When Gaming Is No Longer A Game

By | NESCA Notes 2021 | No Comments

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist and Therapist

Many parents are wrestling with how much time their children are engaging with screens, and finding themselves wondering how much is too much. Children who experience difficulty related to symptoms of ADHD are especially drawn to the stimulation of screens. And children with ADHD tend to require frequent and immediate rewards, making them especially drawn to screen-time activities. While a specific cause for ADHD has not been identified, there is some consensus that a shortage of dopamine could be to blame. Dopamine not only plays a role in how we feel pleasure, it is also significant in the uniquely human ability to think and plan.

Part of the allure of gaming – and social media – is that each new level reached and each new “like,” instantly releases a small dose of dopamine directly into the brain’s reward center. If you have ever had to fight with your child to get off technology, this is likely why. A deficit in dopamine is easily fed by screen-time activities, leading children to want more. This has led to a demand for content, resulting in tens of millions of dollars having been made by YouTubers whose entire platform is gaming, and children love watching them. They are entertaining, and kids learn tips for improving their own gaming.

Children worship gaming YouTubers, and many strive to be one someday. It is challenging for parents to keep up with the content their children are accessing largely because YouTube has created an algorithm in the system that suggests what to watch next based on frequent views or recent searches. YouTube’s recommendation system is specifically engineered to maximize watch time and often “up next” videos play automatically. In fact, this feature is responsible for more than 70 percent of all time spent on the site, indicating that children, and others, are consistently and reliably exploring recommended “up next” content. It is important for parents to do their research and know who their children are watching and following on YouTube, as they may be drawn into content that could be highly influential and contrary to family values. While many YouTubers are harmless, there are those who include brief, perhaps undetectable messages (e.g., PewDiePie) that influence what shows up next. Children are curious, and YouTube’s goal is to keep them engaged, which can turn into the perfect storm.

YouTube consists of a business model that rewards provocative videos with large sums of money. They strive to attract viewers by leading them down paths meant to keep people engaged. While much of the content may seem innocuous, there are reasons to be cautious as things aren’t always as innocent as they seem. Provocative content creates intrigue. It piques interest and may be especially attractive to older children and adolescents. As individuals strive to create the next viral video, putting forth extreme beliefs and violent content may be their pathway to becoming a celebrity. For these reasons, and as technology becomes increasingly embedded in children’s lives, it is important for parents to do their research and stay informed.

Some helpful resources include:

https://www.pewresearch.org/internet/2020/07/28/parenting-children-in-the-age-of-screens/

https://chadd.org/wp-content/uploads/2018/06/ATTN_06_15_TooMuchScreenTime.pdf

https://childmind.org/article/healthy-limits-on-video-games/

 

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations.

 

To schedule an appointment with one of NESCA’s 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.

 

Developing S-M-A-R-T Goals in 2021

By | NESCA Notes 2021

By: Tabitha Monahan, M.A., CRC
NESCA Transition Specialist/Counselor

Happy New Year! Now two weeks into 2021, maybe it’s time to revisit those New Year Resolutions.  French writer Antoine de Saint-Exupéry wrote: “a goal without a plan is just a wish.” This is true for resolutions, just as it is for any goal. How can we help our young people change their wishes, visions and dreams into goals? We teach them (and maybe ourselves while we’re at it) how to plan. One of my favorite strategies for both teaching and reaching goals is by creating SMART Goals. What is a Smart Goal?

Specific – The goal should be specific. I’ll increase the distance I run is vague. Will you increase the distance by 20 feet, 2 miles? Are you planning for a marathon? Instead, let’s take a look at step 2, making it measurable.

Measurable – There’s a good chance that if your goal is not specific enough, it will be hard to measure if you have succeeded in that goal. So, let’s make our exercise goal both specific and measurable. I’ll increase the distance I run from 1 mile to 3.2 miles (5k).

Attainable – Attainable is the hard one for many students who are still building awareness of their strengths and challenges. Let’s say a person who has never run wants to run in the Boston Marathon. This is likely not an attainable goal, even if it is specific and measurable. Couch to 5k training exists; I have not seen the couch to marathon training program. Having measurable steps also helps break down the goal into smaller pieces, which will be further discussed later.

Relevant – If I am trying to increase my social circle and group leisure skills, running is unlikely to get me there. However, if, like many people, we’re trying to improve our health in 2021 (or take off some of those quarantine pounds), increasing the distance we run certainly will get us there. Many young adults may need to bounce ideas off someone to ensure the goal is relevant to the area at hand.

Time-bound – Attainable and time-based work tightly together. If you do not give yourself a deadline, the goal may still be there come December 2021. Humans work best with deadlines. We need the motivation to complete a plan, and often motivation needs a sense of urgency.

Okay, so what does our SMART goal look like for increased health and wellness? I will increase the distance I run from 1 mile to 3.2 miles (5k) in ¼ mile increments by June 30, 2021.

We have all the pieces. It is specific, and we know precisely what the end goal will be and how we will get there. It’s measurable; there is something we can check off as complete, like a to-do list. It’s attainable and seems realistic. We are not trying to run the Boston Marathon course after only running a mile. We will start as a beginner runner and work towards a 5k, and we are not trying to do it tomorrow with no steps in between. It’s relevant; we are working on bettering our health in 2021. And it is time-based. We want to meet our goal by the end of June.

Now that we’ve refreshed our minds on SMART goals, how do we build these skills in transition-aged youth? Ask them. Ask your child, your students, your clients what they want for themselves in education, employment and independent living. We already have the starting points. We have their vision. We have the IEP TEAM’s goals and objectives.

The youth may have a far-reaching (and maybe seemingly unattainable) goal. Help them break that big goal down into smaller parts and work backward. Do they want to be an engineer? Engineers need a college degree. What does the student need to do to graduate college? They need to get into college. How do they get into college? They need to apply and graduate from high school. What do they need to do to graduate high school? They need to pass their science class. That seems like a reasonable starting place, and it is still related to the vision. What might a SMART goal look like for that student? I will receive a passing grade on my final exam by answering the end of chapter questions each week and asking for clarification from my teacher for any questions I got wrong by the end of the spring semester.

But how do we support them when they aren’t making progress? Many people have a hard time adjusting once they have made a plan. Whenever we set a goal, we need to look at our progress periodically. We need to check that the goal is still attainable by the deadline we gave ourselves. Are we making progress? If we are still running only a mile and it’s March, what adjustments do we need to make? Suppose a student is not finding answering the end of chapter questions helpful in confirming their knowledge of the material. What changes can they make to increase their understanding of the material? Maybe the student asks the teacher if they can work one-on-one twice a week to increase understanding? Frustration, when the plan doesn’t work, makes many give up on the goal. Learning how to adapt is just as essential as learning how to make a goal.

A person who has practiced SMART goals is a person who will have an increased understanding of the objectives and smaller steps they need to reach their vision. They will have more confidence in their abilities and more awareness of their challenges. A person who has goal-setting skills is a person who has control of their own life. What are your SMART goals for 2021?

 

About the Author

Tabitha Monahan, M.A., CRC, is an experienced transition evaluator and vocational counselor. While she is well-versed in supporting a wide range of transition-aged youth, she is especially passionate and knowledgeable in helping clients and their families navigate the complex systems of adult services and benefits as well as medical and mental health systems. She is further adept in working individually with students of all abilities to empower self-advocacy and goal achievement.

 

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

 

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.

 

The Intention to Thrive

By | NESCA Notes 2021

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

As I reflect on the year that we have all come through, my overwhelming emotion (aside from exhaustion) is pride in the NESCA team for working together in an extraordinary manner under incredibly challenging circumstances. Just before closing the doors at NESCA in mid-March, I wrote to all staff:

NESCA is going to not only survive through this pandemic but we are going to thrive as an organization and show leadership in the special education community. The needs of our clients have not gone away; in fact, they are likely increasing.  School systems are scrambling to meet their obligations for students with special needs. We will continue to do the work we have always done, albeit in a somewhat modified fashion. 

Each of the NESCA staff—clinical and administrative—immediately rose to the occasion to help me realize this vision for navigating the pandemic. We increased the frequency our blog posts and introduced regular webinars, gearing them towards the needs of parents facing the challenges of the pandemic and increased our social media following from 4,000 to more than 40,000 by offering supportive and helpful content. NESCA clinicians offered multiple, free online support groups for parents and professionals related to topics they were now experiencing due to COVID-19. We acknowledged and addressed the unprecedented COVID-19-related concerns and challenges professionals and educators who support those with autism were experiencing through our free Autism Educator Hangouts.

After a great deal of research and discussion about how to conduct evaluations in a manner that ensured the safety of staff and clients while producing valid results, we settled on our “two office model,” renovating our space with plexiglass panes so that clients and clinicians would be able to work together in separate but adjoining offices. We collaborated with Massachusetts Advocates for Children (MAC), Massachusetts Department of Elementary and Secondary Education (DESE), The Federation for Children with Special Needs (FCSN) and the Massachusetts Urban Project, Inc., providing information about assessments and other services during the pandemic.

NESCA grew by adding new staff and service offerings this past year. We welcomed Dr. Moira Creedon to our pediatric neuropsychology staff. Tabitha Monahan, M.A., CRC, and Becki Lauzon, M.A., CRC, both joined NESCA’s Transition Services team. Julie Robinson, OT, joined NESCA in September with three occupational therapists to offer insurance-based, sensory-motor therapy. Abigael Gray, MS, CCC-SLP, also joined at that time to offer insurance-based speech/language and feeding therapy at NESCA. These staff have been incredibly innovative in their use of teletherapy to continue providing services to clients remotely.  And, they and their clients have experienced some surprising benefits stemming from the delivery of services via telehealth. 2020 also saw the introduction of NESCA’s ASD Diagnostic Clinic, helping families to diagnose children with Autism Spectrum Disorder as early as possible so they may gain access to critically important interventions.

Over the last decade, NESCA has had a strong commitment to international work, seeing clients for evaluation and consultation in the NESCA offices as well as abroad. With travel severely limited by the pandemic, we have instituted teletherapy for international work and are pleased to continue to assist  families abroad. NESCA was honored to be a Gold Sponsor for the annual SENIA conference (Special Education Network & Inclusion Association) that was held virtually. I was pleased to present about the differences between testing and assessment with professionals from schools all over Asia.

In the midst of the global pandemic, we continued to do the work that we have always done. We continued to support each other and became even more closely bonded as a team. We contributed to the community. No matter how challenging it has been, we are motivated by the knowledge that children with special needs and their parents need our support now more than ever.

 

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 or therapists, 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.

Teletherapy at NESCA – Benefits and How It Works

By | NESCA Notes 2021

By: Julie Robinson, OT

Director of Clinical Services; Occupational Therapist, NESCA

Now that the second  COVID-19 surge is upon us, many families are again opting to receive occupational, speech-language and feeding therapy services through teletherapy. While COVID-19 is interrupting so many things in our lives, it does not have to interrupt important therapy services. Our clinicians at NESCA encourage teletherapy as a powerful tool to impact progress for your children and foster a smooth family dynamic.

It’s important to note that teletherapy IS covered by insurance, so just because you cannot or may not want to come into the office to be seen in-person, you do not need to put your services on hold.

While some people may not think teletherapy packs the same punch as in-person therapy, we’ve seen some unexpected and valuable benefits stem from this shift in how we deliver services remotely.

Some of the benefits of teletherapy that we’ve observed are:

  • There’s less travel time and more efficiency of service delivery with teletherapy. There’s also more flexibility and scheduling convenience for both the parents and clinicians. We see so many families trying to juggle the responsibilities of remote learning, working from home and managing the needs of multiple kids. Teletherapy can offer the supports that are necessary in an easily accessible way to help families establish consistent and organized routines.
  • Teletherapy allows parents to be more involved in sessions with their child, also allowing the opportunity for clinicians to educate them about activities that can be done at home to facilitate progress. On top of the child receiving therapy, parents get 1:1 real-time training and consultation with a clinician. If parents cannot be involved in sessions, sitters, nannies and other caretakers can participate.
  • For parents who feel that their child is struggling with their experience in school since COVID-19, teletherapy can also be a way to supplement IEP services. Teletherapy as a modality provides more individualized attention to goals that have been established or can fill in gaps in services you feel your child may not be accessing as easily.
  • Clinicians are able to see your children at home—in their natural environment—and to even see some of the daily challenges experienced at home, right in the moment. This allows us to actively problem solve with parents around behavioral challenges and the difficulty their children are having in staying focused during remote learning. Via teletherapy, we can model responses and approaches right in the midst of real-life situations as they are unfolding.
  • Teletherapy allows our occupational therapists to do a virtual house tour with you to suggest modifications or accommodations to your physical environment/space to support sensory needs or motor development with items and areas you already have. Building a home program with our guidance helps to reinforce the work we do with them.
  • In all teletherapy sessions, the child must be present for at least a brief period. But in moments where a child is not able to stay engaged in the process, the clinician is able to stay in the session to provide parent consultation and problem solve.
  • When appropriate and agreed upon by all parties, your clinician can engage other children in the household into teletherapy sessions to incorporate social teaching and positive sibling interactions, as well as structured activity for the family unit.
  • Teletherapy has been a huge plus for our feeding therapists and their clients, as we can work with children in their own kitchens and with food that is typically available and prepared. We can also see how a child behaves throughout the mealtime process in their natural environment as they interact with family members. Therapists report that some of their feeding therapy clients have made more progress via virtual sessions than in their in-clinic sessions.
  • Because teletherapy gives occupational therapists a window into the home setting, we can work with our clients on self-care and hygiene tasks, support learning of chores and other daily household activities in a more natural setting to them.

How a teletherapy session works

Teletherapy is a little different than just showing up for a session in the office and does require some advanced preparation for both the client and the clinician.

  • Initially, your clinician will talk with you to gather information about your home environment, the setting for remote work, and what tools or equipment you may have around at home to incorporate into your sessions.
  • Each week, your clinician will send you an email with a list of items to get ready for your virtual visit, possibly a specific schedule or plan for the session, if needed. This will include a link to access your teletherapy session.
  • In most cases, parents need to be present to facilitate the process, or at the very least accessible to assist with any technology glitches that may arise during the session. We encourage participation from caregivers to ensure that they are educated about our goals as well as the things that can be done at home throughout the week to encourage progress.
  • We try to keep therapy sessions as play-based as possible, often engaging with visual supports or other tools that may help your child to focus and have fun.
  • There may be times when your child is overloaded with remote learning, before our session even begins, or there may be distracting factors in the household at any given moment that can limit their focus on therapeutic tasks. Therapists are able to maintain a flexible approach to end a session early, to give the child a break and talk to a caregiver instead, or to provide parent consultation instead of direct therapy activity. All are benefits to the child and family unit.

To learn more about NESCA’s new clinical therapy services, watch this video interview between NESCA’s Sophie Bellenis, OTD, OTR/L, and Julie Robinson, OT, who oversees the new clinical therapy offerings.

About the Author

Julie Robinson is an occupational therapist with over 25 years of experience as a clinician. The work Julie does is integral to human development, wellness and a solid family unit. She particularly enjoys supporting families through the process of adoption and in working with children who are victims of trauma. Julie has extensive experience working with children diagnosed with an Autism Spectrum Disorder (ASD), or who have learning or emotional disabilities. She provides services that address Sensory Processing Disorder (SPD) and self-regulation challenges, as well as development of motor and executive functioning skills.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services or other clinical therapies, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

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.

 

Approaching 2021 with Ease and Grace

By | NESCA Notes 2021

By Dot Lucci, M.Ed., CAGS

Director of Consultation and Psychoeducational Services, NESCA

I think we are all relieved that 2020 is behind us. All of us experienced a “mental health crisis” of some level of anxiety, depression and fear since March, 2020. As the pandemic spread across our globe, ravaged our lives, took loved ones from us, created economic upheaval, food insecurity and amplified the technological discrepancies that existed within our communities, we adapted and survived…we had to. And the Black Lives Matter movement gained strength also because it had to. From the crisis came opportunity.

Hopefully we learned something about ourselves and each other both across the globe and within our small circles. Now we know the unfathomable and unexpected can and does happen, and it upends our lives like we never expected. What we once thought was important doesn’t seem as important any more. Hopefully, as the months passed in 2020, we settled into the “new normal” and began to develop rhythms and beliefs that sustained us and fed our souls. Let’s hope that we developed a sense of what is truly important and can approach 2021 with new-found hope, resiliency, ease and grace. Approach 2021 by cultivating and remembering the bright spots of this past year, the surprises or treasures of 2020. They may help you think more clearly about 2021.

At the start of a new year, many people make New Year’s resolutions that are long-term goals. Some people manage to keep their resolutions while others aren’t able to sustain the motivation and commitment. Given this past year, it may be difficult to think about resolutions or even conceptualize what the future will look like. Even with vaccines on the horizon, our brains are not ready for long-term planning as our futures may still be a bit unclear. We can hope for a “return to normal,” but what will that “normal” look like?

There is still an uncertainty of what the future holds, so my thinking is to keep it simple. As we start 2021, remember what’s important. If you chose to make New Year’s resolutions, keep them manageable and small. Hopefully what you learned in 2020 can guide your thinking in 2021. Some everyday ideas might be to be kind and gentle with oneself and others. Don’t sweat the small stuff; most of it is small stuff. Smile and laugh every day. Promise yourself to go outside every day and breathe fresh air, be amazed at the glistening snow, the warmth of the sun, the flight of a bird. Take a walk. Three times a day, focus on your breath for at least three minutes. Before going to sleep, think of something to be thankful and grateful for. 2021 can be a year of hope, wonder and faith in a “newer normal” that will emerge, where each of us is responsible for creating a better day, world and a normal that may be even better than the normal of the past.

To everyone, peace, good health and Happy New Year!

 

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 neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician/consultant in the referral line.

 

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.

 

Generalizing Skills from the Classroom to Home and Community – Part 1

By | NESCA Notes 2020

By: Becki Lauzon, M.A., CRC
Transition Specialist and Consultant

“How do I get my student to transfer the skills they are learning in school to the home environment?” This is a question that almost every parent thinks about and asks for suggestions on. I wish I had a simple answer and something that could solve this for each and every student that I have worked with over the years. As you know, every student and home environment are different, so the first step is to individualize the process and see what works best for both the student and the family. Below are some suggestions for two transition areas that have worked, including some resources.

Domestic Skills

Cooking

  • If your student uses a visual recipe in the classroom to learn how to cook, ask the teacher for copies of the exact recipe after it has been mastered in the classroom.
  • Try to have similar cooking tools in the home kitchen that your student uses at school.
  • Start with something basic and that your student likes. It is more of an incentive if they will enjoy eating the end product!
  • Some families choose one night a week that their student cooks with the family or by themselves. This will help build a routine, as well as having your student contribute as an active member of the household.
  • Another motivator for some students is to have a family member take a short video or photo of them cooking (or the final product) so it can be shared with their teacher or other family members. I can’t tell you how much of a confidence booster this has been for students who I have worked with!
  • Other helpful resources:

 

About the Author

Becki Lauzon, M.A., CRC, works with teens, young adults and their families out of the Newton, MA and Plainville, MA offices. Lauzon has unparalleled experience as a Transition Specialist, Transition Consultant and Vocational Program Coordinator. Lauzon will be providing transition assessment (including testing, functional evaluations and observations) consultation, case management, training and professional development for schools; and transition planning, consultation and coaching for transition-aged students and their parents.

 

To schedule an appointment with one of NESCA’s expert transition specialists or 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.

 

Meet Abigael Gray, NESCA’s Speech-Language Pathologist & Feeding Specialist

By | NESCA Notes 2020

This Fall, NESCA debuted its new feeding, speech and language and direct sensory/motor occupational therapy services. Leading NESCA’s feeding and speech and language therapy is Abigael Gray, MS, CCC-SLP. In today’s blog, we sat down with Abbey to learn about her role as a Feeding Specialist; Speech-Language Pathologist.

What led you to your interest in speech and language and feeding, in particular?

I received an undergraduate degree in psychology from Syracuse University. After graduating, I worked in a preschool for children with autism and developmental delays. This is really what made me interested in speech and language pathology (SLP), since all of the children there were receiving speech-language therapy. While I was working there, I observed quite a bit and decided I wanted to learn and do more in this area. After five years of working there, I enrolled at Emerson College to earn my Master’s in Communications Sciences and Disorders. While there, I discovered that Emerson has a great program for feeding. Many schools don’t have a focus on swallowing and feeding in pediatrics, like Emerson does. I had a placement with one of my professors at her practice in Needham. I eventually took a position with this clinic and received great training in pediatric feeding therapy there during my clinical fellowship. This is where I became passionate about feeding therapy. I eventually moved into a multidisciplinary practice for two more years and then joined the team at NESCA.

Why were you attracted to NESCA?

I saw this as a great opportunity to bring speech-language pathology and feeding therapy to NESCA. I loved the  multidisciplinary aspect to the practice and thought I could strengthen what NESCA already offers by adding feeding and SLP to it. I like how all of the various services are built into one practice right here. Many of the  kids being seen at NESCA can also benefit from the therapies that I offer. Having those services available to parents and children right in the same location is a huge plus for them.

After meeting Ann Helmus, Ph.D., NESCA’s founder and director, I knew that it was the right cultural fit for me, being so collaborative. It also gave me the opportunity to continue to work with Julie Robinson, OT, who oversees this new clinical offering. It’s great to be able to continue with my working relationships with the occupational therapists who also joined when I did. The seamless communication between all of us in the clinical therapy practice makes for really well-rounded therapy for the children we treat as well as more convenient for their parents/caregivers.

What are the most exciting and the most challenging parts of your role?

The most exciting part of my new role at NESCA is being able to offer speech-language and feeding  services in-house. Often the recommendations from neuropsychologists through their assessment is to have some SLP support, whether it’s having to do with reading, writing, social skills, expression or comprehension. Being able to offer that right in the same practice allows for continuity of care among clinicians on behalf of the child. It’s exciting for me because I can go back to the neuropsychologist or other clinician at NESCA who referred the client with any new observations or questions I may have. This makes the process much smoother for the parents and our clinicians. There’s just a lot less “red tape” to go through to be able to communicate and collaborate.

It’s also exciting to build this service offering from the ground up. I can take all of the experiences I have had and knowledge I’ve gained through my years in various positions and make our services our own at NESCA.

As far as challenges go, right now as we build out this new service, I am currently the only SLP on board. While that is the case for now, I have a great network of past colleagues and friends who are SLPs to bounce thoughts off of. Our plan is to have other SLPs join our team as we grow the practice.

What are your clinical interests?

Feeding is my big passion area. Within feeding, I am currently completing a lactation counseling training to become a certified lactation counselor. Babies can struggle with breast feeding, then can have even more difficulties transitioning from the breast to solid foods. I love working with infants and toddlers, and having this certification will round out my knowledge about feeding for this age range.

Within speech, I love working on articulation with kids who have speech sound disorders, phonological disorders and childhood apraxia of speech. Within language, I really enjoy working on social pragmatic communication with kids who are on the higher functioning side of the autism spectrum, or Asperger’s, or those who have social pragmatics difficulties.

I also really enjoy working on early literacy skills, sound letters, identification, rhyming and phonological awareness. When it comes to kids who may be in their older elementary school or early middle school years, I love to work on writing skills with them.

One characteristic among NESCA clinicians is that they are all lifelong learners. In what ways are you a lifelong learner?

I loved that having the curiosity to continue to learn is a draw here at NESCA! That’s really important to me. Right now, I’m currently working my way through three different courses:

  • The lactation counseling certification that I mentioned previously
  • A “Feed the Peds” course, which is a refresher course on feeding therapy with some new approaches in the areas of tethered oral tissues (i.e., tongue ties, lip ties) and how those impact feeding. The course covers how to assess and treat these issues. What’s interesting is that these new approaches are appropriate for people across the lifespan – not just for young children. There is also a module on treating those with medical complexities. Often times, medically complex patients have issues with feeding and/or are tube-fed, and can then go on to have challenges progressing through age-appropriate feeding skills or transitioning off of tube-feeding.
  • The third area I am currently in training for is with orofacial myofunctional disorders, including tethered oral tissues and the impact on speech and feeding. This covers anything that structurally or functionally impairs speech, the airway or feeding. This is a growing area in our field, so it’s important to be current and well-informed on this topic.

How has Covid-19 impacted the way you treat patients and families?

Right now, we are delivering speech-language and feeding therapy via teletherapy. While it’s always great to work with a child and/or family in-person, the plus side of teletherapy is that we get to see the child in their natural home environment as well as how the child communicates with family members. Sometimes, when we see the child in this setting, we can detect and observe a feeding or speech-language issue as the family sees it on a regular basis. It’s also nice to be able to work with parents in their own setting. We can better understand their priorities for therapy since we are talking directly with them. It also allows the child to generalize the skills they would normally learn in the clinic setting right into their home. As therapists, we can see what a typical meal at home looks like, which is obviously a more natural setting than the clinic. We used to have to ask parents to send us videos of mealtimes. Now, it’s like we are at a meal with them over Zoom!

Covid-19 was the catalyst for us to offer teletherapy, which has helped parents who work and have to travel to get to therapy tremendously. They are now able to be more hands-on in the therapy sessions. Also, for some medically complex kids, it’s just hard to get out of the house and drive to therapy. And, parents don’t have to cancel appointments if a sibling is home sick or even quarantining. And, we can stay on track with therapy via telehealth even in inclement weather that makes it challenging to drive to the clinic.

Covid-19 has certainly had its drawbacks, but we’re seeing some of the upsides in teletherapy as well.

 

About the Author

Abigael Gray has over six years of experience in assessment and treatment of a variety of disorders, including dysphagia, childhood apraxia of speech, speech sound disorder, receptive and expressive language disorder, autism spectrum disorder and attention deficit hyperactivity disorder. She has a special interest and experience in working with children with feeding and swallowing disorders, including transitioning infants to solid foods, weaning from tube feeding, improving sensory tolerance, developing chewing skills, increasing variety and volume of nutritional intake and reducing avoidance behaviors during mealtimes.

 

 

 

 

If you are interested in learning more about NESCA’s speech-language therapy or feeding therapy, please complete our online intake form, or email NESCA’s Director of Clinical Services Julie Robinson at jrobinson@nesca-newton.com.

 

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.

 

Digital Literacy, Executive Function and Remote Learning

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L

Occupational Therapist; Real-life Skills Program Manager and Coach, NESCA

The experience of watching a small child who is only two or three years old pick up a smartphone, quickly type in a passcode (as they have memorized the pattern) and open up their favorite game can be jarring for adults who remember the days of dial-up internet and who learned to use technology as it staggeringly evolved. For many of today’s children, handheld electronics have always been a fundamental part of their world. Flipping between apps, using their pointer finger to manipulate games and opening a screen using facial recognition all feel like second nature to many in the current generation of school age children. We assume that children have higher digital literacy than we do and intrinsically understand technology in a way that many of us never will. But what do our children actually know? And, are they missing out on vastly important direct instruction when adults make an assumption that they are already tiny experts in the digital field?

Over the past six months, a time fraught with a monumental shift in education, I have worked one-on-one with a widely diverse group of learners. If I had to pinpoint one theme that comes up over and over, across ages, levels of ability and school systems, it is frustration, confusion and lack of problem-solving strategies as they relate to technology. Statements I have heard during this period of remote learning include:

  • “I don’t turn off my Chromebook. I lose everything, and I’m actually not quite sure that I know how to turn it back on.” – High school honors student
  • “I didn’t know that Google Slide and PowerPoint were different things. I lost so much trying to switch between them.” – High school senior
  • “Hardware or software? I didn’t realize there was a difference.” – Middle school student
  • “I just save my document with whatever my computer suggests as a title. I guess it does make it tricky to find things later.” – High school junior

As an occupational therapist focused on making sure our students can access their curriculum, comments like these teach me a few incredibly important lessons.

  1. Students are lacking information on the basics. The same student who is not sure how to turn off his Chromebook can quickly navigate Google Classroom without any support, both uploading files and opening modules with ease. We need to focus on teaching the fundamentals of technology. What are hardware and software and how to they interact? What options exist within the system preferences of a particular device? How is an iPad different from a Chromebook, a Windows laptop or a MacBook? Why do we need to power down devices sometimes? What are the downsides to never restarting a computer or updating an operating system?
  2. Successful digital organization does not come naturally. Students are typically taught specific systems for organizing physical space and materials, such as color-coded folders, binders and labels. Teaching students to organize their digital space and their digital materials is equally, if not even more, important. Learning to create folders for each class and systematic ways of labeling documents saves students time and energy, and this often decreases frustration in the moment.
  3. Academic and professional tools are not particularly intuitive (a stark contrast to entertainment tools). There are incredible programs designed to help students create presentations, synthesize data and put documents together. These include, but are not limited to, the Microsoft Suite and Google Workspace. These tools can be tricky to manipulate and many middle and high school students would benefit from taking an introductory course, watching online tutorials or working directly with teachers to explore their functionality before layering on assignments requiring competent use of the tools.
  4. Students are often completely unaware of their gaps in knowledge. This is potentially due to the fact that today’s students are so impressive when it comes to using technology for leisure purposes. They seamlessly transition from an iPad, to a Chromebook, to a Samsung phone and can access games or social media without difficulty on each device. Unfortunately, very few schools have programs focused on teaching computing skills or digital literacy in the academic context. Our students piece together enough information to get by for a short while, but often come up against challenges later. Students also may believe they have built competency because they have some exposure to a tool. For instance, I have worked with students who are building resumes and including claims such as, “Proficient in Excel, PowerPoint and Word” but score poorly when tested on these computer abilities.

So, what do can we do?

The first step towards ensuring that a child or adolescent has adequate digital literacy skills is to actually assess how much they already know. Some students do have these skills mastered and others will have unexpected deficits or gaps. This assessment can be done formally or informally. A starting point I often use is to sit down with a student at a computer and ask how they organize, how they navigate, how they save files, etc. I also like using online assessment resources, such as TypingClub.com and Northstar Digital Literacy.

Once the skills that a student needs to grow are identified, there are many opportunities available to teach them. A few options include:

  • Online courses in specific software programs. Sites, such as Coursera, LinkedIn and Udemy, have comprehensive courses focused on specific programs for all different levels of learners.
  • Free online videos. A quick search on YouTube often leads to short, accurate videos and tutorials filmed by teachers or professionals. If your student learns well through video format, these can be a great tool.
  • Ask your school for support. Often, students learn better with direct instruction. If a student’s team is aware of their lack of knowledge regarding technology, there are many professionals at school who may be able to teach these skills during a free period, study hall or meeting.

 

About the Author

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. 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. Having spent years delivering direct services at the elementary, middle school and high school levels, Dr. Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

 

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

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.

 

I Can Tell You a Story…I Just Can’t Write It

By | NESCA Notes 2020

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

According to understood.org, “Written expression disorder is a learning disability that results in a person having trouble expressing their thoughts in writing… They might have the greatest ideas, but their writing is disorganized and full of grammar and punctuation mistakes.” Experts believe that between 8 and 15 percent of people have a written expression disorder and it often co-occurs with other learning challenges, with two of the most common being dyslexia and attention-deficit/hyperactivity disorder (AD/HD).

Writing is difficult because it depends upon many separate components that need to be integrated into a complex whole. For example, to write well, a person needs to have acquired knowledge about the topic, retrieve needed vocabulary and express the information in a way that can be followed by the reader. At the same time, the writer needs to be able to self-monitor their progress, including switching between the main idea and writing mechanics, such as spelling, punctuation and grammar. People with written expression disorder might be able to tell an organized and interesting story, but struggle when asked to recreate that information in written form. Receiving a formal diagnosis can help a child receive extra help at school or even specialized instruction. Also, a diagnosis can possibly lead to accommodations at college.

There are also several methods of instruction that can help a student organize their writing. These programs help a student visualize or represent abstract ideas by using visually-based templates. While many of these methods are copyrighted and cannot be reproduced in this blog, some examples are programs such as Thinking maps by David Hyerle, Ed.D. or “Brain Frames.” These programs have developed specific graphic organizers to help a student with a variety of writing assignments (e.g., comparing and contrasting, ordering and sequencing) and provide specialized instruction that can help a student greatly improve their ability to express their ideas in writing.

If you believe that your child may be experiencing difficulties in the area of writing, one step is to determine the root of the difficulty. For example, does the student have an underlying learning disability or reduced self-regulation that may be negatively impacting their progress? Receiving a neuropsychological evaluation could be a useful tool in determining the appropriate supports and services to best help your child.

Sources:

https://www.understood.org/en/learning-thinking-differences

http://www.ldonline.org/article/33079/

http://www.thinkingmaps.com

http://www.architectsforlearning.com

 

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.

Transition Assessment: What is it anyway? How is it different from neuropsychological evaluation?

By | NESCA Notes 2020

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

If you have a child who receives special education services or work in education, you are likely familiar with the Individuals with Disabilities Education Improvement Act of 2004 (IDEA 2004). This is the law that guarantees students with disabilities the right to free appropriate public education (FAPE) and that dictates that the purpose of special education and related services is to prepare students with disabilities for further education, employment, and independent living.

IDEA 2004 mandates that students have measurable postsecondary goals written in their individualized educational programs (IEPs), that describe the outcomes that a team expects for the student to achieve after exiting public education and that these goals must be “based upon age-appropriate transition assessments related to training, education, employment, and where appropriate, independent living skills.”[1] But, IDEA 2004 does not specifically define transition assessment.

Instead, the best and most commonly accepted definition for transition assessment comes from the Division on Career Development and Transition (DCDT). DCDT defines transition assessment as an “…ongoing process of collecting data on the individual’s needs, preferences, and interests as they relate to the demands of current and future working, educational, living, and personal and social environments.”[2]

Transition assessment can include formal testing, such as a standardized, published tests that compare students to others by age or grade or informal activities, such as interviewing or observing a student. Most students who are transition-aged (i.e., 14 or older in Massachusetts; 16 by federal law) have already had some assessments that will inform their transition planning, such as school evaluations, private evaluations, standardized academic testing, report cards, or even activities that happen within their guidance curriculum (e.g., assessment of strengths, learning style, personality type, career interests). But often, there will still be some testing needed to help better determine a student’s strengths and aptitudes, their preferences and interests for postsecondary adult life, and the gaps between their current knowledge and abilities and the requirements of the living, learning, and working environments in which they plan to function when they exit high school.

At NESCA, transition assessment is a highly individualized process that is designed to get a better sense of a student’s postsecondary living, learning, social, and vocational goals, to determine the strengths the student has that will help them reach those goals as well as the skills a student needs to develop to get there. While it is rare for two students to have the same assessment battery, transition assessment at NESCA often evaluates abilities, such as self-care, self-direction, self-advocacy, career interests, career aptitudes, communication, community use, functional academics, health and safety, domestic skills, leisure, readiness for college or other forms of postsecondary learning and training, transferrable work skills and readiness for employment. Once the student’s profile is understood, specific recommendations, aimed at readying that student for transition from high school to the next phase of life, are provided.

Often parents of transition-aged students are familiar with the term “neuropsychological evaluation“ and a student may have even had this type of private evaluation. But there can be some confusion regarding the difference between these two types of comprehensive testing. Neuropsychological evaluation focuses primarily on a student’s learning profile and the fit of that learner within their current academic setting. A good neuropsychological evaluation is a comprehensive assessment of a child’s functioning in many domains, including communication, visual-spatial ability, problem solving, memory, attention, social skills, and emotional status. The assessment of these functions is based upon information obtained from the child’s history, clinical observations, and testing results. Moreover, one of the most important aspects of a neuropsychological evaluation is the integration of all the information about a child into a meaningful profile of functioning that describes “The Whole Child.”

In contrast, a transition assessment evaluates the fit between a student and their future preferred learning, living, and employment activities and environments. While information from a neuropsychological evaluation about a student’s learning profile is greatly informative, a transition assessment gives equal weight to a student’s daily living skills, social skills, coping skills, pre-vocational skills, career interests and preferences, and self-advocacy skills. While transition assessments provide detailed recommendations related to current educational programming and transition services, a strong focus of transition assessment is an emphasis on what will be needed now, and in the near future, to assist a student in functioning, and, actually being successful and satisfied, in their postsecondary adult life.

For more information about transition assessment at NESCA, visit our transition services page and our transition FAQs.

[1] 34 CFR § 300.320(b)

[2] Division on Career Development and Transition (DCDT) of the Council for Exceptional Children, 1997, p. 70-71

 

 

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.