NESCA Notes 2024 Archives - Page 7 of 8

11

Is My Child Neurodivergent, and What Does That Mean?

By | NESCA Notes 2024

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

One of society’s leading sources of information is social media, which can be an excellent source of information and support. Parents may turn to social media when they notice their child struggling, trying to find others with similar concerns or answers about why their child seems “different.” Additionally, many children, adolescents, and young adults who feel different or out of place seek and find people or ideas that resonate with them online. While it may put them at ease, it often leads parents and their children to question if there is a diagnosis that will help them understand their child or themselves. Increasingly, people are asking if it is autism or another neurodivergent condition.

Neurodivergence is a term used to describe individuals whose brains function differently from what is considered typical. Neurodivergence is a broad term describing neurodevelopmental disorders present at birth and lasting throughout one’s life. Identifying if your child is neurodivergent can be the first step in understanding their unique strengths and challenges. There are numerous neurodivergent conditions, such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), dyslexia, and others, each with their own characteristics and support needs.

Recognizing signs of neurodivergence in children can vary depending on the specific condition, but some common indicators include:

Difficulty with social interactions and communication
Repetitive behaviors or intense interests
Sensory sensitivities or aversions
Challenges with attention and focus
Delayed speech or language development
Difficulties with organization and planning
Impulsivity or hyperactivity
Unusual reactions to sensory stimuli
Emotional regulation difficulties
Learning and academic challenges

Observing patterns of behavior, communication, and sensory processing in your child can help indicate if they may be neurodivergent. Seeking a professional evaluation from a psychologist or developmental specialist can provide a more accurate diagnosis and guidance on supporting your child effectively. It is essential to remember that neurodivergence is not a label or limitation but a spectrum of diverse traits and abilities that contribute to the richness of human experience. By recognizing and embracing neurodiversity, society can benefit from the unique perspectives, talents, and contributions of individuals with diverse neurological profiles. Proper diagnosis, support, understanding, and accommodation are essential in helping neurodivergent individuals thrive and succeed in their lives.

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 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.

13

The Intersection of Mental Health and Executive Function

By | NESCA Notes 2024

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

Mental Health challenges and executive function (EF) deficits are often intertwined, as one can easily impact the severity of the other. As a psychotherapist and executive function coach, I find myself regularly assessing my clients with comorbid EF and mental health challenges in order to identify which presented first.

Why does this matter?
Emotional regulation and executive control both live in the frontal lobe of the brain. They operate close together and impact one another. Because of this, mental health challenges, such as depression and anxiety, can be overlooked and mislabeled as an executive function deficit. Identifying the root cause of a student’s EF struggles is critical for properly planning appropriate next steps and necessary supports. For example, if a student’s depression is causing them not to initiate and/or complete work, the depression usually needs to be addressed before they receive EF coaching. If the student is already working with a mental health professional, such as a therapist, it is important for them to be cleared by the therapist to add in an EF coach. Working on too many new skills at once can be overwhelming, so it is important that enough foundational coping skills are learned first.

An example of anxiety causing an EF deficit:
Clara gets extremely anxious in social situations due to a lack of self-esteem. She had a negative experience in middle school where other students made fun of her lisp whenever she read out loud in class. Now, in high school, Clara is afraid to ask questions, even when she is confused. She is left not fully understanding the material, class assignment expectations, or how to approach studying for quizzes and tests. Rather than asking for help, Clara keeps to herself. Even when teachers offer to help her, she responds with, “Thank you, but I’m all set.”

Clara’s parents can see that she struggles to initiate homework assignments, rarely studies for upcoming tests, and that her grades are declining. They don’t fully understand why, because when they ask her, she is quick to deflect and change the subject.

By checking in with Clara’s teachers, her parents may receive feedback that she often shies away from their support. With a lack of understanding why, her teachers aren’t sure how else to approach the situation other than continuing to check in. Jumping into EF coaching to address her task initiation and study skills may help, but it doesn’t address the root of the problem. A more appropriate action plan would be for Clara to first receive psychotherapy, addressing the bullying that led to her social anxiety and self-esteem issues and then shifting to EF skill building.

An example of an EF deficit causing anxiety/depression:
Gabriel is a seventh grade student diagnosed with ADHD. He has a difficult time advocating for himself and asking for help due to some additional communication challenges. His ADHD also makes it challenging to stay on task and pay attention to details. This results in Gabriel constantly forgetting what his homework assignments are and when they are due, creating a lot of missing work. Gabriel’s teachers are often redirecting him and reminding him of incomplete work. They have tried to help him develop plans to make it up, but he struggles to follow through with these plans. At home, Gabriel’s parents often share their frustrations with him and try to help him get back on track. With adults constantly reminding him he’s behind, Gabriel has developed internalized anxiety, often wondering why he can’t be like everyone else. He tries so hard to remember what his homework is and when it is due, but can never seem to get it right. Over time, he begins to experience symptoms of depression as his self-esteem declines.

In this situation, Gabriel’s lack of EF skills is the root cause of his negative thinking patterns. By receiving EF coaching, he can learn ways to regularly track his assignments. He can be taught how to break them down into smaller, more manageable tasks in a way that helps him overcome procrastination. Additionally, he is able to become proactive and communicate with his teachers so that they are kept on the same page. As these skills get stronger, Gabriel becomes more responsible, and gets praise from his teachers and parents in return. Given the impact of this situation, he may also benefit from short-term counseling to better understand the connection between his EF and anxiety. Increased self-awareness helps students learn how to advocate for themselves the next time they encounter a similar situation.

Does this sound familiar?
These scenarios are common and can be difficult to navigate without proper assessment and guidance from professionals. If you or your child struggles with mental health and EF-related challenges and you are not sure where to start, book a free introductory call with me or one of our other wonderful and experienced EF coaches. NESCA also offers comprehensive neuropsychological evaluation services and neuropsychological consultation for families who are wondering about possible missed learning, attention, mental health, or other diagnoses. We look forward to working with you!

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 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.

45

Summer Planning for Teenagers

By | NESCA Notes 2024

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

March is an incredibly busy time in my household. Three out of four of our family members celebrate birthdays, winter sports turn into playoffs, and school events seem to pop up every week. March is also the time when we finalize our “summer camp plan” and manage lengthy online registration processes. If you have a teenager in the household, particularly a teen with a disability, you may also be thinking about summer and feeling particular pressure to “make the most” of the time while your child is still in high school. In case you are still scrambling for your own summer plan, I wanted to offer up several activities that are worth considering as part of your teen’s summer plan.

Get a paid summer job! Time and time again, research indicates that individuals who have paid employment in high school are more successful college students and more successful in obtaining employment as adults. If your child is college bound, having a paid work experience among their high school activities is a huge boost to their college applications. And, if not, paid work experiences teach soft skills for employment, help students figure out more about their career interests and preferences, and help to build meaningful resumes. Being able to do work that meets someone else’s standards is a vital life skill, and summer is an optimal time to build that skill.

Gain overnight experience. Students who plan to go to college but have never spent a night away from home need to know how they are going to handle that experience. There are all sorts of summer programs where students can spend time overnight, away from home, among peers. Overnight programs vary in length. Students who are just venturing out for the first time may feel most comfortable in a program that lasts a week or less, whereas other students may want a 3-week or 6-week experience. For college-bound students, I often recommend taking advantage of programs that happen right on college campuses in dorms. But there are also great programs outdoors or even travel programs in the United States or overseas. Knowing that you can spend the night away from family (and knowing what it’s like to “live” among a whole group of young people) is often a critical step in setting post-high school goals.

Use the time to build new executive functioning or emotional regulation skills. Students who struggle with executive functioning or emotional regulation often need coaching or therapy during the school year, just to keep up with school activities. However, students and families often reach out for these resources because they are already in crisis. A student will seek out an executive function coach when a student is already behind with assigned work or grades. Families often seek out therapy when an emotional crisis has occurred. School provides a number of executive functioning and emotional demands, so it can be hard for a coach or therapist to build new skills with a student while the student is also meeting those demands. Summer can be an optimal time to work more intensively to build new skills, strategies, and systems because it is a time when other demands are reduced. If your teen has a therapist, tutor, executive function coach, social pragmatic coach, or other support person who is helping them to tread water during the school year, it’s definitely worth asking whether intensive services over the summer might help the student to build skills that will last long-term and help the student be better prepared for the following school year.

Summer can also be a great time to tackle time-consuming activities, like completing the college application, drafting a college essay or two, cleaning out a bedroom or reorganizing study space, or building a new life skill, like driving, cooking, or mastering a laundry routine.

March is a great time to take stock of what your teenager wants to do after high school, what challenges might impede them smoothly transitioning to those activities, and thinking about how summer might be the perfect time to eliminate some of those challenges!

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 the most meaningful ways for their student to spend the summer: 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/.

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.

5

Mindfulness-based Interventions for Children with ADHD

By | NESCA Notes 2024

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

Children with Attention Deficit-Hyperactivity Disorder (ADHD) often struggle to sustain attention, follow directions, and appropriately interact with peers when compared to children with typical development. Executive functioning challenges, including difficulties with self-regulation, are also common in individuals with ADHD. Executive functioning refers to the neuropsychological-based functions involved in the regulation of behavioral states and the organization of goal-directed behavior. This can present as difficulty breaking down goals into steps, planning, monitoring the effectiveness of an approach to a task, modulating one’s emotions, etc.

Currently, evidence-based treatment methods for managing ADHD symptomology include medication, behavioral interventions, or the combination of the two. In addition, one domain that has received increased attention from the scientific community over the past several years is the integration of mindfulness-based interventions (MBI) within treatment (Felver & Jennings, 2016).

Mindfulness is the ability to bring one’s attention to experiences occurring in the present moment, which can allow an individual to consider alternative ways to perceive and react to a situation (Singh et al., 2007). Many MBI curriculums include lessons on focusing one’s attention on the present moment, which can improve individuals’ self-regulation, executive functioning, concentration, and emotional-reactivity, while reducing aggressive behavior, social problems, and anxiety (Keng et al., 2011; Parker et al., 2014).

One such curriculum, originally developed for adults with Intellectual Disabilities and aggressive behaviors, is Soles of the Feet (SoF) (Singh et al., 2003). The purpose of this exercise is to shift the individual’s attention from a typically triggering situation to a neutral stimulus. The SoF intervention involves teaching an individual to recognize situations that trigger an emotional response in real life or through role-play scenarios. Next, the individual is guided through steps in the curriculum that consist of finding a neutral body posture, breathing naturally while thinking about the triggering event, and shifting attention to the soles of the feet. Then the individual is guided to be mindful of their feet on the ground. The goal is for the individual to end this process having appropriately responded to the situation without engaging in behavior that was contrary to expectations. Research suggests that engaging in this intervention significantly improved participants’ ability to regulate their aggressive and disruptive behaviors, and appropriately engage with others (Felver et al., 2013; Singh et al., 2007).

There are several mindfulness-based activities, such as progressive muscle relaxation and focusing on your five senses, that can be modified to support children’s attentional and emotional regulation. For some ideas, please consider visiting the American Psychological Association (APA)’s Magination Press website, where they offer several children’s book titles related to a variety of topics, including mindfulness.

References

Felver, J. C., Doerner, E., Jones, J., Kaye, N., & Merrell, K. M. (2013). Mindfulness in school psychology: Applications for intervention and research. Psychology in the Schools, 50, 531–547

Felver, J. C., Celis-DeHoyos, C., Tezanos, K., & Singh, N. N. (2016) A systematic review of mindfulness-based interventions for youth in school settings. Mindfulness. doi:10.1007/s12671-015-0389-4

Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: a review of empirical studies. Clinical Psychology Review, 31(6), 1041-56.

Parker, A. E., Kupersmidt, J. B., Mathis, E. T., Scull, T. M., & Sims, C. (2014). The impact of Mindfulness education on elementary school students: evaluation of the Master Mind program. Advances in School Mental Health Promotion, 7(3), 184-204. doi:10.1080/1754730x.2014.916497

Singh, N. N., Wahler, R. G., Winton, Adkins, A. D., Myers, R. E., & The Mindfulness Research Group. (2003). Soles of the feet: A mindfulness based self-control intervention for aggression by an individual with mild mental retardation and mental illness. Research in Developmental Disabilities, 24, 158–169.

Singh, N. N., Lancioni, G. E., Winton, A. S. W., Singh, J., Curtis, W. J., Wahler, R. G., & McAleavey, K. M. (2007). Mindful parenting decreases aggression and increases social behavior in children with developmental disabilities. Behavior Modification, 31(6), 749-771. doi:10.1177/0145445507300924

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; 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

A Little Coaching for Caretakers Goes a Long Way When Building Executive Function Skills for Students

By | NESCA Notes 2024

By Jasmine Badamo, MA
Educational Counselor; Executive Function Coach

In my work as an executive function tutor, a priority is to foster collaborations with the other adults in my clients’ lives. Every relationship brings something different to a young person: different perspectives, areas of expertise, support abilities, opportunities for conflict management, etc. But while every person in your child’s life plays a unique role in their growth, family members often serve as the “control tower” for communication between the various environments of a child’s life. That’s why, of all the collaborations I engage in, parent/guardian collaboration can have the most significant impact on my clients’ executive functioning progress.

When I start working with an executive function client, I work to establish a clear line of communication with caregivers at the outset so they are well-informed of our session work. But direct parent/guardian coaching allows for collaboration on a much deeper and consistent level. Similar to executive function tutoring, parent/guardian coaching is regularly scheduled, has established goals, and serves as a space to discover and learn different strategies for supporting executive functioning skill development. Furthermore, because of the individualized nature of coaching, it can address a wide range of family needs, such as assistance with school documentation; brainstorming and creating home supports for a neurodivergent child; receiving reassurance and guidance in difficult-to-navigate or novel parenting situations; and managing your own daily demands so that you have more bandwidth for supporting your child, etc.

Here are some example situations demonstrating when and how parent/guardian coaching can have a big impact:

→ Your child is in elementary school and is still developing their self-awareness and ability to self-reflect. In their weekly executive function tutoring, they cannot always accurately self-report the daily demands they face or struggle with. You’ve set up brief weekly parent/guardian coaching in order to share important background/contextual updates that will help me direct my tutoring focus and strategy suggestions. I offer weekly tips that help you to practice accurate self-reflection with your child. It also allows you to share any new concerns that arise.

→ Your 9th grade child has been working with an executive function tutor for a little over a year now and has learned several executive function management strategies. They’ve reached the point in their development where they need to generalize their knowledge. You’ve decided to start parent/guardian coaching because you are uniquely positioned to support this generalization at home. I touch base with school staff to also support generalization at school.

→ Your high school child is struggling with executive functioning, and you want them to get support, but they are not open to meeting with an executive function tutor. You start parent/guardian coaching in order to learn concrete strategies to support your child with the executive function demands of school and home. The parent coaching is also helping you to reflect on the ways you can facilitate a better communication dynamic with your child.

As you can see in the above examples, even though the coaching sessions are attended by the parent/guardian, the purpose of the work is to supplement the executive function (EF) development of your child. Here are just a few ways in which parent/guardian coaching contributes to your child’s success. Coaching can:

→ help you further create a home environment that is supportive of your child’s EF needs and skill development

→ help you know how to “lend” your prefrontal cortex to your child in a way that reduces overwhelm, but still provides limits so that they have opportunities to develop and practice skills for managing EF tasks with greater independence

→ help you expand your strategies for responding to challenges or conflicts that arise while working on EF goals between tutoring sessions

→ help you know how to prioritize your focus in supporting your child’s goals (there are so many resources, it can be a challenge to know which to start with)

→ help you use strategies that promote a mindset of growth, reflection, and self-compassion (all important for your child’s EF skill development)

→ help normalize the act of receiving help and support. Your commitment to coaching models for your child the importance of getting support for your needs, being open to feedback, and embracing personal change/growth.

The list can go on because the opportunity to work with clients and caretakers in tandem offers exponential benefits for the client. What parent/guardian coaching does on a fundamental level is support families in developing a new filter, perspective, and framework for approaching and supporting the young person’s executive function needs.

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.

8

Redshirting: Pros and Cons of Delaying a Child’s Entry to Kindergarten

By | NESCA Notes 2024

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

Redshirting is a phrase that has traditionally been associated with college athletics, such as when coaches “redshirt” first-year athletes, providing younger athletes an additional year to develop skills and extend their playing eligibility. Academically, redshirting your child means choosing to delay kindergarten for a year even though your child is technically old enough to attend kindergarten.

Current research suggests there are pros and cons to redshirting kindergarten depending upon your child’s development and needs. One advantage of redshirting is the opportunity for the child to develop emotional maturity. While some students are ready academically, they may not be ready emotionally. This difference becomes particularly notable in the middle school and high school years, as a year difference in age (or almost two years if some students have been redshirted and your child is young for their grade), can lead to exposure to topics and behaviors your child is not emotionally ready for.

However, if your child has an identified or suspected disability, or you feel they may need extra help in school, you may not want to redshirt, as doing so would result in delay of necessary services provided free through the public schools (e.g., occupational or speech therapy, specialized academic instruction), which research finds to have a meaningful impact on improving a student’s long-term outcome. Additionally, if redshirted, a child loses up to a year of special education eligibility at the other end of their school experience if a student has significant disabilities covered under the IDEA, as those services end based on age (e.g., special education rights end at the age of 22 in Massachusetts).

To help you make an informed decision, it is also recommended that you speak with your child’s preschool teacher in addition to any professionals (e.g., speech therapist or psychologist) working with your child. You may also want to consider meeting with an educational consultant who specializes in this area. Finally, you may consider a neuropsychological evaluation to gain a better understanding of your child’s strengths and challenges as well as to obtain educational recommendations.

Clearly, there is no right or wrong answer to redshirting in kindergarten. It is highly dependent on a child’s level of development and needs. Parents are encouraged to watch for signs of readiness, such as the ability of their child to communicate and listen well, follow instructions, and be able to sit and focus for 10-15 minutes at a time. Also, having a good understanding of your child’s developmental profile (language skills, self-regulation skills, social skills, etc.) can help a parent make an educated decision.

Sources

https://www.psychologytoday.com/us/

https://www.sciencedirect.com/

https://cepa.stanfod.edu

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; 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.

10

Understanding the Neuropsychological Evaluation Process When an Autism Spectrum Disorder is Suspected

By | NESCA Notes 2024

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

In January, Dr. Folsom published a blog post detailing the reasons why so many females on the autism spectrum are misdiagnosed in childhood. Here at NESCA, we are continuously working to improve our testing practices and administration protocols to ensure that we accurately capture one’s diagnostic picture when they come in for a comprehensive neuropsychological evaluation regardless of gender identity, age, or diagnostic presentation. As clinicians, tailoring an appropriate testing protocol is only one piece of the puzzle when working with our clients. From the moment we review your intake paperwork and questions/concerns, we work diligently to make sure we are teasing apart each component of a child’s neuropsychological profile to ensure clarity and accuracy for diagnoses and tailored recommendations. Here is a look into some of what that process looks like:

Initial Paperwork: Before your first intake appointment, your clinician will thoroughly review all of the intake paperwork and supporting documents you have submitted to us. We make sure to read all of your questions and concerns, while also making our own notes of questions that we will have for you during the intake appointment. All neuropsychologists here at NESCA are trained to identify “red flags” or areas of potential concern that we want to know more about through our interviews with you, your child, teachers, and our testing protocols.

Intake Appointment: During this appointment, we will ask you more in-depth questions about your responses and questions from the intake paperwork you provided. This is an opportunity for us to explore any concerns we may have. For many diagnoses, there are overlapping diagnostic features that are important to tease apart. For example, inflexibility and rigidity (not handling transitions well, struggling with changes in routine) may be related to an anxiety diagnosis, a mood disorder, an autism spectrum diagnosis, and/or executive functioning weaknesses.

Speaking with Collaterals: Oftentimes, clinicians will ask for permission to speak to other caregivers who have knowledge of your child, such as teachers, therapists, and pediatricians. Because we only see your child for a “snapshot” in time, it is important for us to also consider the perspectives of those who have longstanding relationships with them in a variety of contexts and environments.

Developing a Testing Battery: After the intake appointment, clinicians put together a tentative list of assessment measures that we may want to utilize. Tentative is the key word because oftentimes testing batteries change throughout the course of the assessment as a diagnostic picture becomes clearer or when specific areas of deficit become more apparent.

At NESCA, we have access to multiple testing tools that allow us to tailor our testing battery to capture any nuanced constellation of symptoms or diagnostic profile. For example, when thinking about how to accurately diagnose someone who is “high functioning” or “masking” areas of vulnerability related to an autism spectrum diagnosis, clinicians have access to the following batteries:

Autism Diagnostic Observation Schedule—2^nd (ADOS-2): The ADOS-2 is one of the most well-known assessments for autism as it utilizes a semi-structured format to assess social communication skills as well as restricted interests, repetitive behaviors, sensory sensitivities, and rigidity. The ADOS-2 relies on standardized observations to capture any difficulties in the aforementioned categories.
Childhood Autism Rating Scale—2^nd (CARS-2): The CARS-2 is another measure that involves a standardized rating scale based on direct observations of the child. While playing and interacting with your child, the clinician is able to fill out this rating scale to assess symptoms associated with an Autism Spectrum Disorder. The CARS-2 also includes a parent questionnaire to allow for qualitative parent observations.
Monteiro Interview Guidelines for Diagnosing the Autism Spectrum—2^nd (MIGDAS-2): The MIGDAS-2 assesses qualitative observations of language and communication skills, social relationships, emotional responses, as well as sensory interests and/or sensitivities. The MIGDAS-2 can be particularly helpful for children and adolescents who are “high-functioning,” or do not fit the presentation of the “male prototype” described in Dr. Folsom’s blog.
Social Language Development Test (SLDT): The SLDT measures social communication skills such as the ability to make inferences, interpret social situations, and navigate peer conflicts.

In addition to the above measures, clinicians may also choose to administer subtests related to social thinking, perspective taking, and/or emotion identification. Examples of these subtests include:

Affect Recognition and Theory of Mind from the NEPSY-II
Inferences, Meaning from Context, Idiomatic Language and Pragmatic Language on the CASL-2

For older children and adolescents, clinicians may ask them to fill out/answer questions about their own perceptions of their lived experiences. This can be done through an unstructured interview or by one of the following:

Camouflaging Autistic Traits Questionnaire (CAT-Q)
Ritvo Autism Asperger Diagnostic Scale—Revised (RAADS-R)
Autism Spectrum Quotient (ASQ)

Parent Questionnaires: Whenever there are any questions or concerns related to social communication and interpersonal relatedness, your clinician may ask you to fill out rating scales assessing your perception of your child’s ability to interact with others, engage in age-appropriate play, be flexible in their responses to change or new environments, and have a variety of interests. These questionnaires include:

Social Responsiveness Scale—2^nd (SRS-2)
Social Communication Questionnaire (SCQ)
Autism Diagnostic Interview—Revised (ADI-R)
Gilliam Autism Rating Scale—3^rd (GARS-3)
Gilliam Asperger’s Disorder Scale (GADS)
Autism Spectrum Rating Scales (ASRS)

As you can see, we have a wide variety of measures available at NESCA to look at symptoms of an Autism Spectrum Disorder. Based on the discretion of your clinician, one or more of these may be used to further assess social communication concerns. While you may have heard of some of these being referred to as “the gold standard,” your clinician will use their knowledge, experience, and training to tailor a testing battery for the individual needs of your child. There is never a one size fits all approach to neuropsychological testing!

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, including attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.

To book an appointment with Dr. Miranda Milana or another expert NESCA neuropsychologist, please complete our Intake Form today.

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

Technology Tools to Boost Your Productivity Part 2

By | NESCA Notes 2024

By: Lyndsay Wood, OTD, OTR/L
NESCA Executive Function and Real-life Skills Program Manager

As winter envelops us in its chilly embrace, it’s easy to feel the drag on our productivity. The cold, dark days can sap our motivation, making it challenging to tackle our to-do lists. But fear not! In this second part of our series on technology tools to enhance productivity, we’ll explore five more applications designed to support you through the winter slump.

Before diving into these tools, remember to be kind to yourself. It’s normal to experience dips in productivity, especially during the winter months. These apps are here to provide an extra boost for those who may need it.

Finch: Finch is a self-care app used to build healthy habits and routines. Within this app you will be given a virtual pet bird. As you set, meet, and reach your goals, you will boost your pet’s energy so that it is able to go out on adventures. You will earn coins to buy your pet new outfits, home décor, and flights to new destinations. This app helps gamify the process of building healthy habits by creating fun incentives to get your tasks done.
Forest App: Spending too much time on your phone or computer can contribute to feelings of lethargy and distraction, especially during the winter months. Forest is a clever app that encourages you to put down your device and focus on what’s important. Simply set a timer, plant a virtual tree, and watch it grow while you work. If you succumb to the temptation of checking your phone or browsing the web, your tree will wither and die. With Forest, you can cultivate healthier digital habits and reclaim your productivity.
Cozi: Cozi is a family organizer app designed to streamline your household routines. From managing schedules and appointments to coordinating grocery lists and meal plans, Cozi helps keep your family on track during the hectic winter months. With shared calendars and reminders, everyone stays in sync, reducing stress and ensuring that nothing falls through the cracks.
Streaks: Forming good habits is essential for maintaining productivity, especially when the days are short and the nights are long. Streaks is a habit-tracking app that helps you establish and maintain positive routines. Whether you want to exercise more, drink more water, or practice mindfulness, Streaks makes it easy to track your progress and stay motivated. Streaks empowers you to build habits that stick, even when the winter weather tempts you to hibernate.
Headspace: Taking care of your mental well-being is crucial, especially during the darker days of winter. Headspace is a meditation app that offers guided mindfulness exercises to help you reduce stress, improve focus, and cultivate a sense of calm. Whether you’re struggling with seasonal affective disorder or simply feeling overwhelmed by winter blues, Headspace can provide the support you need to prioritize your mental health and boost your productivity.

The winter months can be challenging, but with the right technology tools at your disposal, you can stay focused, organized, and productive. Whether you’re building healthy habits and routines, reducing screen time, coordinating family schedules, or prioritizing mental health, these apps are here to support you every step of the way. So don’t let the winter blues hold you back—embrace the power of technology and conquer your to-do list!

About Lyndsay Wood, OTD, OTR/L

Lyndsay Wood, OTD, OTR/L, Vermont-based Executive Function and Real-life Skills Program Manager, is an occupational therapist who focuses on helping students and young adults with disabilities to build meaningful skills in order to reach their goals. She has spent the majority of her career working in a private school for students with ASD. She has also spent some time working in an inpatient mental health setting. Lyndsay uses occupation-based interventions and strategies to develop life skills, executive functioning, and emotional regulation. While completely her doctoral degree at MGH Institute of Health Professions, Lyndsay worked with the Boston Center for Independent Living to evaluate transition age services. She uses the results from her research to deliver services in a way that is most beneficial for clients. Specifically, she focuses on hands-on, occupation-based learning that is tailored the client’s goals and interests.

Dr. Wood accepts Vermont- and Massachusetts-based transition and occupational therapy assessments. Her in-home and community-based coaching services are available in the greater Burlington, Vermont area. Dr. Wood can accept virtual coaching clients from both Massachusetts and Vermont.

To book coaching and transition services 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.

46

Why is it so hard to develop Executive Function skills for college as a high school student?

By | NESCA Notes 2024

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

Students with disabilities often have challenges with executive function skills. These may include difficulties with organization, planning and prioritization, time management, task initiation, attention and effort, working memory, self-regulation, self-monitoring, and mental flexibility. Being successful as a college student often depends on using and integrating these skills. Therefore, it’s no surprise that most of the IEPs I read when working with teenage and young adult students have goals or objectives aimed at remediating executive function (EF) skills. However, many students on IEPs have these “EF” goals for years and still don’t effectively develop the skills they need to successfully manage executive functioning tasks as college students.

One of the reasons for the remaining skill gap when students matriculate to college is because high school student responsibilities are pretty radically different from college student responsibilities. While research indicates that individuals can continue developing executive function skills throughout the lifespan, this requires a very particular set of activities. Executive function skills develop through a combination of direct instruction and opportunities to practice using the learned skills with and without support. But there often are not opportunities for practicing the skills needed for college as a high school student.

Below is a list of executive function supports that exist in high school, but often disappear in college:

Classes are small and always taught by teachers
Class material is centralized in books or on the board in the classroom
Time is structured by the school
Students are told what they need to learn from homework
Students are reminded of assignments and due dates
Completed homework is checked by teachers
Reading is discussed in classes
Studying is limited to a few hours per week
Testing is frequent and covers small amounts of material
Teachers approach students who need help
Schools are required to find students with disabilities who need specialized instruction and accommodations
Parents and teachers will remind students of their responsibilities
Parents and teachers will help to set priorities (or simply set them for the student)
Parents and teachers will correct students when behavior is unexpected

In college, students may have large classes taught by other students or experts in their fields who aren’t experts on teaching. They have to use syllabi, manage their own schedules (with large swaths of unscheduled time), integrate academic materials from a wide range of sources, and self-direct long hours of reading and studying. They also have to be responsible for advocating for themselves, knowing when they need help, and knowing what they are responsible for (academically, socially, and in their dorms) and getting those things done without parent and teacher reminders. For students who have strengths with executive functioning, often the transition to college still presents a steep learning curve. But for those who have vulnerabilities in these areas, it can be critical to recognize that the gaps are large between these two learning environments, and sometimes additional support and instruction is necessary while students are taking college classes. Some students will still need to build effective academic and executive function skills, and practice and master those executive function skills, while they are in college and managing this new set of demands.

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 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/ .

Reference:

Many of the bulleted items of executive function supports that exist in high school are adapted from this high school versus college comparison by King’s College: https://www.kings.edu/admissions/high_school_vs_college