evaluation. To learn more specifically about our coaching services, visit: https://nesca-newton.com/coaching-services/ . NESCA also offers postsecondary transition consultation to families who want support identifying whether students are ready for college transition, or they may need a step in between or a scaffolded transition: https://nesca-newton.com/transition/#planning. To schedule an appointment with one of our expert clinicians or coaches, please complete our intake at: https://nesca-newton.com/intake/.