NESCA’s Newton, MA location has immediate availability for neuropsychological evaluations. Our MA clinicians specialize in the following evaluations: Neuropsychological; Autism; and Emotional and Psychological, as well as Academic Achievement and Learning Disability Testing.

Visit www.nesca-newton.com/intake for more information or to book an evaluation.

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NESCA Notes 2025

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Image of a child reading, quote by Olivia Rogers, SLP

Literacy & Language: Intertwined Systems Through the Lens of Scarborough’s Reading Rope

By | NESCA Notes 2025 | No Comments

Image of a child reading, quote by Olivia Rogers, SLPBy Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

Literacy is often viewed as a set of academic skills – reading, writing, spelling. But at its core, literacy is a language process. Scarborough’s Reading Rope illustrates how language comprehension and word recognition weave together to create skilled reading.

Image of Scarborough's Reading Rope

Image courtesy of Dr. Hollis Scarborough, 2001.

Language Is the Foundation of Literacy

Students may decode fluently but without language, they will struggle with retelling, summarizing, inferencing, written organization, and academic demands. Before students can read for meaning or write to communicate ideas, they need the language system that carries meaning. Literacy is not just recognizing words on a page; it is understanding and expressing ideas through text. That requires language.

Language supports literacy through several mechanisms:

  1. Vocabulary gives words meaning. Decoding tells a student how to say a word. Language tells them what it means. If a student reads the word “evaporation” but doesn’t know the concept, comprehension breaks down. Depth of vocabulary – not just number of words – predicts reading comprehension.
  2. Syntax supports sentence comprehension. Written language is more complex than spoken language. Students must interpret longer sentences, embedded clauses, passive voice, academic phrasing. Understanding sentence structure is a language skill that allows students to follow these complex texts.
  3. Narrative language supports text structure. Stories, informational texts, and essays all follow organizational patterns. Students rely on language to understand text features buried within, such as cause and effect, problem–solution, character motivation, sequencing events, and more. Narrative and discourse skills are the blueprint for comprehension and writing.
  4. Internal language supports strategy use. Skilled readers talk themselves through text using internal dialogues such as, “This part is confusing,” or “Let me reread.” Skilled readers make connections, with internal dialogues, such as, “This reminds me of….” This internal self-talk is language acting as executive control over literacy.

Literacy Strengthens Language

The relationship then flips. Reading and writing expand vocabulary, syntactic complexity, narrative structure, verbal reasoning, and metalinguistic awareness. Literacy becomes one of the most powerful engines for language growth. Reading and writing expose students to language they rarely hear in conversation.

Literacy strengthens language in several ways:

  1. Literacy expands vocabulary exponentially. Books contain more rare and precise words than everyday speech. Research shows that repeated text exposure builds semantic networks, conceptual knowledge, word relationships, and morphological awareness.
  2. Text builds complex language. Students encounter longer, more complex sentence structures through reading. Over time they begin to understand complex syntax, produce more sophisticated sentences, use academic language, and embed ideas within ideas. Writing then reinforces this!
  3. Literacy develops discourse and organization. Writing requires students to externalize language structure. In order to write, they must plan ideas, sequence information, clarify meaning, and revise their work. This strengthens expressive language far beyond conversation.
  4. Reading builds knowledge, which builds language. Background knowledge fuels comprehension. As students read, they gain concept knowledge, world knowledge, topic vocabulary, and schema (a fancy word for background knowledge and how it is organized). Language becomes richer because knowledge expands.

The Big Picture

Literacy and language are strands of the same rope, continuously shaping each other as students grow. Targeting both areas together can improve comprehension, written expression, and classroom participation. Language makes literacy possible, and literacy accelerates language growth.

At NESCA, we use evidence-based strategy to target language and literacy. Our clinicians use a comprehensive approach to treat the systems of learning as integrative, helping students develop valuable skills they can use in and out of the classroom! For more information on Speech and Language Therapy and Literacy Support at NESCA, please complete our online Inquiry/Intake Form or email me directly at orogers@nesca-newton.com.

 

Reference:  

Scarborough, Hollis S. “Connecting Early Language and Literacy to Later Reading (Dis)Abilities: Evidence, Theory, and Practice.” Handbook of Early Literacy Research, edited by Susan B. Neuman and David K. Dickinson, Guilford Press, 2001, pp. 97–110.

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

 

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

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Image of teens holding hands, signifying a romantic relationship along with a quote by Sexual Health Educator Sarah LaFerriere

How to Teach Consent to Teens with Autism – A Guide for Parents and Professionals

By | NESCA Notes 2025

Image of teens holding hands, signifying a romantic relationship along with a quote by Sexual Health Educator Sarah LaFerriereBy: Sarah LaFerriere, M.Ed.
Transition Specialist & Special Educator, NESCA

Consent is often treated as a one-time conversation: something brief, uncomfortable, and easy to delay. But for teens with autism, that approach isn’t just ineffective, it can leave them without the tools they need to safely and confidently navigate relationships. Consent is not a single talk. It’s a set of learnable, teachable skills. And for many teens, those skills need to be taught explicitly, practiced regularly, and reinforced across environments.

Why Consent Needs to Be Taught Explicitly
Many autistic teens:

  • Have difficulty interpreting nonverbal communication (facial expressions, tone, body language)
  • Tend to think in concrete, literal terms
  • Have a history of being reinforced for compliance
  • May strongly desire connection but lack clear social frameworks

Because of this, common advice like “you’ll know when it’s right” or “just pay attention to cues” is not actionable. Instead, they benefit from clear language, direct instruction, and repetition.

Start with a Clear, Concrete Definition
Avoid vague or abstract explanations. Define consent in simple, direct terms:

  • Consent means asking first
  • Consent means getting a clear “yes”
  • Consent can be changed or taken back at any time
  • Silence, hesitation, or “I guess” = not consent

Provide actual scripts teens can use:

  • “Can I hug you?”
  • “Is this okay?”
  • “Do you want to keep going?”

When we give language, we reduce guesswork.

Teaching Both Sides: Asking and Responding
Teens need to understand both roles in an interaction:

How to:

  • Ask for permission clearly
  • Recognize a genuine “yes”
  • Say “no” in a direct way
  • Respond appropriately when someone else says “no”

This is especially important for teens who may default to people-pleasing or masking. They need to hear explicitly: “You are allowed to say no, even if you said yes before.”

Make It Concrete and Practice-based
Conceptual discussions alone are not enough. Use structured, real-life examples:

  • “What would you say if you want to hold someone’s hand?”
  • “What do you do if someone says, ‘not right now’?”
  • “What if someone doesn’t answer you?”

Role-play is one of the most effective tools here. While it may feel uncomfortable, it creates a safe space to:

  • Practice asking for consent
  • Practice declining
  • Practice handling rejection

For professionals, this can be embedded into social skills groups or transition programming. For parents, this can happen in brief, low-pressure moments at home.

Explicitly Teach What Consent Is Not
Many teens benefit from clear contrasts. Consent is not:

  • Silence or lack of response
  • Freezing or shutting down
  • Agreeing due to pressure
  • Continuing after someone changes their mind

Side-by-side examples (“This is consent” vs. “This is not”) can make abstract ideas more concrete.

Include Digital Boundaries
Consent extends beyond in-person interactions. Make sure to address:

  • Sending photos or messages (“Do you want me to send this?”)
  • Respecting privacy (not sharing others’ images or texts)
  • Navigating online relationships and pressure

Teens may understand physical boundaries but struggle to apply the same rules digitally unless explicitly taught.

Normalize and Teach How to Handle “No”
Rejection is a critical part of understanding consent – and often one of the hardest skills. Teens should learn that:

  • Hearing “no” is normal and expected at times
  • It is not a personal failure
  • The correct response is to respect it immediately

Provide simple, usable responses:

  • “Okay, that’s fine.”
  • “Thanks for telling me.”
  • “No problem.”

Practicing these responses reduces anxiety and increases appropriate behavior in real situations.

Frame Consent as a Relationship Skill, Not Just a Rule
Consent is often taught in a risk-avoidance framework. While safety matters, that alone can feel limiting or fear-based.

It’s equally important to frame consent as:

  • A way to show respect
  • A way to build trust
  • A foundation for healthy relationships

This perspective can be especially motivating for teens who are seeking connection.

Make It Ongoing and Integrated
Consent should not be a one-time lesson. Revisit and build on it:

  • As teens mature
  • As relationships become more complex
  • As new situations arise (dating, work, online interactions)

Final Thoughts
Too often, autistic teens are either shielded from conversations about relationships or expected to figure them out independently. Neither approach sets them up for success. When parents and professionals take a direct, skill-based approach to teaching consent, we give teens something essential: a clear, usable framework for understanding their own boundaries and respecting someone else’s.

For families and professionals looking for more individualized support, Transition Specialist & Special Educator Sarah LaFerriere, M.Ed. offers virtual sexual health coaching through NESCA in Newton. These sessions are designed to meet students where they are, using clear, direct, and developmentally appropriate instruction to build understanding of consent, boundaries, relationships, and personal safety. Coaching is tailored to each individual’s needs and can be especially helpful for students who benefit from explicit teaching and guided practice in a supportive, judgment-free environment. To learn more or inquire about services, families can explore options through NESCA.

 

About the AuthorHeadshot of Sarah LaFerriere, M.Ed.

Sarah LaFerriere, M.Ed., is a transition specialist and special educator who has nearly a decade of experience working with transition aged students in public schools, college, and home-based settings. She provides transition assessment, consultation, and coaching services to a wide range of clients, and specializes in supporting students with autism, intellectual disabilities, developmental disabilities, mental health conditions, and medical conditions.

To book with Sarah LaFerriere or one of our many other expert transition specialists, neuropsychologists, or other clinicians, complete NESCA’s online intake form.

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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Student trying to write despite hidden language demands

The Hidden Language Demands of Upper Elementary and Middle School

By | NESCA Notes 2022, NESCA Notes 2025

Student trying to write despite hidden language demandsBy Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

By upper elementary school, learning shifts dramatically. Students are no longer learning foundational skills; they are expected to apply them flexibly, independently, and across subjects. The academic language load increases quietly but significantly.

What Changes in Grades 4 to 7?

  • Students are reading to learn
  • Texts become denser and more abstract
  • Vocabulary shifts from concrete to conceptual
  • Sentence structures become longer and more syntactically complex
  • Students are expected to compare, analyze, justify, and synthesize
  • Writing moves from short responses to multi-paragraph compositions

The Cognitive Load Increases
Students must now hold multiple ideas in working memory, track shifting perspectives in texts, interpret figurative language, and integrate background knowledge – often simultaneously. These demands require strong executive functioning and well-developed language networks.

The Invisible Language Skills Required

  • Understanding complex sentences with embedded clauses
  • Interpreting nuanced vocabulary and morphology
  • Making inferences beyond literal meaning
  • Organizing ideas cohesively in speech and writing
  • Explaining reasoning using precise academic language

Common Signs of Strain

  • Strong verbal knowledge but weak written output
  • Short, underdeveloped written responses
  • Difficulty summarizing or explaining key ideas
  • Avoidance of reading-heavy assignments
  • Homework taking significantly longer than expected
  • Increased anxiety or shutdown around school tasks

Why This Stage Matters
Upper elementary and early middle school are pivotal years for our students. If language organization, executive functioning, and literacy systems are strengthened during this window, students often transition into higher grades with greater confidence and independence. When gaps remain unaddressed, demands compound year after year.

If This Sounds Familiar…
If your child is bright but suddenly struggling with writing, comprehension, or workload, it may not be motivation. It may be due to the increased language load. Strong academic performance is not just about effort. It’s about systems of learning. When language, executive functioning, and literacy are strengthened together, students gain not only skill, but confidence.

 

At NESCA, we view communication holistically. Our therapists use a comprehensive approach to treat the systems of learning as integrative, helping students develop valuable skills they can use in and out of the classroom! If you’re curious whether this integrative approach would benefit your child, I welcome the opportunity to connect to identify what targeted support may make the greatest difference. For more information on Speech and Language Therapy, Literacy, and Executive Functioning Support at NESCA, please complete our online Intake Form or email me directly at orogers@nesca-newton.com.

 

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

 

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

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Image of a student taking a test and quote from Dr. Hernandez Medellin

What English Language Learners Really Need: A Parent’s Guide

By | NESCA Notes 2025

Image of a student taking a test and quote from Dr. Hernandez MedellinBy Luisa Hernandez Medellin, Psy.D., PMH-C
Bilingual Pediatric Neuropsychologist; PSYPACT-authorized

If your child is learning English at school while also using another language at home, you are not alone. Millions of children in the U.S. are English Language Learners (ELLs). These students bring rich language skills, culture, and life experiences into their classrooms, but they also face unique challenges that schools don’t always understand well.

As a parent, understanding what your child truly needs can help you advocate more effectively and feel more confident working with schools.

English Learners Are Not All the Same

One of the biggest misunderstandings about English learners is the idea that they are all similar. In reality, ELL students come from many different backgrounds. Some were born in the United States, while others arrived recently. Some had strong schooling in their home country, and others experienced interruptions due to migration, poverty, or trauma.

Children may speak one language, two languages, or several. Some can speak well but struggle to read or write. Others understand more than they can say. All of this matters when teachers and specialists try to figure out how a child is doing in school.

Speaking English Isn’t the Same as Doing Schoolwork in English

Many parents hear, “Your child speaks English just fine,” and assume that means they should also be doing well academically. But everyday conversation and school language are very different.

Children often learn social English (chatting with friends, answering simple questions) within a few years. Academic English, the language needed for reading stories, writing essays, solving math word problems, and taking tests, takes much longer to develop. This means a child can sound fluent but still may struggle with schoolwork, and that struggle may be completely normal.

When a Child Is Struggling, What Should Happen?

Teachers are usually the first to notice when a child is having a hard time. The key is figuring out why.

Is the child still learning English? Is the instruction matched to the child’s language level? Has the child had access to consistent schooling? Or is there something more, like a learning or language disorder?

Schools should never rush to label a child with a disability just because they are learning English. At the same time, children who truly have learning challenges should not be ignored because “they just need more time.”

The goal is to understand the whole child, not just test scores.

Parents Must Be Part of the Process

Families play a critical role in helping schools understand a child’s strengths and challenges. However, many parents feel left out because of language barriers or unfamiliarity with the school system.

Schools are responsible for making sure parents understand what’s happening. This includes:

  • Providing interpreters and translated documents
  • Explaining processes step by step
  • Avoiding educational jargon
  • Checking for understanding, not just agreement

Parents should never be expected to rely on their child to translate important information.

Evaluations Should Be Fair and Culturally Sensitive

When a child needs testing (for learning difficulties, speech and language, or attention concerns), the evaluation must match the child’s language and background. Testing a child only in English when they are stronger in another language can give misleading results.

Good evaluations consider:

  • Which language the child is strongest in
  • How long the child has been learning English
  • The language used at home and at school
  • Cultural differences that may affect test performance

Sometimes, no formal diagnosis is given, and that’s okay. Evaluations can still identify areas of need and lead to helpful supports and accommodations.

Understanding Results and Moving Forward

Test results should be explained in plain language. Parents deserve to understand what the findings mean, how English learning affects their child’s performance, and what steps can help next.

Recommendations should be realistic and respectful of family values, beliefs, and resources. The most important part of the process is collaboration – parents, teachers, and specialists working together for the child’s success.

The Bottom Line

Children who are learning English are capable, resilient, and full of potential. What they need most is time, appropriate instruction, fair assessment, and adults who understand the difference between language learning and learning problems.

When schools take a whole‑child approach – one that respects language, culture, and family – English learners don’t just catch up. They thrive.

If you ever feel unsure, ask questions. Your voice matters, and you are your child’s strongest advocate.

 

Headshot of NESCA Pediatric Neuropsychologist Dr. Luisa Hernandez MedellinAbout the Author

As a bilingual pediatric neuropsychologist, Dr. Hernandez Medellin conducts comprehensive and culturally sensitive neurodevelopmental and neuropsychological assessments, comprehensive diagnostic evaluations, and effective care plans, providing appropriate recommendations for the client’s school, home, and the community. She specializes in the identification and assessment of neurodevelopmental disorders such as Autism Spectrum Disorders, ADHD, developmental and learning disorders, and their co-occurrence with anxiety and mood disorders. She also works with children and young adults with acquired brain injuries, epilepsy, brain tumors, strokes, general medical conditions, and genetic disorders affecting the nervous system. She is a native Spanish-speaker, passionate about serving the eclectic and vibrant South Florida community, as well as international patients looking for high-quality and compassionate care.

To book evaluation services at NESCA in Coral Gables, Florida, complete NESCA’s online intake form. 

To book a neuropsychological evaluation or other services at NESCA’s New England offices, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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Teen frustrated with homework

When Effort Masks Inefficiency – The Student That Flies Under the Radar

By | NESCA Notes 2022, NESCA Notes 2025

Teen frustrated with homeworkBy Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

There is a particular kind of student who rarely raises concern. They follow directions. They turn in assignments. They earn decent grades. They don’t disrupt class. They are described as sweet, hardworking, responsible – and they are exhausted.

These are the students who fly under the radar. You may notice it at home before anyone else does. Homework takes hours. Writing assignments feel disproportionately heavy. Reading requires constant rereading. They erase and rewrite sentences repeatedly. They melt down at home – not at school. From the outside, everything appears fine. From the inside, everything feels effortful.

Tiered support systems are designed to identify clear gaps: measurable academic decline, benchmark concerns, noticeable skill deficits, etc. But under-the-radar students often compensate beautifully. They memorize sentence frames. They overprepare and tend to avoid risks. They rely on intelligence to mask inefficiencies and oftentimes, they meet expectations…but at a cost.

Compensation works…until it doesn’t. As academic demands increase, including longer texts, multi-paragraph essays, and independent projects, the effort curve steepens. Middle school is often when the cracks begin to show – not because the child suddenly can’t, but because the system was never optimized.

These students frequently have subtle weaknesses in:

  • Academic language processing
  • Sentence formulation flexibility
  • Discourse-level organization
  • Working memory under load
  • Cognitive flexibility
  • Idea generation efficiency

They can explain ideas verbally but struggle to organize them in writing. They understand what they read, but only after rereading. Frequently they know the answer, but tend to hesitate to share it. The issue is rarely intelligence; instead, it’s about efficiency.

Over time, this exhaustive effort can unfortunately become a student’s identity. Students begin to believe school is supposed to feel this hard. They start to internalize messages like, “I just need to try harder. I’m just slow. I’m not good at writing.” But often, they are working around systems that were never explicitly strengthened. This is not about remediation; these students are not failing. They are often highly capable.

What they need is system strengthening. When we strengthen language networks, syntactic flexibility, executive functioning integration, organizational frameworks, and generalization across contexts, tasks that once felt overwhelming become manageable.

Support does not have to begin with failure. Some of the most powerful growth happens when we intervene before burnout. An integrative model that targets language, literacy, and executive functioning together addresses the systems underneath performance, not just the performance itself.

When these systems are strengthened, families often tell us that it no longer takes three hours to do homework, that they are raising their hands to answer questions in class again, that students don’t dread writing anymore, and that everything seems to feel lighter. Strong academic performance isn’t just about effort. It’s really about the systems.

Working Smarter, Not Harder

High-functioning students don’t always need remediation. Sometimes they may need optimization. When we strengthen the underlying systems, like language organization, executive functioning integration, and discourse-level structure, effort decreases and independence increases. The goal is not to push harder; it’s about building smarter.

If your child is capable but working harder than they should be, an integrative approach focused on building foundational skills with a speech-language pathologist may provide the missing layer of support.

If you’re curious whether this integrative approach would benefit your child, I welcome the opportunity to connect to identify what kind of targeted support would make the greatest difference. For more information on Speech and Language Therapy, Literacy, and Executive Functioning Support at NESCA, please complete our online Intake Form or email me directly at orogers@nesca-newton.com.

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

 

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

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image of kids exploring in nature, with a quote from Dr. Yvonne Asher

In Praise of Under-Scheduling

By | NESCA Notes 2025

image of kids exploring in nature, with a quote from Dr. Yvonne AsherBy: Yvonne Asher, Ph.D.
NESCA Pediatric Neuropsychologist

This is the time of year where things can go off the rails. Standardized testing, planning for summer, planning for next year, winter sports wrapping up, spring sports starting, recitals, end of year performances, science fairs, prom, graduation. And somewhere on social media are the perfect families with the impeccable photo collages of their children’s activities, everyone posed in matching outfits, effortlessly adorable.

Somewhere far more real are the rest of us, begging one child to put on anything other than sweatpants for their piano recital while comforting another because they KNOW they will “never have friends again” once they start middle school, all while someone eats too many cookies at the lacrosse banquet and pukes all over the car.

Extracurricular activities can be wonderful – they can teach valuable motor and self-regulation skills, build creativity and independence, help children gain self-confidence, build friendships and social competence, and support emotional development. As neuropsychologists, we recommend a multitude of non-school-based activities – sports, martial arts, tutoring, outpatient therapies, therapeutic horseback riding, social skills groups, and more.

And.

They can be a lot. Draining, expensive, exhausting, and unpleasant. For some kids, some families, and some situations, extracurricular activities are the lynchpin. Maybe your kid lives to play soccer. Or participate in competitive gymnastics. Or play violin. If it works for your kid and your family, that is amazing. However, for many families, there is downward pressure into toddlerhood to “expose” children to dozens of structured activities. This can cause stress and anxiety for kids, parents, and siblings, and can eat away at the small amounts of calm family time remaining in between work and school.

What is true is that children need exposure to new things in order to learn and build skills. But, as adults, we forget that so much of simply living is novel to children. Going to a new grocery store? Let’s figure out how to get there using a map and our visual-spatial skills. Beautiful spring day? Take a walk in a new neighborhood. Better yet? Take a hike! What plants do you see? Bugs? Animals? Habitats? Science abounds outside. Have a weekend day with nothing to do? Make a new recipe! Read the recipe, write a shopping list, use math to double it or halve it.

Extracurricular activities themselves are, of course, not the true problem. As often happens in this digital age of parenting, the problem is pressure from others. Feeling like our kids are falling behind the curve, late to the game. And this is dramatically exacerbated for kids with disabilities or challenges, when parents know that they are, in some areas, behind their peers already. It can feel embarrassing to have the one kid who won’t stand up for the choir concert or cries when it is their turn at bat in t-ball. So why must we push them into it?

Of course, sometimes there is a very good “why.” Maybe they love it most of the time and are anxious at recitals. Maybe it’s deeply important to your family and a long tradition for kids to learn this particular skill. Maybe they really need outpatient speech therapy. Many “whys” make it worthwhile to push through an activity. But, sometimes, the “why” is simply “everyone else seems to be doing it” or “they have to do something.”

In these cases, a step back may be worthwhile. At least for now. Enjoy some Saturday mornings spent in pajamas making six different kinds of pancakes because you have nowhere else to be. Play a board game after a lengthy family dinner because everyone got home early. Let your kid pick up every rock they see on the way home from school – maybe today is a good day to paint some for your garden.

 

About the Author

Dr. Yvonne M. Asher enjoys working with a wide range of children and teens, including those with autism spectrum disorder, developmental delays, learning disabilities, attention difficulties and executive functioning challenges. She often works with children whose complex profiles are not easily captured by a single label or diagnosis. She particularly enjoys working with young children and helping parents through their “first touch” with mental health care or developmental concerns.

Dr. Asher’s approach to assessment is gentle and supportive, and recognizes the importance of building rapport and trust. When working with young children, Dr. Asher incorporates play and “games” that allow children to complete standardized assessments in a fun and engaging environment.

Dr. Asher has extensive experience working in public, charter and religious schools, both as a classroom teacher and psychologist. She holds a master’s degree in education and continues to love working with educators. As a psychologist working in public schools, she gained invaluable experience with the IEP process from start to finish. She incorporates both her educational and psychological training when formulating recommendations to school teams.

Dr. Asher attended Swarthmore College and the Jewish Theological Seminary. She completed her doctoral degree at Suffolk University, where her dissertation looked at the impact of starting middle school on children’s social and emotional wellbeing. After graduating, she completed an intensive fellowship at the MGH Lurie Center for Autism, where she worked with a wide range of children, adolescents and young adults with autism and related disorders.

 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; Coral Gables, Florida; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

To book an appointment with a NESCA clinician, please complete our Inquiry/Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

7
SLP working with a student on a summer intensive program focused on speech

Seven Signs Your Child Would Benefit from a Summer Writing Intensive

By | NESCA Notes 2022, NESCA Notes 2025

SLP working with a student on a summer intensive program focused on speechBy Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

Summer is often seen as a break from academics, but for many students, it’s also the most powerful window for growth. If writing has been a source of stress, avoidance, or frustration during the school year, a structured summer writing intensive program can make a meaningful difference before fall. Here are the most common signs that a student may benefit from targeted, language-based writing support.

  1. They Have Strong Ideas. . . But Difficulty Getting Them Onto Paper
    Your child may speak clearly and express complex ideas verbally, yet struggle to translate those thoughts into written form. Pages remain blank, sentences feel short or incomplete, and written work does not reflect their true ability.
  2. Writing Takes a Long Time
    Assignments that should take 20 minutes stretch into an hour or more. Slow writing can signal challenges with planning, organization, working memory, or executive functioning fatigue.
  3. Paragraphs Lack Structure
    You may notice missing topic sentences, disconnected details, weak transitions, or repetitive ideas. These patterns often reflect underlying language organization challenges rather than simple grammar issues.
  4. Writing Causes Emotional Stress
    Avoidance, frustration, or shutdown at the mention of writing or during the writing process are common signs. When writing feels overwhelming, students often lack internal planning systems to guide them.
  5. Teacher Feedback Highlights Organization or Elaboration Concerns
    Comments such as, “needs more detail,” “ideas are unclear,” or “work lacks organization” often indicate that both language development and executive functioning need targeted support.
  6. ADHD or Executive Functioning Challenges
    Writing requires planning, working memory, inhibition, flexibility, and self-monitoring. Students with executive functioning weaknesses often benefit from explicit writing routines that reduce cognitive load.
  7. Transitioning to a New School Level
    Rising 3rd, 6th, or 9th graders face increased writing demands. Strengthening foundational systems before expectations rise can dramatically improve confidence and performance.

Why Summer Is So Effective
Without academic pressure and competing demands, students can build writing fluency, strengthen organization systems, and increase independence in a focused and supportive environment. Application can be embedded in students’ areas of interest, for added motivation. The goal of a writing intensive is not simply to be able to create “better essays.” It is reduced anxiety, stronger thinking on paper, increased independence, and systems students can carry into the fall.

 

At NESCA, we offer intensive summer therapy that targets both verbal communication (such as listening comprehension, expressive language, and social communication) and written expression, an area where many students struggle. For more information on summer intensives and written language support at NESCA, please complete our online Intake Form or email me directly at orogers@nesca-newton.com.

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

 

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

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Image of child working in an OT session on balance and movement; quote from Dot Lucci of NESCA

Coming to our Senses

By | NESCA Notes 2025

Image of child working in an OT session on balance and movement; quote from Dot Lucci of NESCABy Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Services, NESCA

If you ask young children and adults to name their senses, they will typically name the five senses that are taught to all children in school – taste, smell, sight, hearing, and touch. Some of these senses “come on board” at birth while others continue to develop, refine, and mature into early adulthood. Then as we age, some of our senses may diminish – think eyesight and hearing, as well as fluidity of movement and balance. Most people wouldn’t think of fluidity of movement and balance as senses, but they are. These are considered part of our “hidden or internal senses,” and are connected to the three others. Who knew we had eight senses? Many adults don’t even know about these three other senses, yet they are very important to our functioning and are in use all the time. These three other hidden or internal senses are proprioception, vestibular, and interoception, each having a crucial role in our daily functioning in the world and with materials or objects.

Proprioception is often described as a sense of our body awareness in relation to the world around us. This system helps us integrate systems such as our musculoskeletal and central nervous systems. We get feedback from our muscles, ligaments, and joints so we know how to coordinate movements, sense where our body parts are in relation to our surroundings, and how to determine and apply the right amount of pressure or tension needed for certain tasks or movements. Proprioception is the secret ingredient that makes our motor skills intentional.

People with excellent proprioception are coordinated and may even be graceful. They rarely bump into things/people, don’t spill food on themselves, or misjudge how much pressure to use when touching someone else. They navigate their environment and materials well.

On the other hand, a person with poor proprioception may often bump into people, especially if the room/hallway is crowded. Or they may step on others’ toes while waiting in a line, stub their own toe, spill things on themselves, touch other people too hard or too lightly when playing tag, tear the paper when erasing, and so on. They may also experience difficulty with handwriting, using scissors, and doing other weight-bearing activities.

The vestibular system is located in the middle ear and is concerned with balance and gravitational awareness. I often use the term “sea legs” to describe this sense. If you are not familiar with “sea legs,” it is often used to describe a person’s ability to adjust their balance to a ship’s motion and not get seasick as well as the lingering sensation of movement or rocking when on land after disembarking a ship. It also is responsible for an awareness of gravity. Think of the astronauts who recently left the Artemis shuttle. They needed to be helped onto the “porch platform” and were then sat down as their bodies, having just been in space, had to adjust to the gravitational pull of the earth. This sense helps us to know if we are moving or stationary, how fast/slow we are moving, if we are standing still/speeding up, lying down, and more. Our vestibular system can be impacted by inner ear infections, head injuries, and other medical conditions. People with heightened vestibular systems may get dizzy often, suffer from car sickness, and dislike swinging, spinning, having their feet off the ground, or being upside down. On the flip side, some individuals have a hypo-responsive vestibular system. This can look like a constant hunger for movement. In this situation you may see someone excessively rocking back and forth, spinning for a long period of time without getting dizzy, happily swinging for hours, trying to reach the highest height, and have the constant need for high speed. People with “intact” vestibular system are seen as perfectly calibrated and can smoothly multitask balance, movement, and purposeful actions to move through the world with more ease.

Interoception is the third “hidden sense” and is related to what is happening inside our bodies – bringing our internal needs and awareness to our minds. This sense makes us aware of our internal organs, helping us to know when we are in pain, hungry, thirsty, or full, have to use the bathroom, are cold or hot, tired, ill, or have a fast heart rate. They can easily identify these sensations, whereas people with diminished awareness of their internal states have difficulty identifying feelings or sensations in their bodies. They may not notice when they are hungry, in pain, have to use the restroom, have a stomach or headache, are feeling their heart race, among other internal sensations. They may forget to drink or eat and get dehydrated or shake from low blood sugar, whereas people with heightened interoception may get “hangry” (hungry and angry) because they can’t tolerate hunger…and they recognize it. They may be overly sensitive to pain or temperature changes. Likewise, some foods are intolerable due to texture (smooth, chewy, etc.), and certain flavors (sweet, bitter, sour, etc.) may also not be tolerated. Therefore, they only eat bland foods.

People with impacted interoception “know they have a need or sensation,” but can’t identify it. This disrupts their quality of life as they may overeat or drink. People who are overly aware may become so anxious about these sensations that their anxiety may intensify until their need to handle the sensation is met.

Our senses and sensory profiles change with development, age, lifestyle, and health. Many of our senses work independently or behind the scenes, without our even thinking about them. However, if you try to walk on a balance beam versus just walking down the sidewalk, your balance may be challenged, requiring more conscious awareness. All of the senses work together to help us utilize, understand, and integrate sensory information to be in the world in a “functional way.” Many individuals with impacted sensory processing or integration systems may experience physical, mental, emotional, and social consequences as a result of an atypical sensory profile. Understanding one’s own sensory profile is important to living a full life. If warranted, an occupational and sensory evaluation may be necessary to help identify sensory-motor processing needs. This self-awareness and knowledge may help guide individuals to understand what they need, what they can and can’t do, what makes them comfortable, and what will help them better function and interact in the world. We are all sensory beings, and the better we are at knowing ourselves, the better we will be at advocating for ourselves.

If your child or teen can benefit from learning about their sensory system, complete NESCA’s online Inquiry/Intake Form for additional information or to book sessions with NESCA’s occupational therapists.

 

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 related services center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

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student writing in a notebook and quote by Olivia Rogers, SLP

Why Speech-Language Pathologists Are Uniquely Equipped to Support Written Language

By | NESCA Notes 2022, NESCA Notes 2025

student writing in a notebook and quote by Olivia Rogers, SLPBy Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

Written language refers to the system of communication that involves the use of written symbols to represent language, and it encompasses skills such as fluent word recognition, reading comprehension, written spelling, and written expression. It is one of the most complex academic skills students are asked to master. It requires vocabulary, grammar, organization, working memory, attention, reading skills, and the ability to translate ideas into structured sentences and paragraphs.

Because written expression sits at the intersection of language, literacy, and executive functioning, Speech-Language Pathologists (SLPs) are uniquely positioned to support it. At NESCA, speech language pathologists bring specialized training – including EmPOWER, Brain Frames, and The Orton-Gillingham Approach – that allows them to address writing and reading comprehension in a comprehensive, structured, and functional way.

Written Language Is… Language
Writing is not just handwriting or spelling. At its core, writing is language expressed on paper. Students must generate ideas and vocabulary, use grammar and sentence structure, organize thoughts into narratives or explanations, maintain cohesion across sentences, and consider audience and purpose.

Reading is not just decoding words on a page. True, reading happens when a child understands, connects, and makes meaning from what they read. Comprehension – linking new information to background knowledge, vocabulary, and language skills – is what transforms word calling into real literacy.

These are core areas of SLP expertise. SLPs are trained to analyze how language breaks down,  whether at the word, sentence, or discourse level, and to teach skills explicitly and systematically.

The Executive Function Connection
As discussed in last week’s blog, writing and reading are executive functioning tasks. When writing, students must plan what to say, hold ideas in working memory, organize information, initiate writing, and revise and edit. When reading, students exercise their working memory, inhibition, and metacognitive skills.

NESCA SLPs use the EmPOWER and Brain Frames approaches to make these invisible thinking processes visible. EmPOWER supports students in navigating “how” to bring the writing process from start to finish. Brain Frames provide visual scaffolds that help students map ideas before writing, organize paragraphs, and understand the structure of different text types.

Structured Literacy Strengthens Writing
Strong writing depends on strong reading and spelling skills. NESCA SLPs, trained in Orton-Gillingham, also bring a structured literacy lens to written language intervention through explicit teaching of phonology, morphology, and spelling patterns – all while integrating reading and writing instruction systematically.

SLPs Bridge Ideas and Expression
Many students know what they want to say but cannot translate it into written form. SLPs help students expand sentences, develop narrative and expository structure, use academic vocabulary, improve cohesion and clarity, verbalize ideas before writing, and revise language for precision.  Because SLPs focus on communication, written language therapy is functional and meaningful. Intervention often targets classroom assignments, essays and projects, note-taking, digital communication, and self-advocacy writing so that strategies learned transfer directly to school demands. SLPs brings a functional, real-world approach to written language.

Speech-Language Pathologists are not an alternative option for written language support; they are a natural fit. With explicit strategy instruction, visual scaffolding, and structured literacy methods, SLPs help students move from uncertainty to confident, organized expression. When writing is approached through language, thinking, and literacy together, students gain tools that extend far beyond the page.

The NESCA Difference
NESCA SLPs combine deep knowledge of language development with specialized training in executive functioning and structured literacy. Our intervention addresses how students think, understand language, read and spell, and express ideas in writing.

 

At NESCA, we use evidence-based strategy to target written language. Our clinicians use a comprehensive approach to treat the systems of learning as integrative, helping students develop valuable skills they can use in and out of the classroom!  For more information on written language support at NESCA, please complete our online Intake Form or email me directly at orogers@nesca-newton.com.

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

 

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

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image of yarns intertwined representing EF and language skills being intertwined and a quote from Olivia Rogers, SLP at NESCA

Executive Functioning & Language: Intertwined and Recursive Systems of Learning

By | NESCA Notes 2022, NESCA Notes 2025

image of yarns intertwined representing EF and language skills being intertwined and a quote from Olivia Rogers, SLP at NESCA

By Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

When we think about learning, we often separate skills into categories – language, executive functioning, literacy, academics, just to name some. But in real life, these systems don’t operate independently. They are deeply intertwined and recursive, meaning they continuously influence, shape, and strengthen one another over time.

What Is Executive Functioning?
Executive functioning refers to the brain’s management system. These skills help students plan and organize ideas, initiate tasks, hold information in working memory, monitor understanding, shift between strategies, and manage time and attention.

What Is Language?
Language includes understanding directions, expressing ideas clearly orally and in writing, narrative organization, comprehension of complex oral and written information, academic language use, and internal self-talk.

How Executive Functioning Depends on Language
Students rely on language to talk themselves through steps, plan written responses, explain reasoning, organize narratives, monitor comprehension, and use strategies independently.

How Language Depends on Executive Functioning
Producing and understanding language requires holding ideas in working memory, sequencing information, shifting between topics, inhibiting irrelevant details, revising messages, and planning written expression.

The Recursive Relationship image showing the recursive nature of EF and language skills
Growth in one area supports growth in the other. Stronger language supports clearer thinking, and better executive skills support more organized language.

The Big Picture
Integrated support helps students explain their thinking, plan before speaking or writing, use language as a strategy, monitor understanding, and become more independent learners. Executive functioning and language are overlapping systems that continuously shape each other. Supporting both together makes learning more accessible, meaningful, and transferable.

At NESCA, we view communication holistically. Our speech language pathologists use a comprehensive approach to treat the systems of learning as integrative, helping students develop valuable skills they can use in and out of the classroom! For more information on Speech and Language Therapy at NESCA, please complete our online Intake Form or email me directly at orogers@nesca-newton.com.

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

 

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

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