NESCA is open and currently scheduling contactless evaluations in all three of our locations (Newton and Plainville, MA and Londonderry, NH). For more information, please view, “Testing in the Age of COVID-19” on our Video Resources page.

Category

NESCA Notes 2019

Transition Planning at IEP Team Meetings – The Good, The Fun and The Beautiful

By | NESCA Notes 2019

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

Transition planning is a complicated process for schools, families and related service professionals. It is not something that can be done well without key ingredients, such as open minds, collaboration and creative brain power… not to mention time. But when good transition planning happens in the context of a team meeting, it is a really powerful and awesome process – and even, dare I say, fun!

I recently worked with a young woman – let us call her Julie – who had spent four years of high school in a small therapeutic program. It took Julie, with great support from her team, a lot of effort to get through the academic demands of high school while simultaneously managing and remediating social and emotional complexities. As Julie progressed through her senior year, her school team recognized that she had not had the time or opportunities to build some critical life skills, including the self-advocacy and executive function skills she would need to manage post-secondary, real-world activities. Everyone agreed that she needed another year to build and generalize the functional skills that are essential for being a student in a post-secondary learning environment and to be deemed employable. With no option available for Julie to continue in her therapeutic school program, the team agreed to set up a meeting to create a new IEP that focused largely on Julie’s remaining transition-focused needs. Due to time constraints, the team meeting occurred at the start of this school year.

I was fortunate to be invited to consult at this meeting. After introductions, we dug in together to review Julie’s most recent transition evaluation. Julie had a thorough evaluation that had been completed by the school district, which provided a lot of information about her disability-related needs as well as her vision and interests. We talked about the most pressing areas to address in developing the IEP goals and debated options for creatively writing the annual goals in the IEP document (i.e. whether to focus annual goals on life, vocational and college participation skills with objectives related to social, emotional, executive functioning and self-advocacy issues in each arena or whether to employ a more traditional IEP format with seven goal areas).

We discussed objectives that would be most useful in the context of Julie’s long-term goals – attaining a college degree and working as a nutritionist. Julie’s mom had done a great deal of work prior to the team meeting, helping Julie apply to Massachusetts Rehabilitation Commission (MRC) Vocational Rehabilitation (VR) Services, connecting with the local agency contracted to provide Pre-Employment Transition Services (Pre-ETS), and setting up Julie’s first internship experience for the summer. She also helped Julie to sign up for an adaptive driver’s education class to occur on weekends throughout the fall. Julie’s mother had also researched options for college classes that Julie might be able to participate in, even though she had missed the start of many fall classes.

Julie’s Special Education Director had worked equally hard in looking into resources within the school district and community that could provide Julie with meaningful activities and experiences and assist her in making progress with the skills outlined in the transition assessment. One such resource identified by Julie’s Special Education Director was a non-profit social skills group. Another resource was a coach who could provide hands-on support on a college campus and was already in place as part of a postgraduate program run through a nearby district. The Director also identified several staff withing the school district who were experienced in supporting transition-age students – the school social worker and lead teacher within the school’s therapeutic program – who could work with Julie.

We gathered in a room together not to talk about a program that already existed, but to design the individualized, unique transition program that Julie required. We brainstormed options for shoring up her writing skills with such approaches as drafting an independent research paper on being a nutritionist and participating in a dual enrollment college writing class. We thought of ways to build money management skills through an online personal finance class with school support and real-life practice by visiting her local bank and several ATMs with her school’s occupational therapist.

When we left the meeting, we had designed a brand new program for Julie that would satisfy her needs in the areas of social, emotional, self-advocacy, executive functioning, adaptive and vocational skills development through a combination of school-, community- and home-based activities, with defined support from the school district, community agencies and her family. Everyone left the meeting ready to carry out the next steps of planning for Julie, with roles and responsibilities clearly outlined to initiate the activities that would hopefully propel Julie toward greater independence and satisfaction in her adult life.

This is just one example of a great team meeting that I have been a part of this school year. Over the years, I’ve been fortunate to have had the opportunity to contribute to many of these meetings as well as some of the more challenging ones. After this meeting, I drove all the way home smiling about how much can be accomplished in a 75-minute team meeting when everyone comes to the table thinking about the student, willing to brainstorm, interested in collaborative problem-solving, thinking outside the box, and eager to share responsibility in supporting the student.

Certainly, there are many times when a school district or local collaborative already has a great program and peer group that will work for a student’s post-12th-grade needs, but, as a Transition Specialist, it is truly a lot of fun when everyone is ready to roll their sleeves up and pitch in to create a new tailored individualized education program that taps into the internal resources available to the student and school, while adding community supports and services as appropriate.

In thinking about what makes transition planning at IEP team meetings, such as Julie’s, notably successful, the following “ingredients” stand out:

  • The meeting focuses on the student, with the student’s vision presented at the start of the meeting (ideally by the student), and the team is in agreement about supporting that vision;
  • Team members come to the table eager to work with one another, willing to problem-solve, ask questions, listen to feedback and build on one another’s ideas;
  • There is good assessment data to inform the team process, whereby the team has a good sense of the student’s strengths, preferences and needs, and works together to prioritize what has to be addressed through the IEP; and
  • Team members come to the table knowing what resources exist inside and outside of the school program, with parents and educators having researched and reached out to invite new team members who may know about internal and external resources.

If you are interested in working with a transition specialist at NESCA for consultation, planning or evaluation, please complete our online intake form: https://nesca-newton.com/intake-form/.

About the Author:

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

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

Why We Should Weed Out Lawnmower Parenting

By | NESCA Notes 2019

By:  Alissa Talamo, Ph.D.
Pediatric Neuropsychologist

There are many parenting styles and trends…helicopter parents, attachment parents, free range parents, and now…the lawnmower parent. All of these parenting styles come from loving, well-meaning parents who want to do what is best for their children and protect them from harm. However, the lawnmower parent, the newest iteration of such approaches, often prevents a child from gaining necessary lifelong skills.

If a helicopter parent is a parent who hovers over their child and jumps in to solve a problem that a child could actually resolve on their own, a lawnmower parent (also referred to as a snowplow parent or bulldozing parent) is a parent who goes out of their way to remove every obstacle for their child; trying to anticipate their child’s every need and solve the problem before the child even experiences it. Lawnmower parent behaviors include everything from choosing a young child’s activities to directly calling a child’s college professor to ask for an extension on an assignment, and—as recently seen play out in the news—the college admissions scandal. One college professor (as shared on the Pittsburgh Moms blog) described lawnmower parenting as ‘Curling Parents,’ “given the similarity to the Olympic athletes who scurry ahead of the gently thrown stone, frantically brushing a smooth path and guiding the stone towards an exact pre-determined location.”

A negative side effect of the lawnmower parent approach is that it suggests to the child they are not able to handle any situation on their own, and possibly the idea that their parents believe they will fail rather than succeed unless the parent clears the way. How can a child develop a sense of self, and confidence to know they can make mistakes and still be ok, unless they are allowed to experience both success and failure? Children need to develop their own problem-solving skills, at a developmentally appropriate level, to know they can solve bigger problems. While it is ok to help your child (or friend, spouse, sibling) out of a difficult situation at times, everyone needs to learn to self-advocate, develop problem-solving skills and feel that sense of accomplishment that doing so yields.

References:

https://grownandflown.com/college-professor-warns-lawnmower-parent/

https://pittsburgh.citymomsblog.com/

https://www.goodhousekeeping.com/life/parenting

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 teenage girl.

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

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

Understanding Empathy

By | NESCA Notes 2019

By:  Stephanie Monaghan-Blout, Psy.D.
Pediatric Neuropsychologist

Our children are growing up in a social environment that is too often flavored by fear; fear of inexplicable violence, fear of people who look different than us, whose politics are contrary to what we hold dear, people who seem to despise us as much as we discount them. At the same time, we are realizing that in order to help our children learn, we must pay attention to their emotional and social states as well as their intellectual development.

In the context of these paradoxes, the concept of empathy has become a topic of considerable interest. The fact of the matter is that empathy may be at play in the divisiveness of our communities as well as in the efforts to include all children in our schools. Empathy is critical in forming close and supportive relationships, but at the same time, it is also responsible for a built-in bias toward people with whom one feels a connection. Further, being empathetic towards others does not ensure that one will follow that feeling of concern with acts of kindness. Finally, too much empathy for those in pain is very painful and can cause the empathizer to pull back or avoid the situation or person  in order to protect themselves. The research of the past 15 years has deepened our understanding of empathy and has helped to explain some of these contradictions. In an article in the Scientific American (December 13, 2017), Science Writer Lydia Denworth summarized the general consensus of the scientific community to describe three different but interactive aspects of empathy:

  • Emotional empathy refers to the experience of sharing one’s feelings and matching that person’s behavioral states; for example, feeling afraid when watching a movie in which someone is being attacked by a lion. This form of empathy is a biological response that is seen in a variety of animals as well as children as young as one year old.
  • Cognitive empathy is the capacity to think about and understand other people’s feelings. It is often referred to as perspective taking or theory of mind. While aspects of this ability can be seen in very young children, it is not fully developed until adulthood.
  • Empathetic concern, or compassion is the feeling of concern that motivates one to help in some way. This capacity can also be seen in young children.

True empathy requires the engagement of all three capacities. Consider, for instance, the experience of many people on the Autism Spectrum. They may be fully capable of feeling emotional empathy; in fact, they are often overwhelmed by the sharing of pain. However, they struggle with the cognitive task of  perspective taking, or appreciating that the other person may not see things in the same way that they do. On the other hand, people with antisocial tendencies may be very good at understanding how someone feels, but do not have any interest in helping them. Finally, it is extremely difficult for people who live in a homogeneous cultural area to be able to extend the same kind of care and consideration to others who look and sound different and whose views may run counter to their own.

Gwen DeWar is a biological anthropologist who edits the Parenting Science website. In one of her articles, she describes 10 steps parents can take to encourage the development of empathy in their children. These include tasks such as, providing the support needed to develop strong self-regulation skills, the modeling of empathic behavior, the avoidance of reward or punishment in favor of thinking through the impact of one’s actions on others, the fostering of cognitive empathy through literature and role-playing, and the education of children to avoid the “empathy gap” that occurs when people forget what it is like to be in the grip of pain, discomfort or fear. It is worth reading.

About the Author:

Formerly an adolescent and family therapist, Dr. Stephanie Monaghan-Blout is a senior clinician who joined NESCA at its inception in 2007. Dr. Monaghan-Blout specializes in the assessment of clients with complex learning and emotional issues. She is proficient in the administration of psychological (projective) tests, as well as in neuropsychological testing. Her responsibilities at NESCA also include acting as Clinical Coordinator, overseeing psycho-educational and therapeutic services. She has a particular interest in working with adopted children and their families, as well as those impacted by traumatic experiences. She is a member of the Trauma and Learning Policy Initiative (TLPI) associated with Massachusetts Advocates for Children and the Harvard Law Clinic, and is working with that group on an interdisciplinary guide to trauma sensitive evaluations.

To book an evaluation with Dr. Monaghan-Blout or one of our many other expert neuropsychologists and transition specialists, complete NESCA’s online intake form.

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

New Decade; New Director’s Update

By | NESCA Notes 2019

By: Ann Helmus, Ph.D.
NESCA Founder/Director

Welcome to the new year and a new decade! It’s a perfect time to take a look in the mirror and determine who we are. We reflect on what’s taken place in our lives and ask questions about what’s next. What do we want to keep in our lives or discard? What motivates us? What drives us to accomplish the plans we make?

At NESCA, we started this reflection early in the fall by dedicating a full day to a company-wide workshop to define who we are as a group practice and what our core values are. The main question to ourselves was, “What makes NESCA different?”.

Throughout the exercise, we outlined our mission and—as a values-driven organization—what our core values are. It’s not that we didn’t regularly follow them before our workshop, but we now had them down on paper to help guide us on a daily basis and as we forge ahead in the new decade. We shared our views on being so much more than evaluators who write neuropsychological reports and came to a consensus on what our bigger purpose is. We create the game plan, the roadmap that helps people rewrite the script of their lives, tell a new story and create a new path forward.

Throughout the workshop day, one unanimous theme emerged from NESCA’s team of clinicians, consultants, transition specialists, wellness providers and administrative staff is that we are a community of lifetime learners who are dedicated to collaboratively helping the families we work with, both now and as they develop throughout their life.

While each one of us at NESCA is smart, we know we are smarter together. NESCA clinicians are experienced professionals, veterans of their respective domains, who truly enjoy what they do and seek opportunities to collaborate, all so we can deliver the best possible recommendations for the individuals and families we work with. Many of us have worked together for decades. We understand SPED laws and the myriad of available services from preschool to adulthood. We work in a supportive environment where the perspectives and experiences of all employees are valued, respected and counted—whether that experience comes from our formal education, decades of work with families, conversations with our colleagues, being parents of children with special needs or other areas. This knowledge allows us to create plans that accommodate the services that are appropriate now as well as create a window for what an individual may need in the future.

As a team, we continually and proactively seek the expertise of each other as well as external professionals to enhance and strengthen our perspectives and consequently shape our individualized recommendations to those we work with. We don’t just do this on an ad hoc basis. We dedicate untouchable time on a weekly basis to our case conferences where we meet as a team, share resources and new evidence-based research and discuss challenging cases, with each clinician or practitioner offering insight and expertise from their vast past experience and body of connections to provide stronger and more worthwhile guidance and recommendations to families and schools.

Because of this group collaboration, we are highly equipped to take on complex cases. As the largest group of neuropsychologists and complementary clinicians in Greater Boston/New Hampshire, we bring a broad range of skills, perspectives and unique tools and approaches to the complex issues that are often presented to us.

During our workshop, we stated our core values—what motivates us every day to do what we do. We created them together and re-examine them regularly to ensure they reflect our mission, our commitment to children, young people and families, and our overall vision. Collaboration is just one of the core values that drives us. Throughout the year, we will bring you more of the outputs from our workshop, sharing what makes NESCA different.

About the Author: 

NESCA Founder/Director Ann Helmus, Ph.D. is a licensed clinical neuropsychologist who has been practicing for almost 20 years. In 1996, she jointly founded the  Children’s Evaluation Center (CEC) in Newton, Massachusetts, serving as co-director there for almost ten years. During that time, CEC emerged as a leading regional center for the diagnosis and remediation of both learning disabilities and Autism Spectrum Disorders.

In September of 2007, Dr. Helmus established NESCA (Neuropsychology & Education Services for Children & Adolescents), a client and family-centered group of seasoned neuropsychologists and allied staff, many of whom she trained, striving to create and refine innovative clinical protocols and dedicated to setting new standards of care in the field.

Dr. Helmus specializes in the evaluation of children with learning disabilities, attention and executive function deficits and primary neurological disorders. In addition to assessing children, she also provides consultation and training to both public and private school systems. She frequently makes presentations to groups of parents, particularly on the topics of non-verbal learning disability and executive functioning.

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

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

New Year’s Resolution to Lasting Lifestyle Changes

By | NESCA Notes 2019

By Billy Demiri, CPT
Certified Personal Trainer

The New Year can bring with it so many possibilities, and beginning a new decade is even more exciting. This is the time of year so many of us envision great goals and changes that we want to make in the new year. A 2016 study published in scientific journal Personality and Social Psychology Bulletin, investigated New Year’s resolutions and found that, “55% of resolutions were health related, such as exercising more, or eating healthier.” I know from personal experience and working with so many people, helping them achieve their fitness and lifestyle goals, just how hard it can be to make lasting changes. So how do we stay on track with all of our New Year’s resolutions when, “about 80% of people fail to stick to their New Year’s resolutions for longer than six weeks”? Here are some of the best strategies I use when setting goals and staying consistent with them.

First, when it comes to New Year’s resolutions and goal setting, it is important to make sure they are doable and meaningful if we want to give ourselves the best shot at success. It is essential to make sure that whatever goal we choose really matters to us, and we are making it for the right reasons. I like to use the acronym SMART when setting goals for myself and my clients. That means goals should be S-Specific, M-Measurable, A-Achievable, R-Relevant and T-Time-bound. For example, if your goal is to lose weight, you should be specific about how much weight you want to lose. Also, make sure it is realistic and set a time frame for yourself; such as losing 1-2 pounds a week vs. 5 pounds per week. Most important of all, it has to be the right goal for you! It is really easy to lose sight of our goal if we are making changes based on what someone else or society is telling us to change. So how do we find a goal that will be right for us?

My favorite technique for finding goals that matter to me and my clients is asking the 5- Whys—or the Downward Arrow Technique—which was coined by psychiatrist Dr. David Burns. It works for any goal or statement by asking why five times to really explore why that goal is important. For example, let’s stick with the goal of losing weight and explore it further:

  1. Why do you want to lose weight?
  • Because I want to lose fat and build some muscle.
  1. Why does that matter?
  • So I could walk around with my shirt off in the summer.
  1. Why do you want to be able to walk around with your shirt off?
  • Because I will look good and feel good about myself.
  1. Why do you want to feel good about yourself?
  • Because when I feel good about myself, I am more confident and assertive.
  1. Why do you want to be more confident and assertive?
  • Because I will be in control and will have a better chance at getting what I want out of life.

By using the 5-Whys technique, we can gain critical insight to our goals. For this person, weight loss was really a matter of taking charge of his life. He’s not really motivated by the number on the scale or just looking good with his shirt off. By having that insight, he is far more likely to keep working towards his goal—even if the scale hasn’t moved as fast as he would have liked.

Now that we have a way of choosing the right goals for ourselves, how do we stay consistent and make sure we reach our objectives? The two most important steps to achieving any goal are making time and taking action! Making time declares that you matter, and it is a commitment to your values, priorities and goals. If you don’t make time, time will be taken from you. Practicing making time will also help you practice valuable life skills, such as identifying what is important to you and looking ahead, planning and preparing for anything life throws at you. One way to start this process is by making a time diary. For one day, about every 30 minutes, record how you are spending your time. This will help you assess how you are spending your time and figure out what activities are helping you, adding value, what is non-negotiable, and what is taking your time but not helping you. Now you can figure out what activities you can do less of so you can do more to accomplish your goals.

Once you find the time, now you can take action! Often, we come up with great, elaborate plans and idea, but  then get stuck in the thought process. The world’s best workout plan, diet plan or life plan is no good unless we can do something about it. The best way to get unstuck in this process is by taking a five-minute action. Only action creates change! Taking action almost always comes before motivation, and it is usually only after we’ve done something that we feel motivated. By taking small actions, we can gain momentum and bust out of procrastination. Usually, all we have to do is drive through the first few minutes of resistance and then five minutes turns into 30 and then into 60 minutes. By being consistent and learning to use this five-minute action, we will not only achieve our goals, but also learn these valuable life skills and truths along with it. Action is empowering, satisfying and serves as evidence that you’re getting things done even if it’s just for five minutes.

To accomplish any goal, we need to build certain skills and practices, then put them into action. Each goal requires different skills and practices to apply, but the process is the same for all of them. Let’s stick with the goal of losing weight by working out. To do so, we must develop and build up the skill of time management. Then we can practice making time to go to the gym or for a jog. Finally, we can take action and go to the gym or do anything that will help us reach our goal. The more we focus on this process, rather than the outcome, the better the results we will see. We will also build valuable life skills that can be used for more than just fitness goals.

So, now that you have a way to find a meaningful goal and an action plan to go with it, it is time to take charge of your path. Also, it’s really important to remember that when working toward a goal or resolution, that you only compare yourself to where you were yesterday, not to where someone else is in the present moment. Adopt a growth mindset and know that there is no such thing as failure…only feedback. There may be setbacks, and that is normal, but you can learn from it and take a five-minute action. Most importantly, have fun with the process, try new things and as Jocko Willink would say, “Get After It!”

References:

https://faculty.chicagobooth.edu/ayelet.fishbach/research/Woolley&FishbachPSPB.pdf
About the Author:

Certified Personal Trainer Billy Demiri offers Personal and Social Coaching (PSC) at NESCA. Billy has several fitness certifications including: NSCA-CPT (National Strength Condition Association- Certified Personal Trainer) Certified and Autism Fit Certified.

To book sessions with Billy Demiri, complete NESCA’s online intake form and note that you are interested in Personal & Social Coaching.

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

How to Advocate for Your Child

By | NESCA Notes 2019

By: Reva Tankle, Ph.D.
Pediatric Neuropsychologist

The Federation for Children with Special Needs in Boston offers a Parent Consultant Training course several times every year. I have been privileged to teach this group about Neuropsychological Assessment and the IEP Process for the past 15 years. While many people take this course to become Parent Advocates as a profession, it is just as common that the participants are trying to figure out how to best advocate for their own children.

The process always starts with a concern. Parents request an initial evaluation from either the school or a private clinician because they have a concern about their child’s development. They are looking to understand their child’s challenges, obtain a definitive diagnosis and most importantly develop a treatment plan that will ensure their child’s positive trajectory into the future. What I have learned from the many participants in this course is that they are hungry for information about what they should be doing for their children.

It is encouraging that there are so many resources available for parents to help them with some of these concerns. However, the sheer amount of information can also be overwhelming, as it can be hard to know where to start. And it is important that parents get started right away, as we know there is a great advantage in early diagnosis and intervention; especially when autism is suspected. But where does one start?

  • Assessment/Diagnosis
  • Education
  • Parent Support
  • Advocacy

If you suspect your child may be on the autism spectrum, organizations such as AANE, The Asperger/Autism Network, and Autism Speaks can help you find diagnosticians in your area. Your child’s pediatrician may also be knowledgeable about local referral sources for assessment for suspected learning or developmental issues. Finally, word of mouth referrals from those who have previously navigated the process on behalf of their own child is often another great resource to rely on.

Once there is a diagnosis, parents should educate themselves as much as possible about the needs of their child and the options available. Organizations such as AANE and Autism Speaks can provide a lot of the information parents need at this often stressful time if their child has autism. Of particular benefit, Autism Speaks offers a “100 Day Kit for the Newly Diagnosed Family of Young Children.” This step-by-step guide helps parents feel more in control and confident about how and where to start this journey.

For language-based learning disabilities, parents may find needed resources through organizations such as Decoding Dyslexia or the International Dyslexia Association. Whatever diagnosis a parent is facing on behalf of their child, there are resources to provide the education that is needed.

The internet provides so many resources to parents, which is both a blessing and a curse. How can a parent sort through it all and establish priorities? How do they avoid becoming overwhelmed? Parent Support Groups! It may seem like an overly simple solution, but the benefits of sharing with others who have gone through what you are going through are immeasurable. And not feeling like you are in this alone will give you the confidence to keep going.

Armed with a diagnosis as well as education and support, a parent is ready to advocate as needed. Organizations like the Federation for Children with Special Needs are there to help throughout the advocacy journey. Finally, a strong partnership between the child’s parents and school district is critical to ensure that the district understands the individual child, their unique needs and to know that they will work to provide the appropriate educational opportunities for the child.

It may not be an easy journey to embark on, but know there are wonderful resources out there to help make things smoother.

About the Author

Combining her experience and training in both pediatric neuropsychology and educational advocacy, Dr. Reva Tankle has particular expertise in working with families who are navigating the IEP process. Having participated in numerous team meetings over the years, Dr. Tankle is especially knowledgeable about the many ways that schools can support and accommodate students with special learning needs, information that she clearly communicates in her evaluation reports and in team meetings, if needed. She also has a great deal of experience in articulating the reasons that a student may need a program outside of the public school.

Dr. Tankle evaluates students with ADHD, learning disabilities, high functioning autism spectrum disorders, and neurological conditions, as well as children with complex profiles that are not easily captured by a single diagnostic category.

To schedule an appointment with Dr. Reva Tankle in Plainville, MA, or any of our expert neuropsychologists, please complete our online intake form

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

Enjoying the Holidays with Sensory Needs

By | NESCA Notes 2018, NESCA Notes 2019

 

By: Sophie Bellenis, OTD, OTR/L 
NESCA Occupational Therapist; Community-based Skills Coach

School vacation! Bright lights! Snow! Holiday cards on the wall! Bells a’ringing!

For many of us, the holiday season is an exciting, family-filled occasion that brings people together to celebrate yearly traditions. However, for some with sensory needs, the season can be over-stimulating, anxiety producing and difficult to navigate successfully. Even children who love the spirit of the season can quickly become saturated with the onslaught of visual, auditory, tactile and olfactory input. Here are some tips to consider as we head into holiday mode!

  1. Make Your Home a Safe Space – Consider reducing decorations, holding off on moving furniture and choosing a select few holiday cards from friends and family to display. With everything from daily routines to the look of familiar neighborhood streets changing throughout the month, maintaining consistency within a child’s home can help offer a much needed respite from the visual clutter. While these changes may seem minor, visual clutter causes some children’s eyes to continuously scan the room, move from place to place and constantly work to perceive all of the information. This is exhausting!
  2. Less is Often More – For a child who is easily over-stimulated, opening two presents can be much more exciting and rewarding than 10. One hour visiting family can feel easy, while two hours feels impossible. And a small tree can look beautiful, while a huge tree feels intimidating and scary. Set children up for success by keeping activities manageable.
  3. Have a Designated Sensory RetreatWhen venturing out to visit family or friends, preparation is always key. Discussing a sensory plan before arriving and having supports in place can catch stressful situations before they develop. A pre-planned hand signal or code word can save a child from having to explain that their body feels dysregulated and they are overwhelmed. Children may want to take breaks in a quiet bedroom, bring a pop-up tent to hide in, or eat their meal somewhere quiet before a big sit down dinner begins. For adolescents, this sensory retreat may simply be sitting in the car for 10-15 minutes in silence. Give children permission to take what they need.
  4. Enlist the Help of TeachersSocial stories, modified visual routines and exposure to holiday sensory input are all strategies that teachers and therapists in the school setting can help to develop and introduce to a child. Previewing the plan for school vacation can make the week off go much more smoothly.

In a household such as mine, that celebrates both Christmas and Hanukkah, the month of December is fraught with routine change, decorations and new smells from rarely cooked, homemade meals. Allowing our children with sensory processing disorder, autism spectrum disorder and other sensory needs to prioritize their internal regulation can help make the season fun for everyone!

About the Author:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. For the past five years her work has primarily been split between children and adolescents on the Autism Spectrum in the United States, and marginalized children in Tanzania, East Africa.

Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists.

Dr. Bellenis has worked for the Northshore Education Consortium at the Kevin O’Grady School providing occupational therapy services and also at the Spaulding Cambridge Outpatient Center. She also has extensive experience working at the Northeast ARC Spotlight Program using a drama-based method to teach social skills to children, adolescents, and young adults with autism, Asperger’s Syndrome, and related social cognitive challenges.

Internationally, Dr. Bellenis has done extensive work with the Tanzanian Children’s Fund providing educational enrichment and support. She has also spent time working with The Plaster House, a post-surgical, pediatric rehabilitation center in Ngaramtoni, Tanzania.

Dr. Bellenis currently works as a school-based occupational therapist for the city of Salem Public Schools and believes that individual sensory needs and visual motor skills must be taken into account to create comprehensive educational programming. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as well as social skills coaching as part of NESCA’s transition team.

If you are interested in an Occupational Therapy consultation/ assessment or individualized skill coaching with Dr. Bellenis, please complete NESCA’s online intake form today.

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

Acupuncture for the Treatment of Specific Conditions

By | NESCA Notes 2019

By: Meghan Meade, L.Ac, MAOM, MS PREP, CYT

Licensed Acupuncturist, NESCA

A Primer on Acupuncture

While the insertion of needles into the skin to provoke a healing response is a hallmark characteristic of acupuncture, the practice actually involves the potential use of a number of other tools and techniques, including cupping, magnets and other non-insertive tools, and moxibustion, the topical application of a heated herbal substance designed to improve circulation and reduce inflammation.

Chinese medicine approaches healing by seeking to restore balance in the body; in so doing, it evaluates the patient as a complex and ever-changing ecosystem, a composite of multiple interrelated and mutually interdependent systems. Though a patient may be seeking relief from anxiety, for example, acupuncture addresses the issue within the context of a wider landscape, as there are often other symptoms and imbalances accompanying a primary imbalance. To that end, treatments will, of course, take into account a patient’s reported symptoms, but they are rarely the main driver of an acupuncturist’s treatment decisions. Acupuncturists additionally rely on observation of patients’ mannerisms, the sound and qualities of their voices, how they carry themselves and perhaps most importantly – the use of palpation techniques to elicit feedback from the body that guide treatment decisions. What an acupuncturist feels in a patient’s pulse or palpates on a patient’s abdomen or acupuncture channels is immensely influential to the diagnostic and treatment processes.

Implicit in this process is the notion that despite the fact that a patient may be seeking relief from a particular condition, that patient is not the same person he is today as he was yesterday, nor the same as he will be tomorrow. The treatment aims to address the nuances of a patient’s presentation within the present moment, guided by the knowledge of the patient’s health history and health objectives for the future.

Put into a biological context, we humans are continually and necessarily affected by our innate biochemistry as well as by our surroundings – both our mental-emotional and physical environments. Chinese medicine does not reduce a condition down to its primary symptoms, but rather considers all symptoms that are overtly or seemingly less-directly related. If the immune system is affected by a virus, for example, because of its cross-talk with the nervous and endocrine systems, all systems will be influenced in some way, shape or form. Though the rest of this article will discuss the ways in which acupuncture can impact specific conditions that commonly affect the pediatric population, it is predicated on this concept of mutual inter-relatedness and interdependence of the body’s systems.

Acupuncture’s Impact on Mental and Emotional Conditions

The incidence of anxiety, depression and behavior disorders has increased markedly in recent years, with data from the CDC indicating that anxiety and depression incidence among children aged 6-17 has grown from 5.4% in 2003 to 8.4% in 2011-2012. Currently, incidence rates among children aged 3-17 are 7.4% for behavior problems; 7.1% for anxiety; and 3.2% for depression. These afflictions do not occur in isolation and often accompany each other, as 73.8% of children aged 3-17 with diagnosed depression also have anxiety and 47.2% also have behavior problems.

Though we should keep in mind that enhanced awareness of these conditions among children as well as improved assessment and detection in recent years may paint a more dire picture of afflictions that have never in actuality been absent from the pediatric population, the data do represent a critical need to help children in their formative and impressionable years feel more at ease in their bodies as they navigate growth and development.

A dysregulation of the stress response is characteristic of chronic depression, anxiety and behavior disorders. The HPA (hypothalamic-pituitary-adrenal) axis is responsible in part for regulating the body’s response to stress, whether that stress be mental, emotional or physical. When stress becomes chronic, the ability of the HPA axis to allow for functional communication between the brain and body to keep a person feeling safe and calm becomes impaired, resulting in altered activity of stress hormones, such as cortisol, and neurotransmitters such as serotonin and dopamine. Cortisol is of particular interest in this context, as it not only plays a significant role in the stress response but also modulates immune system activity. When cortisol is elevated due to chronic stress, the body ultimately becomes resistant to it, and the immune system is not kept in check, resulting in a proliferation of inflammation. Acupuncture has demonstrated the capacity to modulate HPA axis function to alleviate stress-related symptoms by restoring the body’s responsiveness to cortisol so that its roles in nervous and immune system function can be maintained appropriately. Dysregulated HPA axis function has been implicated in a number of allergic conditions, such as asthma and dermatitis; somatic conditions, such as Fibromyalgia and Chronic Fatigue Syndrome; psychiatric conditions such as PTSD and depression; and numerous immune and autoimmune diseases, underscoring the importance of maintaining proper function of the HPA axis.

Another component of the body’s response to stress involves the autonomic nervous system, comprised of two branches – the sympathetic nervous system and the parasympathetic nervous system. Where the sympathetic branch of the nervous system is responsible for the ‘fight, flight or freeze’ response that alerts us to and helps us remove ourselves from danger, the parasympathetic branch of the nervous system represents the ‘rest and digest’ state, which we’re biologically designed to occupy the majority of the time. Dysfunction of the autonomic nervous system is thought to underlie a number of prevalent mental, developmental and behavioral disorders, such as depression and anxiety, ADHD, and autism. Acupuncture has been shown to activate and modulate the function of brain regions involved with the autonomic nervous system through a number of mechanisms, including increasing concentrations of endogenous opioids, regulating the function of amino acids, such as GABA and glutamate, and enhancing the activity of neurotrophins, such as nerve growth factor (NGF) and brain derived neurotrophic factor (BDNF).

While depression and anxiety are highly heterogeneous in their presentations, and are driven by numerous mechanisms in the central and peripheral nervous systems, increases in inflammation are thought to play a correlational – if not at least partly causative – role in their development. Depression and anxiety have been associated with elevated levels of inflammatory markers, such as C-reactive protein (CRP), Interleukin 6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-alpha), all of which have been shown to be reduced through acupuncture.

Acupuncture and ADHD

ADHD, as defined by the DSM-IV, has a prevalence of 5.9% – 7.1% among children. Characterized by inattention, hyperactivity and impulsivity, ADHD is commonly treated pharmacologically with stimulant medications, such as methylphenidate. While little is known about the long term effects of stimulant medication in this population, and short-to intermediate-term effects include anxiety, depression, weight loss and insomnia, 12% – 64% of parents of children with ADHD have sought out complementary and alternative (CAM) therapies, including acupuncture. In a study of children aged 7-18 diagnosed with ADHD, twice weekly acupuncture treatments for six weeks demonstrated improved attention and memory function among children not taking medication. Another study explored the potential for acupuncture to improve school performance among children aged 7-16; following a series of 10 acupuncture sessions over the course of eight weeks, study subjects showed significant improvements across all three school subjects: math, social studies and Turkish language. Aside from the capacity of acupuncture to improve the stress response through modulation of the HPA axis and autonomic nervous system, acupuncture’s effects on attention and memory and on learning and perception are thought to be mediated in part by its regulation of the neurotransmitters dopamine and serotonin, respectively.

Acupuncture and Autism

With prevalence reports ranging from as low as 1 in 500 to as high as 1 in 50, Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects social communication and interaction, language and behavior. Standard treatment of ASD includes pharmacological therapy and behavioral/educational therapy, though reports from a wide sampling of children with ASD indicate that approximately 88% had utilized CAM therapies to address symptoms such as hyperactivity, inattention, poor sleep and digestive issues. In a study of boys with autism, a treatment regimen of five daily acupuncture sessions over the course of eight weeks demonstrated improvements in speech, self-care and cognition. Significant increases in glucose uptake were shown within the intervention group (vs. control), with improved glucose metabolism in areas of the brain involved in visual, auditory and attentional functioning being thought to underlie the improvements seen in language, attention and cognition. An analysis of 13 studies on acupuncture for autism indicated that the most effective treatment regimen entailed 12 sessions within four weeks, each using a minimum of four acupuncture points, and went on to associate individual acupuncture points with specific effects, from improved language comprehension to enhanced self-care abilities. A meta-analysis of 27 randomized controlled trials found that acupuncture in combination with behavioral and educational interventions (BEI) was more effective than BEI in improving symptoms as determined by a number of evaluation scales (CARS, ABC1, ATEC), suggesting the potential for acupuncture to yield an additive positive effect when utilized with standard of care therapy.

Ultimately, though research supports the use of acupuncture for specific conditions among children and adolescents, it is important to remember that the approach of an acupuncturist is generally not solely protocol-driven as it would be in a research setting. While research findings can and certainly do inform treatment decisions, acupuncturists also rely to a great extent on what is observed and felt during the treatment – they listen to patients’ reported symptoms and experiences, observe how patients speak and carry themselves, palpate acupuncture channels and reflex areas, and feel the pulse to determine imbalances in the body. In this way, Western and Eastern science and medicine are invited to work together to treat imbalances in an informed, patient-centric, holistic way.

References

Almaali, H. M. M. A., Gelewkhan, A., & Mahdi, Z. A. A. (2017, November 11). Analysis of Evidence-Based Autism Symptoms Enhancement by Acupuncture. Retrieved from https://www.sciencedirect.com/science/article/pii/S2005290117301395.

Data and Statistics on Children’s Mental Health. (2019, April 19). Retrieved from https://www.cdc.gov/childrensmentalhealth/data.html.

Duivis, H. E., Vogelzangs, N., Kupper, N., Jonge, P. de, & Penninx, B. W. J. H. (2013, February 8). Differential association of somatic and cognitive symptoms of depression and anxiety with inflammation: Findings from the Netherlands Study of Depression and Anxiety (NESDA). Retrieved from https://www.sciencedirect.com/science/article/pii/S0306453013000073.

Hong, S.-S., & Cho, S.-H. (2015, November 22). Treating attention deficit hyperactivity disorder with acupuncture: A randomized controlled trial. Retrieved from https://www.sciencedirect.com/science/article/pii/S1876382015300585.

Lee, B., Kim, S.-N., Park, H.-J., & Lee, H. (2014, April 1). Research advances in treatment of neurological and psychological diseases by acupuncture at the Acupuncture Meridian Science Research Center. Retrieved from https://www.sciencedirect.com/science/article/pii/S2213422014000237.

Lee, B., Lee, J., Cheon, J.-H., Sung, H.-K., Cho, S.-H., & Chang, G. T. (2018, January 11). The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29552077.

Li, Q.-Q., Shi, G.-X., Xu, Q., Wang, J., Liu, C.-Z., & Wang, L.-P. (2013). Acupuncture effect and central autonomic regulation. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677642/.

Musser, E. D., Backs, R. W., Schmitt, C. F., Ablow, J. C., Measelle, J. R., & Nigg, J. T. (2011, August). Emotion regulation via the autonomic nervous system in children with attention-deficit/hyperactivity disorder (ADHD). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3112468/.

Wong, V. C.-N., Sun, J.-G., & Yeung, D. W.-C. (2014, December 19). Randomized control trial of using tongue acupuncture in autism spectrum disorder. Retrieved from https://www.sciencedirect.com/science/article/pii/S2095754814000064.

 

About the Author

Meghan Meade is a licensed acupuncturist practicing part-time at NESCA.

Having suffered from anxiety, digestive issues, hormonal imbalances and exercise-induced repetitive stress injuries throughout her adolescence and twenties, Meghan first sought out acupuncture as a last ditch effort to salvage some semblance of health and sanity during a particularly stressful period in her life. It worked. Remarkably well. So palpable was the influence of acupuncture on her well being that she was compelled to leave a career in advertising to study Chinese medicine so that she could help others benefit from its effects.

Meghan earned her masters degree in Acupuncture and Oriental Medicine from the New England School of Acupuncture at Massachusetts College of Pharmacy and Health Sciences (MCPHS) and a masters degree in Pain Research, Education and Policy from Tufts University Medical School. She is licensed by the Massachusetts Board of Medicine and is a Diplomate of Oriental Medicine, certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

In her clinical practice, Meghan integrates both Eastern and Western perspectives to provide treatments unique to each patient’s needs and endeavors to empower patients to move forward on their paths to not just feeling good, but feeling like their true selves. In addition to her work as a licensed acupuncturist and herbalist, Meghan serves as adjunct faculty at MCPHS and is a certified yoga teacher.

 

To learn even more about Meghan and acupuncture, visit her alternate web site or read her blog: https://meghanmeadeacu.com/Meghan is practicing at NESCA during the following hours. Appointments at NESCA can be booked by reaching out to me directly at meghan@meghanmeadeacu.com.

Monday: 10am – 6pm

Thursday: 9am – 7pm

 

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

Why the Autism CARES Act Matters

By | NESCA Notes 2019

 

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

The CDC estimates that 1 in 59 children are diagnosed with an autism spectrum disorder (ASD), and studies by Autism Speaks also found that children with autism have a nearly four times greater chances of having unmet health care needs compared to children without disabilities. With those sobering statistics in mind, it’s important for us to take a closer look at recent legislation to help the growing number of people with an ASD diagnosis.

On September 30, 2019, President Trump signed the Autism CARES Act of 2019, which was due to expire on the same day. Originally called the Combating Autism Act, which was established in 2006. It was reauthorized in 2011, and again in 2014 when the name was changed to the Autism (Collaboration, Accountability, Research, Education and Support) CARES Act. This Act is the primary source of federal funding for autism research, services, training and monitoring

Because of this important Act, the 2014 legislation dedicated over $3.1 billion for autism programming. President Trump renewing this Act in 2019 allowed for an extension of the current primary autism law and authorized $1.8 billion in spending on the developmental disorder over the next five years.

The Autism CARES Act of 2019 renews federal support for existing autism research and programs, but also expands these activities, placing an increased emphasis on reducing health disparities and improving services throughout the lifespan. More specifically, the funding provides:

  • Autism research grants awarded by NIH, focusing on advancing scientific understanding of autism, expanded efforts to develop treatments for medical conditions often associated with autism and address the needs of people affected by it. The NIH also works to foster collaboration among research centers to increase the effect of their efforts.
  • Ongoing support for programs across the country focused on ensuring high-quality services for people with autism. This includes funding 52 Leadership Education in Neurodevelopmental and Other Related Disabilities (LEND) programs and 12 Developmental Behavioral Pediatric Training Programs. These programs allow for the continuation of education, early detection and intervention activities through the training of future leaders and healthcare professionals.
  • The continuation of Collaborative programs like Autism Intervention Research Network on Physical Health (AIR-P), which helps to translate research into improved care and tangible resources for families and clinicians.

The Act also calls for the Department of Health and Human Services to once again produce a report for Congress on the health and well-being of individuals with autism. In 2014, this important report to Congress emphasized the needs of individuals with autism as they transitioned out of school-based services and into adulthood. The 2019 Act has placed an increased emphasis on the needs of individuals with autism “across the lifespan,” highlighting a need to understand challenges faced by individuals of all ages. As noted by Autism Speaks President and CEO Angela Geiger, “this legislation ensures sustained funding to better support people with autism across the spectrum and at every stage of life.”

Indeed, as a neuropsychologist, working side-by-side with NESCA’s team of Transition Specialists, I have the privilege of following many individuals with autism spectrum disorders from early childhood throughout their transition to young adulthood.  I find that families begin to scramble as special education funding runs out and they struggle to understand how these young people will continue to get their needs met. For many years, the focus of funding and research was on children, but as these individuals aged out of school-based services, their needs did not end. Yet,  the funding was and continues to be well below what is necessary. While there have certainly been improvements, there continues to be many more needs than are able to be supported. Research remains essential in understanding the longitudinal needs throughout the lifespan, and I am encouraged that our country continues to support these efforts.

 

Reference:

Autism Speaks

About the Author:

Dr. Amity Kulis joined NESCA in 2012 after earning her doctoral degree in clinical psychology from the Massachusetts School of Professional Psychology, with a concentration in Children, Adolescents and Families (CAF). She completed post-doctoral training in pediatric neuropsychology with an emphasis on treating children with developmental, intellectual, learning and executive functioning challenges. She also has extensive training psychological (projective) testing and has conducted individual and group therapies for children of all ages. Before joining NESCA, Dr. Kulis worked in private practices, clinics, and schools, conducting comprehensive assessments on children ranging from toddlers through young adults. In addition, Dr. Kulis has had the opportunity to consult with various school systems, conducting observations of programs, and providing in-service trainings for staff. Dr. Kulis currently conducts neuropsychological and psychological (projective) assessments for school-aged children through young adulthood. She regularly participates in transition assessments (focusing on the needs of adolescents as they emerge into adulthood) and has a special interest in working with complex learners that may also struggle with emotional challenges and psychiatric conditions. In addition to administering comprehensive and data-driven evaluations, Dr. Kulis regularly conducts school-based observations and participates in school meetings to help share her findings and consultation with a student’s TEAM.

 

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

 

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

 

 

Teenage Stress and Executive Functioning

By | NESCA Notes 2019

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

It is increasingly clear to educators, parents, clinicians and the like that teens are experiencing high levels of stress. Why? There are, of course, many reasons stemming from family, social, historical, and systemic “forces” that impact a teen’s personal day-to-day experience.

As an evaluator, I am very aware of one “force” affecting our teens: the “mis-match” between what teens are expected to do and what their executive function skills can handle. I recently participated in a panel discussion along with professionals from Summit Education Group, Engaging Minds and Beyond BookSmart to discuss this “mis-match,” a large contributing factor to student stress. Here are a few important “take-aways” from the discussion:

First, what is executive functioning?  Executive functioning skills are a “family” of skills that operate in a “top-down” process, controlling and regulating brain regions associated with attention, impulse control, emotion regulation and meta-cognition or “thinking about thinking.” A helpful analogy is that executive function skills are the CEO or the “boss” in the brain that monitors, plans, organizes and makes decisions. Here is a useful diagram from ADD Vantages describing executive function skills.

This depicted “family” of executive function skills develops throughout our development. A six year-old is not expected to plan multi-step assignments and check for errors when they write. A six year-old is expected to begin controlling impulses (e.g. waiting their turn in a game) and respond to adult prompts to organize belongings. As a child grows, their brain develops, and executive function skills expand.

However, higher-level metacognition and executive function skills do not simply “magically appear in the brain” or develop “in a vacuum.” Akin to learning a subject, such as math or science, children and teens need to learn executive function skills through teaching, modeling, observing and doing.

We know that teens face a number of responsibilities, particularly in high school – whether that be studying for exams, working on projects, participating in extra-curricular activities, participating in community-run volunteer opportunities, considering academic options post-high school, following their family’s weekly schedule, manage their social media page – and all while getting enough sleep, eating three meals a day and having self-care or “me time.” That adds up to a lot of expectations and demands. Some may posit that these are higher expectations for teens than in decades prior. Yet, what we know is that all teens are unique and develop executive function skills at different speeds. It is therefore logical to expect that many teens will become stressed…stressed because there is a “mis-match” between their daily expectations and the executive function skills that are required to carry out and manage those activities.

As an evaluator, I have worked with a number of teens who experience this “mis-match.” They haven’t yet learned the tools and strategies needed to manage their academic, social and personal responsibilities, and this contributes to low self-confidence, academic underperformance, limited independence, depression and worries about the future. They not only need support and teaching to grow executive function skills to study, work and live more efficiently now and in the future, they also need this “mis-match” and the stress it produces identified and acknowledged by the adults around them.

This “mis-match” can be identified by parents, teachers and/or through a comprehensive neuropsychological evaluation, which is oftentimes critical for determining a teen’s unique learning strengths and challenges. This “mis-match” is also sometimes identified by teens themselves – who are often highly aware of their own needs and simultaneously aware of difficulties that are impacting their vision and goals. As educators, clinicians and professionals who work with stressed teens, we have a responsibility to recognize when executive function “mis-matches” may be a source of stress and support our teens in developing an individualized, collaborative action plan.

 

About the Author:

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

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

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

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

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

 

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

 

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