School Observations

By | NESCA Notes 2018

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

One of my favorite activities as a neuropsychologist is getting to conduct school observations. Many parents ask why would I need a school observation? And the answer is simple, they provide a wealth of information about your child and their everyday experience at school. For so many, understanding the comings and goings of a child’s day at school is something most parents do not have the opportunity to explore. You ask your child, “how was your day?” and for many, all you get is a “fine” or “okay” with no elaboration of what actually happened. Understanding a child’s experience of the school day is important for all families, but especially important if your child is having difficulties at school such as learning, social or emotional stressors.

After conducting a neuropsychological assessment of a child, I am able to get a good understanding of the child’s learning profile and a good grasp of the child’s strengths and needs. With this information, I am able to conduct school observations with a lens towards what the children I am seeing might need and how they interact with their environment. For the majority of the children I observe at school they are already getting specialized services and for one reason or another, their parents are concerned.

During the observation, I am able to gain a better understanding of a child’s social functioning within the context of their peers at school. I often purposefully schedule observations during a combination of structured class time as well as less structured time such as art or gym, and finally during an unstructured time such as lunch or recess. This combination of environments allows me to see the child interact with peers in a variety of settings. I am able to answer questions about where a child does best and what types of environments might be more challenging. Are they a rock star during group lessons or are they leading a group of peers across the playground? For other children they may fade into the background, refusing to participate during large group instruction but become more animated during one-on-one time with their teacher. Or maybe they are a child that cannot handle the unstructured recess time and hide in the corner isolating themselves. Gaining a better understanding of a child’s social successes and then relating that information to their neuropsychological profile can help to explain why a child is struggling and how best to support them.

Beyond looking at a child’s social functioning during the school day, I am also able to observe the delivery of instruction and how the child responds. I am always watching how a teacher deliveries information to the class and then seeing how the child is able to respond. Does the child follow the direction the first time they are heard or do they need them repeated and modeled by watching other students begin the activity first? I also look at how a child interacts during whole group instruction or discussion versus a small group or more individual work. I also love the opportunity to speak with teachers during the observation to understand what curriculums they are using as well as answering questions about how they see the child interacting in the classroom. If a child is on an education plan I am also paying close attention to how accommodations and supports are being integrated into and across the child’s school day.

In addition to being a fun and engaging part of my job, observations also provide such valuable information from which I can create very specific and targeted recommendations for a child based on their own school environment. There is definitely not a one-size-fits-all recipe for helping a child with a particular profile because an environment is so influential on a child’s successes and challenges. An amazing relationship with one teacher can go a long way toward helping a child take chances and make progress, just as the opposite is true. With a school observation, there is the opportunity to gain more clarity into a child’s everyday school life to help foster their strengths and support their vulnerabilities.

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.

 

 

 

 

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.

 

 

Blog Update: Intensive Therapy

By | NESCA Notes 2018

By: Ryan Ruth Conway, PsyD
Clinical Psychologist, NESCA

Earlier this month, the New York Times published an article about intensive therapy, a type of treatment that is more accelerated and condensed than traditional once weekly therapy. The author described a “new wave” of therapy programs popping up around the country designed to help clients with all types of anxiety experience relief more quickly. The article cited new research to explain the growing popularity of concentrated treatment, which shows that the approach is generally just as effective, and in some ways more effective, than longer-term care for both children and adults. Also noteworthy is that fewer clients dropped out of the intensive treatment, which suggests that clients are more likely to “stick with” therapy when it is delivered in a shortened, consistent format.

In short-term therapies, clients have the opportunity to practice using newly learned skills to face their fears in all different situations and environments that elicit anxiety. For instance, a client with social fears might be instructed to order for himself at a restaurant, ask a stranger for directions or purposely do something embarrassing in public. By practicing daily in session and also for homework, you see a lot of carryover from day to day and faster acquisition of skills, which is a huge confidence booster! Exposure and Response Prevention (ERP), a technique often used in Cognitive Behavioral Therapy (CBT), helps clients approach anxiety-provoking situations and learn that anxiety eventually habituates, or dissipates, on its own over time, and those other behaviors they have been using to manage their fears (e.g., excessive washing, checking, seeking reassurance from parents or avoidance) are neither helpful nor necessary.

NESCA offers intensive CBT “boot camps” for children and adolescents with anxiety, including (but not limited to) social anxiety, phobias, OCD and generalized anxiety. NESCA clinicians thoroughly enjoyed helping clients build coping skills and feel better through intensive treatments this past summer, and received a positive response from children and their families! Our treatment programs are individually tailored for each client and also include parent sessions in order to teach caregivers the tools they need to best support their child. Summer or school breaks can be the perfect time to focus on mental health without the distractions of the academic year or other extracurricular activities.

To learn more about intensive therapy and NESCA’s program visit: http://www.nesca-news.com/2018/03/intensive-cognitive-behavioral-therapy.html

For any questions about NESCA’s intensive treatment program or to sign up please contact Ryan Ruth Conway, PsyD at rconway@nesca-newton.com or (617) 658-9831.

 

About the Author: 
Conway

Ryan Ruth Conway, PsyD, is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.

 

 

 

 

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.

Interview with Erin Gibbons, NESCA Pediatric Neuropsychologist

By | NESCA Notes 2018

 

By:
Ashlee Cooper
Marketing and Outreach Coordinator, NESCA

 

What is neuropsychology? How did you get interested in this field?

My first introduction to neuropsychology was as a college student when I took coursework in neuroscience and cognition and found it to be fascinating. However, when I started graduate school, I was initially intimidated by neuropsychology courses as I feared they would be too “medical” or focused on research. I specialized in pediatric psychology, but always assumed I would become a therapist. It was not until I took an internship with a pediatric neuropsychologist that I really understood the field and fell in love with this work.

Although the field of neuropsychology is extensive, what we do at NESCA is focus on its practical applications. An evaluation is comprised of a set of tests that seek to assess students’ skills in a variety of areas such as intelligence, memory, organization, learning/academics, and social skills. The data being generated by those tests are then considered within the context of the student’s developmental history and current challenges. Ultimately, the goal is to provide parents with a complete picture of their child’s learning profile – helping to understand where their child might excel and where he or she might struggle. Moreover, recommendations will be provided in an effort to help each student meet his or her innate potential and to experience success.

What do you like about your job?

I love the opportunity to work with many different children and families from across the state and, in some cases, from other countries. Families place a lot of trust in me by sharing very difficult stories about their children’s struggles and I feel privileged to be a member of their team. For me, the most impactful part of the evaluation is often the parent feedback session when I explain the results of the testing and lay out my recommendations. Through this process, I hope to provide parents with an understanding of their child’s learning profile in a way that helps them establish a road map for the next several years. 

Do you have a specialty? What do you specialize in?

At NESCA, we see a wide variety of students presenting with all types of issues. My caseload is always varied and never boring! That said, I tend to see younger clients and have extensive training in evaluating children under 5 years of age. I also enjoy working with students who have developmental disabilities such as autism spectrum disorders or intellectual impairments. I often evaluate students who are considered “difficult to test; for example, those who are nonverbal, have vision impairments, or significant motor delays. 

What brought you to NESCA?

After completing my doctorate, I spent two years working in a hospital setting. Although I learned an extraordinary amount during my time there, I had very little opportunity to interact with parents as they were typically followed by their child’s physician. I really wanted to work in a place where I could see an evaluation through from start to finish, and working at NESCA allows me to do this. I also appreciate the opportunity to observe students in settings outside of the office and work closely with teachers and other providers. Through the entire process, I get to know each student very well, and I am also able to establish a meaningful relationship with their parents.

What do you enjoy about working at NESCA?

NESCA has a wonderful work culture that is extremely collaborative, supportive, and enriching. Everyone truly enjoys each other’s company and we often have social gatherings to celebrate milestones such as weddings, graduations, and births. Aside from that, our director Dr. Ann Helmus is committed to having all clinicians stay up to date on current research and treatment in the field of neuropsychology. Every other week, we have outside professionals provide staff training, allowing us to learn about local resources, which we can then share with our clients. We also frequently share new information with one another as we attend conferences or read new articles.

What do you think sets NESCA apart? Why should a parent bring their child here when there are so many other neuropsychologists in Massachusetts and New Hampshire?

Every clinician at NESCA is extraordinarily dedicated to providing the best care to their clients. We have case conferences every week during which clinicians discuss challenging cases and seek input from our colleagues. With each new presentation, it is clear that the clinician has genuine compassion for the child and family and is striving to help in every way possible.

Further, our evaluations are remarkably in depth, and we often ask students to return for additional appointments if we feel that we need more information to help round out our understanding of a particular case. Every clinician conducts school or community observations on a regular basis as well; these are often essential in order to see how a student is functioning on a daily basis since test scores do not always tell the “whole story.” Along with these very detailed evaluations, the reports that are provided by NESCA clinicians are outstanding. I have the opportunity to read many, many neuropsychological reports, and I can honestly say that I believe NESCA reports are the best. They describe the student as a whole, including both strengths and weaknesses. Recommendations are consistently specific, detailed, and thoughtful. I often hear parents say that after reading the report, they have a better understanding of their own child.

What advice do you have for parents who are not sure if a neuropsychological evaluation is needed for their child?

The best first step is to have a consult with one of our clinicians. These one-hour appointments give parents the opportunity to describe their concerns and seek advice on next steps. While a neuropsychological evaluation might be necessary in order to answer their specific questions and address their concerns, this is not always the case. Having the chance to talk things out with an expert can be extremely helpful in terms of creating the most sensible plan.

 

 

We are very excited to announce that on October 1, 2018, NESCA will open a bright new, satellite office in Plainville, MA! To schedule an appointment with Dr. Erin Gibbons in Plainville, please complete our online intake form: https://nesca-newton.com/intake-form/  The address of NESCA-Plainville is 60 Man Mar Drive, Suite 8, Plainville, MA 02762.

 

 

About the Author: 

As Marketing and Outreach Coordinator, Ashlee oversees marketing campaigns and develops community relationships through various programming activities – all of which expand NESCA’s well-respected reputation in New England. Ashlee brings a wide range of marketing, design and communications experience in the social service and non-profit industry. She lives in Newton with her husband and their beloved dog, Winnie. In her free time, she enjoys doing yoga, watching documentaries and promoting her and her husband’s housewares startup.

Get in touch with Ashlee with any questions you may have about NESCA’s programs and events at acooper@nesca-newton.com. She looks forward to hearing from you!

 

 

 

 

 

 

 

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.

The Northeast Arc Spotlight Model: Drama-Based Social Skills Intervention using evidence-based Socio-dramatic, affective relational intervention (SDARI)

By | NESCA Notes 2018

By:
Rebecca Girard, LICSW, CAS
Licensed Clinical Social Worker, NESCA

Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Community-Based Skills Coach, NESCA

 

This summer, NESCA piloted its first series of social pragmatics groups using the Northeast Arc Spotlight/SDARI model. We are excited to continue offering these groups in the 2018-2019 school year. Please read below to learn more about this model and whether it sounds like to fit for a child or adolescent in your life:

For those of us in the autism community, you may have noticed a lot of buzz recently around drama-based social pragmatic intervention for children on the spectrum. Perhaps this is because they provoke creativity, self-expression of participants, and are often more fun than traditional didactic models. Creating spaces for ASD individuals to practice social interactions in a semi-structured setting while providing fun and interactive activities allow for true, authentic social connection.

The Spotlight Model was originally developed in 2004 at the Northeast Arc under the clinical guidance of Dr. Matthew Lerner and Dr. Karen Levine. Since that time, Dr. Lerner has used the acronym SDARI (Socio-Dramatic Affective Relational Intervention) to describe the model in his past and current research studies. The Northeast Arc Spotlight Model was created in response to children who were not having success in traditional social skills models, and who needed something more engaging and personalized. This method was developed as a way to teach social pragmatics, as opposed to social skills.  While these terms may sound similar, the differences are vast when it comes to developing generalizable skills. Simply put, social skills consist of rote memorization, manners, active listening, and following a basic set of social rules. Social pragmatics focus on finding one’s own unique social style that is intrinsically motivating and fluid. It is the ability to effectively use communication in social situations while maintaining individuality and being able to respond to unpredictable circumstances.

What makes the Northeast Arc Spotlight Model different?

The Spotlight Model/SDARI uses a three-part model to create engaging groups that maximize the potential for ongoing friendships. Groups are formed by taking into account a number of factors, including personality, socialization style, common interests and, to a lesser degree, age and gender.

  1. Improvisation and dramatic training as social learning. Many of the skills necessary to be a confident social individual are the same skills necessary to become a successful actor. Goals such as Thinking of Your Feet, Body Language, Tone of Voice, and Someone Else’s Perceptive work on both improv and skills, dramatic training, and reciprocal scene work, as well as social competence and confidence. Improvisation’s one and only rule is “yes, and”; meaning that no matter what happens in a game/scene/activity, the participant must say, “yes” to accept what is happening and not block to flow, the “and” to build on that idea with a new one. Improv games allow groups to implicitly work on skills while laughing together, being creative, and forming lasting bonds. After all – laughter is the shortest distance between two people!
  2. Relational reinforcement. Counselors using the Northeast Arc Spotlight Model work to form trust and real relationships with participants. Each group has a head counselor, the individual responsible for creating the flow of the day, overseeing the group as a whole, and maintaining momentum. They are complemented by support counselors who check in with each child, create ways for everyone to be involved, and use strategies to help everyone feel like a contributing group member. Counselors use redirection, side-coaching, playful humor, inside jokes, and even passwords or codes. For example, during the opening meeting, the head counselor asks each participant the “question of the day” – a support counselor may sit next to a participant with slower processing to help them quietly prepare an answer before it is their turn to speak. During improvisation games, a support counselor may have a secret code word with a participant as a reminder to stay focused on the game they are playing. Participation looks different for everyone, and improv games and activities allow for a wide range of abilities and engagement.
  3. Strong use of age-appropriate motivators. The Northeast Arc Spotlight Model incorporates the use of video games, board games, and special interests to promote connection and interaction. During “break time” participants are encouraged to choose a preferred activity, as long as they are working together with a peer. This creates a space for independent conversation and interaction, with active facilitation from staff, and a way to share what they love. In addition, counselors often use a participant’s special interest to keep them engaged and excited. For example, someone who loves trains may play the game, Ask an Expert! to teach his peers about his favorite topic.

Many of our autistic friends and family thrive when their quirky humor is encouraged. Their unique perspective and disinhibited nature often lend itself to a unique and hilarious sense of humor. The Northeast Arc Spotlight Model creates a setting where children can be fully themselves, while simultaneously working to develop their social abilities. The facilitation of positive interactions and collaborative learning builds confidence and successful peer relationships.

Learn more and schedule an intake:

  • For more information about the Northeast Arc Spotlight Model groups being run at NESCA, please contact Rebecca Girard at rgirard@nesca-newton.com.
  • To learn more about the Northeast Arc in Danvers, MA, visit: ne-arc.org
  • To read more about the current efficacy of the SDARI model please visit lernerlab.com.

 

About the Authors: 
Girard

Rebecca Girard, LICSW, CAS is a licensed clinical social worker specializing in neurodivergent issues, sexual trauma, and international social work. She has worked primarily with children, adolescents, adults with Autism Spectrum Disorders and their families for over a decade. Ms. Girard is highly experienced in using Cognitive Behavior Therapy (CBT) as well as Socio-dramatic Affective Relational Intervention (SDARI), in addition to a number of other modalities. She provides enhanced psychotherapy to children with ASD at NESCA as well as to provide therapeutic support to youth with a range of mood, anxiety, social and behavioral challenges. Her approach is child-centered, strengths-based, creative and compassionate.

 

Sophie Bellenis, OTD, OTR/L is Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. 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.

 

 

 

 

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.

Blog Update: Increased Access to Publicly Funded Independent Educational Evaluations (IEEs)

By | NESCA Notes 2018

By: Nancy Roosa, Psy.D.
Pediatric Neuropsychologist, NESCA

In the last blog post about increased access to independent evaluations, we cited some provisions that were in the original bill, filed by State Senator Barbara L’Italien and State Representative Jim O’Day, which ultimately did not pass. The increase in rates for IEEs were made by a regulation from the agency, the Executive Office of Health and Human Services (EOHHS), not legislative action. A corrected version of the article is reprinted below. We remain excited about these changes and thankful for the hard work of our friends at MAC, the Ed Law Project, and the many advocates, parents, and psychologists who helped advocate for these changes.

As an independent group practice, not allied with any one school district, medical or advocacy group, neuropsychologists at NESCA are often called upon to perform independent evaluations for parents who are seeking an unbiased expert opinion related to their child’s developmental and educational needs. In some cases, this is the first evaluation a family is seeking for their child. In others, the family is in disagreement with the progression or conclusions of a school-based evaluation process. In Massachusetts, parents may seek private evaluation of their child at their own expense at any time and their educational team must meet to consider the results and recommendations of that evaluation. State and federal laws also provide parents with a procedure for requesting that a school district fund an Independent Educational Evaluation (IEE) if they believe that the school’s evaluation is not adequate or comprehensive enough. It is often helpful for parents who are interested in this important resource to consult with an educational advocate to see if they have a legitimate reason to request public funding for an IEE.

Unfortunately, in the past, the ability of families to access a publicly funded IEE has been limited by the low rates that school districts were required to pay to the independent evaluator, as set by state regulations. The maximum allowable rates were, until recently, $74.94 per hour with an allowed range of 8-12 hours, for a total of $899.28. Very few practicing evaluators are able or willing to accept less than $900 to perform what, by definition, needs to be a comprehensive evaluation in the context of what is often a complex situation centering on a disagreement between a family and a school district. These rates had not been raised since 2007, more than ten years ago. Thus, even when a school district agreed to fund an IEE, the school and family often had trouble finding an expert evaluator willing and able to perform it for the state rate.

This situation has changed, thanks in large part to the committed lobbying efforts of our friends at Mass Advocates for Children (MAC), a group of dedicated lawyers, advocates, parents and others who work tirelessly to ensure that all children in the state have equal access to educational and life opportunities. They focus particularly on those children who have disabilities, are low income and/or are racially, culturally, or linguistically diverse.  Thanks to MAC’s leadership in lobbying for this new change, the Executive Office of Health and Human Services (EOHHS) passed new regulations, effective April 1, 2018, which allow a maximum rate of $88.43 per hour, and the range of hours has increased to 9-20, bringing the maximum total rate to $1,768.60. This means more families, particularly those of limited means, should be able to access IEEs if they are needed.

We thank our friends at MAC for their dedicated work on this and other efforts that benefit the most vulnerable children in the Commonwealth. MAC also gives grateful credit to the Ed Law Project and other advocates, parents, and psychologists who helped advocate for this bill, as well as Lead Sponsors of the bill: State Senator Barbara L’Italien and State Representative Jim O’Day.

Please visit the MAC website to appreciate the scope of their many efforts.  https://massadvocates.org/

For more information about the Independent Educational Evaluation process in MA, check out these resources:

NESCA is proud to continue to provide evaluations funded both privately and publicly. While our rates are higher than the state’s standard rate, we are thankful that this increased funding is available to defray costs for families in need.

About the Author: 
Roosa

Dr. Roosa has been engaged in providing neuropsychological evaluations for children since 1997. She enjoys working with a range of children, particularly those with autism spectrum disorders, as well as children with attentional issues, executive function deficits, anxiety disorders, learning disabilities, or other social, emotional or behavioral problems. Her evaluations are particularly appropriate for children with complex profiles and those whose presentations do not fit neatly into any one diagnostic box. As part of this process, Dr. Roosa is frequently engaged in school visits, IEP Team Meetings, home observations and phone consultations with collateral providers. Dr. Roosa has also consulted with several area schools, either about individual children or about programmatic concerns. She speaks to parent or school groups, upon request.

 

 

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.

Increased Access to Publicly Funded Independent Educational Evaluations (IEEs)

By | NESCA Notes 2018

By: Nancy Roosa, Psy.D.
Pediatric Neuropsychologist, NESCA

As an independent group practice, not allied with any one school district, medical or advocacy group, neuropsychologists at NESCA are often called upon to perform independent evaluations for parents who are seeking an unbiased expert opinion related to their child’s developmental and educational needs. In some cases, this is the first evaluation a family is seeking for their child. In others, the family is in disagreement with the progression or conclusions of a school-based evaluation process. In Massachusetts, parents may seek private evaluation of their child at their own expense at any time and their educational team must meet to consider the results and recommendations of that evaluation. State and federal laws also provide parents with a procedure for requesting that a school district fund an Independent Educational Evaluation (IEE) if they believe that the school’s evaluation is not adequate or comprehensive enough. It is often helpful for parents who are interested in this important resource to consult with an educational advocate to see if they have a legitimate reason to request public funding for an IEE.

Unfortunately, in the past, the ability of families to access a publicly funded IEE has been limited by the low rates that school districts were required to pay to the independent evaluator, as set by state regulations. The maximum allowable rates were, until recently, $74.94 per hour with an allowed range of 8-12 hours, for a total of $899.28. Very few practicing evaluators are able or willing to accept less than $900 to perform what, by definition, needs to be a comprehensive evaluation in the context of what is often a complex situation centering on a disagreement between a family and a school district. These rates had not been raised since 2007, more than ten years ago. Thus, even when a school district agreed to fund an IEE, the school and family often had trouble finding an expert evaluator willing and able to perform it for the state rate.

This situation has changed, thanks in large part to the committed lobbying efforts of our friends at Mass Advocates for Children (MAC), a group of dedicated lawyers, advocates, parents and others who work tirelessly to ensure that all children in the state have equal access to educational and life opportunities. They focus particularly on those children who have disabilities, are low income and/or are racially, culturally, or linguistically diverse.  Thanks to MAC’s leadership in lobbying for this new change, the Executive Office of Health and Human Services (EOHHS) passed new regulations, effective April 1, 2018, which allow a maximum rate of $88.43 per hour, and the range of hours has increased to 9-20, bringing the maximum total rate to $1,768.60.  In addition, the Bureau of Special Education Appeals will be able to order a higher rate in extraordinary cases. Further, in the rare instances that parents prevail at a hearing and have paid expert fees, the parents would have the right to be reimbursed for these fees by the school district. This means more families, particularly those of limited means, should be able to access IEEs if they are needed.

We thank our friends at MAC for their dedicated work on this and other efforts that benefit the most vulnerable children in the Commonwealth. MAC also gives grateful credit to the Ed Law Project and other advocates, parents, and psychologists who helped advocate for this bill, as well as Lead Sponsors of the bill: State Senator Barbara L’Italien and State Representative Jim O’Day.

Please visit the MAC website to appreciate the scope of their many efforts.  https://massadvocates.org/

For more information about the Independent Educational Evaluation process in MA, check out these resources:

NESCA is proud to continue to provide evaluations funded both privately and publicly. While our rates are higher than the state’s standard rate, we are thankful that this increased funding is available to defray costs for families in need.

About the Author: 
Roosa

Dr. Roosa has been engaged in providing neuropsychological evaluations for children since 1997. She enjoys working with a range of children, particularly those with autism spectrum disorders, as well as children with attentional issues, executive function deficits, anxiety disorders, learning disabilities, or other social, emotional or behavioral problems. Her evaluations are particularly appropriate for children with complex profiles and those whose presentations do not fit neatly into any one diagnostic box. As part of this process, Dr. Roosa is frequently engaged in school visits, IEP Team Meetings, home observations and phone consultations with collateral providers. Dr. Roosa has also consulted with several area schools, either about individual children or about programmatic concerns. She speaks to parent or school groups, upon request.

 

 

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.

Double Rainbow: The Intersectionality of Autism Spectrum Disorders and gender variance

By | NESCA Notes 2018

By: Jacquelyn Reinert, Psy.D., LMHC
Pediatric Neuropsychologist, NESCA

“Transgender and autism, that’s not a thing, is it?” Since joining NESCA last September, I have encountered countless parents, teachers, and professionals who ask this exact question in feedback sessions, case consultations, and team meetings. The conversation that typically follows often calls into question the validity of the intersectionality of Autism Spectrum Disorder (ASD), Asperger Syndrome, and trans-identities and gender variance, as well as that of sexual orientation.

ASD is a neurodevelopmental disorder which impacts an individual’s communication, social interactions, play, interests, and behaviors. ASD presentations vary according to age, gender, and development. While functionally these communication and behavior patterns can assist clinicians to make diagnoses and inform interventions, we recognize that there can also be a stigma attached to diagnostic codes and labels. As such, we embrace an affirming stance, recognizing neurodiversity within the ASD community.

One commonly utilized phrase at NESCA is Stephen Shore’s quote, “If you have met a person with autism, then you have met one person with autism.” The same can be said for an individual who questions or is exploring their gender expression. There is a spectrum of gender diversity, ranging from gender non-conforming to non-binary, to transgender, and so on. The terminology and classifications within the community are fluid and ever-evolving, but for now, key terms are provided below. It is estimated that gender diverse youth may make up 5 to 12% of birth assigned females, and 2 to 6% of birth-assigned males; transgender youth, 0.5% (APA Fact Sheet). Of those, how many are also neurodiverse?

 

Key Terms*:

Courtesy of the Boston Children’s GeMS Clinic and the American Psychological Association

Sex: the biological category or identity that a person belongs to; based upon chromosomes, genetic makeup, and internal/external reproductive organs.

Gender identity: a person’s inner sense of oneself as either a woman (female), a man (male), or other/something different.

Gender expression: refers to the way in which we display our gender identity to other individuals and to the world around us.

Cisgender: a person whose gender identity and/or expression are aligned with the sex/gender that they were assigned at birth.

Non-binary: identifying as a gender other than exclusively female/woman or male/man.

Gender nonconforming, gender variant, or gender diverse: an individual who has a gender identity and/or gender expression that does not conform to the gender they were assigned at birth. They may prefer clothing, accessories, hair length/styles, and activities that are not expected in the culture based on their sex assigned at birth.

Transgender: individuals who typically consistently, persistently, and insistently express a cross-gender identity and feel that their gender is different from their assigned sex.

Gender dysphoria (GD): the distress an individual experiences when their assigned gender does not match their gender identity.

* In April, NESCA had the opportunity to meet with Dr. Kerry McGregor, Attending Psychologist at Boston Children’s Hospital in the Division of Endocrinology and Gender Management Service (GeMS) to learn more about the intersectionality of ASD and gender dysphoria and ways in which NESCA clinicians can provide gender affirmative care.

 

Emerging research suggests that indeed there is a relationship between gender variance and autism, although not without reservation and mixed approval. Researchers exploring the link between these spectrums suggest that gender variance is present in 5 to 7% of adolescents with ASD (Van Der Miesen, Hurley, & De Vries, 2016). Opponents suggest that the co-occurrence is merely a manifestation of restrictive, repetitive behavior, interests, and or activities, a hallmark symptom of ASD. Further, they suggest that due to the inherently negative experiences gender variant adolescents face, these individuals are more likely to demonstrate behaviors consistent with social impairments rather than a primary diagnosis of ASD (Turban & van Schalkwyk, 2018).

Regardless of whether a link is clearly identified at this point in time, individuals, families, clinicians, and communities are faced with navigating the complexities of the intersectionality of gender variance and ASD. Further, they face the complex dilemma of who to seek out should a child, adolescent, or family need support, guidance or targeted intervention to address gender dysphoria and other co-occurring challenges, such as anxiety and depression.

Where to start and what can families do to help?

  1. This is a marathon, not a sprint, and the race begins with balanced acceptance. Validating an individual’s disclosure with empathy and understanding is the first step in providing children and adolescents the space to begin exploration. Parents and caregivers should try to avoid either quick dismissal or accelerated enthusiasm. For many adolescents (gender variant, neurodiverse, or not), self-exploration is an essential part of growing up and being allowed a space with which to question and explore in a safe way is key.
  2. Be an advocate for your child or adolescent; ask questions and be curious. If adolescents are disclosing, be willing to have an open conversation. When you are unsure of what a term is, ask permission to clarify. Promoting a culture of acceptance and validation is essential.
  3. Not all challenges are central to either gender exploration or ASD. Navigating adolescence is difficult and although neurodiverse adolescents exploring gender expression may struggle, these concerns may be attributed to other emerging challenges. Parsing out typical adolescence and emerging mental health difficulties should be done in partnership with knowledgeable professionals who can thoroughly explore the issues.
  4. Be kind to yourselves and know that you will not have all the answers immediately. Parents and caregivers can often experience elevations in stress, particularly when outcomes are vague and without the opportunity to truly digest information. Resources provided below are initial starting points to learn more about gender variance, as well as the intersectionality with the neurodiverse community.
  5. Seek support for yourself. Parents and caregivers can benefit from working through concerns and worries, such as how other family members may react to an adolescent’s gender exploration. Working with an individual therapist or in a support group can be highly beneficial in providing the space for adults to process outside of the relationship with your child.
  6. Seek support for the child or adolescent. If your child is currently working with a mental health provider, working with an existing person in tandem with a gender specialist can be highly beneficial. One excellent area resource is Boston Children’s Gender Management Service (GeMS) Program which provides physical and psychological evaluations which inform individualized treatment plans for children. With a comprehensive plan, GeMS multi-disciplinary team can coordinate with existing providers (e.g., clinicians, primary care physicians) and can make referrals as needed. NESCA also has clinicians who provide a variety of services including individual therapy and neuropsychological and psychological evaluations and who are highly versed in the literature surrounding the intersectionality of neurodiversity and gender.

Resources

Books:
Gender Born, Gender Made by Diane Ehrensaft, Ph.D.

The Gender Creative Child: Pathways for Nurturing and Supporting Children by Diane Ehrensaft, Ph.D.

The Transgender Teen: A Handbook for Parents and Professionals Supporting Transgender and Non-Binary Teens by Stephanie Brill and Lisa Kenney

Support Groups:
AANE Gender Identity and the Autism Spectrum Support Group for Transgender Adults on the Spectrum (link: https://www.aane.org/event/gender-identity-autism-spectrum-support-group-transgender-adults-spectrum-13/)

Online Resources:
ASAN, NCTE, and LGBTQ Task Force Joint Statement on the Rights of Transgender and Gender Non-Conforming Autistic People (link: http://www.thetaskforce.org/wp-content/uploads/2016/06/joint_statement_trans_autistic_GNC_people.pdf)

Family Acceptance Project (link: http://familyproject.sfsu.edu/publications) Spectrum News – Living Between Genders (Link: https://www.spectrumnews.org/features/deep-dive/living-between-genders/)

Boston Children’s Gender Management Services (GeMS) Program (link: http://www.childrenshospital.org/centers-and-services/programs/a-_-e/disorders-of-sexual-development-dsd-and-gender-management-service-program

Sexual Orientation, Gender Identity, and Asperger/Autism by Jamie Freed, MSW for AANE
(link: https://www.aane.org/sexual-orientation-gender-identity-aspergerautism/)

 

About the Author: 

Dr. Reinert is a Pediatric Neuropsychology Postdoctoral Fellow who joined NESCA in September 2017. Dr. Reinert assists with neuropsychological and psychological (projective) assessments in the Newton office and in the Londonderry office. In addition to assisting with neuropsychological evaluations, Dr. Reinert co-facilitates parent-child groups and provides clinical consultation. Before joining NESCA Dr. Reinert worked in a variety of clinical settings, including therapeutic schools, residential treatment programs and in community mental health. She has comprehensive training in psychological assessment, conducting testing with children, adolescents, and transitional-aged adults with complex trauma. Dr. Reinert is particularly interested in researching the intersectionality of ASD and gender exploration.

Reach out if you would like to work with Dr. Reinert:  Email jreinert@nesca-newton.com

 

 

 

 

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.

PCIT: Improving Child Behavior, Transforming Parent-Child Relationships

By | NESCA Notes 2018

photo from pcit.org

 

By: Ryan Ruth Conway, Psy.D.
Clinical Psychologist, NESCA

First developed in the 1970’s by Sheila M. Eyberg, Ph.D., Parent-Child Interaction Therapy (PCIT) is a scientifically proven treatment program for young children (ages 2-7) who display challenging behaviors (e.g., noncompliance, defiance, temper tantrums, aggression) and difficulty regulating their emotions. PCIT therapists work with both the child and the parent together. Goals of treatment are to develop warmth and positivity in the parent-child relationship and teach parents how to effectively deal with behavioral problems both at home and publicly. While this efficacious treatment has been around for almost 50 years and is practiced both nationally and internationally, it is not widely known amongst parents and professionals in Massachusetts.

 

The video above provides brief illustrations of the treatment in action at the University of Miami’s PCIT program. Watching the video, you will see clips of a PCIT therapist “coaching” the parent through a one-way mirror, as the parent listens to the therapist’s instructions about interacting with his or her child through an earpiece while they play. PCIT is unique in that it is “in vivo,” or in real time, which helps the therapist directly observe parent-child interactions and also greatly enhances the caregiver’s learning of new skills that promote positive behaviors in children.

The video depicts the first phase of PCIT treatment called Child-Directed Interaction (CDI), which is the relationship enhancement phase. In CDI, parents follow the child’s lead in play while practicing specialized parenting skills. One of the skills applied by the parents in the video is praise. But not just any praise – this is labeled praise (e.g., “Great job playing gently with the toys”). Labeled praise communicates to the child specifically what it is that they did well, which increases the likelihood that this behavior will happen again, bolsters the child’s self-esteem and also promotes positive feelings between the parent and child. Praise feels good to give and to receive! Another skill practiced in CDI is reflection, or repeating what the child says during the play (e.g., Child says “The kangaroo is jumping”; Parent says “He is jumping very high!”) Reflections show that the parent is listening to the child, that the parent approves of what the child is doing and has also been shown to improve speech. Labeled praise and reflections are just two of the many skills taught to parents in CDI.

While positive behaviors are reinforced in CDI, inappropriate behaviors (e.g., whining, crying, talking back) are intentionally ignored to reduce their occurrence. While ignoring disruptive behaviors, parents are coached to use distraction and redirection skills. CDI then sets the foundation for the next phase of PCIT, called Parent-Directed Interaction (PDI), which continues to encourage appropriate play while also focusing on a structured and consistent approach to discipline.

There have been numerous studies documenting the effectiveness of PCIT (http://www.pcit.org/literature.html). Results have shown improvements in child behavior as well as reduced stress and increased confidence amongst caregivers. In addition to these outcomes, we see a stronger, happier parent-child bond!

NESCA is thrilled to announce that we are now offering PCIT! If you or someone you know might be interested in this treatment, please contact Dr. Ryan Ruth Conway at rconway@nesca-newton.com or (617) 658-9831.

To learn more about PCIT, visit http://www.pcit.org/

 

About the Author: 
Conway

Ryan Ruth Conway, Psy.D., is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.

Reach out if you would like to work with Ryan: Email rconway@nesca-newton.com

 

 

 

 

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.

Social Creativity and ASD – Challenging the assumption that autistic people are not social

By | NESCA Notes 2018

Photo from the documentary, Autism: The Musical (2007)

By: Rebecca Girard, LICSW, CAS
Licensed Clinical Social Worker

The New York Times recently published an opinion piece titled, How to Meet Autistic People Halfway, an article that challenges the common belief that people on the autism spectrum are avoidant of social interaction and do not desire social connections. The authors, Vikram K. Jaswal and Nameera Akhtar are psychologists and researchers who study the social lives of people on the autism spectrum. They assert that while core deficits of autism may make social interaction more challenging, it does not mean people on the spectrum do not desire meaningful social connection. For years, many in the ASD community and their allies in the neurodiversity rights movement have attempted to combat this anti-social stereotype, but the notion stubbornly persists. Counter-narratives of the autistic social experience often reflect autistic people as extremely emotionally sensitive, hyper-aware of the feeling states of others, and indeed motivated to experience social success in the form of friendships and social acceptance. Additionally, an increasing number of people believe those on the spectrum may actually display more creative and interesting ways to connect and choose to describe autistic individuals as “socially creative” rather than having “social deficits”.

If we then acknowledge the desire to connect is present, how can we best facilitate social learning and promote social success? First, we can acknowledge that a person on the spectrum will have a myriad of ASD-related challenges that will likely make socializing difficult. These include trouble reading and interpreting social cues (eye contact, body language, facial expressions), attending to and managing sensory challenges during interaction, and repetitive and inflexible thinking (getting “stuck”, echolalia), all of which can lead to preemptive social rejection by peers and a lack of social opportunities to practice and improve upon their social interaction skills. These challenges require multi-disciplinary supports, including (but not limited to) occupational therapy, speech therapy, and cognitive-behavioral therapy. Second, we can provide positive social learning interventions that address and ameliorate the impact of these factors, while providing opportunities to explore and understand the social world.

A popular method of intervention is that of “social knowledge”, or didactic social skills training. This entails imparting concrete social skills, in the effort to explicitly teach what a person may not know about socializing. Think – programming a social computer with many algorithms; if a person does A, you do B. While this may be great at teaching the basics, it often does not adequately prepare ASD individuals for the unpredictability and fluidity of everyday interactions. Another approach is that of “social performance”, a dynamic method of encouraging social pragmatic development by providing semi-structured socialization opportunities in small group settings with immediate, in vivo feedback on what’s working or not. Think – flexing a social muscle. Drama-based social pragmatic groups are gaining in popularity as a method for not only promoting social connections but as a fun way to create an encouraging and supportive space to finds one’s own intrinsically motivating social style.

But enhancing individual social skills and providing adequate social opportunities is admittedly a one-sided approach. Equally important is challenging the stigma and bias that plague the ASD community. We need to be allies to this community by promoting greater acceptance of a wide-range of social styles and approaches to social engagement. To honor the neurodiversity mission, which “rejects the idea that autism should be cured, advocating instead for celebrating autistic forms of communication and self-expression, and for promoting support systems that allow autistic people to live as autistic people.” (What is Neurodiversity? [Website]. (2011).  National Symposium on Neurodiversity at Syracuse University)

As a therapist who has worked with ASD individuals across the lifespan since 2004, I know firsthand that autistic people feel the same loneliness and isolation when chronically socially disconnected, and feel the same anxiety and unease when experiencing social rejection. I have also had the pleasure of witnessing individuals find their own distinctive social style and the joy of connecting with others who appreciate what is different as interesting and exceptional, rather than off-putting or strange. The autistic people in my life, both professionally and personally, have challenged me to rethink narrow and strictly defined social expectations, and have made all my relationships richer as a result. Autistic people are often credited with “out of the box” thinking and innovation, which can be applied to their social lives as well, as they are uninhibited by social convention. For example, Asperger’s are Us are the first all-autistic sketch comedy troupe, and their performances reflect their original and offbeat sense of humor, as well as their deep connection to one another as friends. A great example of what is possible.

The New York Times article said it best in its conclusion, “improving the social lives of autistic people will require putting aside assumptions about how social interest is expressed and recognizing that it can be shown in unexpected ways.” As parents, professionals, and allies, let’s commit to challenging this very basic and long-held assumption and appreciate and embrace the unique and creative ways autistic people chose to engage the world around them.

 

About the Author: 

Rebecca Girard, LICSW, CAS is a licensed clinical social worker specializing in neurodivergent issues, sexual trauma, and international social work. She has worked primarily with children, adolescents, adults with Autism Spectrum Disorders and their families for over a decade. Ms. Girard is highly experienced in using Cognitive Behavior Therapy (CBT) as well as Socio-dramatic Affective Relational Intervention (SDARI), in addition to a number of other modalities. She provides enhanced psychotherapy to children with ASD at NESCA as well as to provide therapeutic support to youth with a range of mood, anxiety, social and behavioral challenges. Her approach is child-centered, strengths-based, creative and compassionate.

Reach out if you would like to work with Rebecca: Email rgirard@nesca-newton.com or call 617-658-9825

 

 

 

 

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.