Child Feedback Sessions: How and Why We Explain What Testing Means To Kids

By | NESCA Notes 2019

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

“Who get’s the results of the testing, me or my parents?” As a neuropsychologist, clients of all ages ask why they are being tested and who is going to get the information from the testing. Sometimes these questions come from a place of nervousness, while others are asking because they have a general curiosity.

Neuropsychological evaluation is an intensive process where students are trying out all sorts of skill sets, some activities that are familiar (e.g., math problems), and some activities that they will only ever do in the context of an evaluation process (e.g., putting pegs in a pegboard, drawing weird rocketship shaped patterns from memory). Even children as young as elementary school are often curious about the results of the assessment (e.g., how did I do? what were you testing? what is the report going to say?). These are such important questions and I am always excited when the children I am working with are curious about what this all means.

At NESCA, a neuropsychology and integrative treatment practice founded in Newton, MA, we conclude our testing with a parent feedback session where results and preliminary recommendations are clearly presented to parents. This is a conversational format so that we can ensure that there is good understanding and a shared picture of what we have learned about the child. Even with a lengthy conversation, parents often question about how to share the findings with their children because it often results in changes for the child like working with new people or getting more/less or different services at school.

Importantly, we offer child/adolescent feedback sessions for children of all ages. These mini-feedback sessions are presented in a developmentally appropriate manner to share the findings of the evaluation. Often with older children and adolescents this conversation includes discussing any diagnosis that came out of the evaluation. For all individuals the conversation always includes a strengths-based approach highlighting the things the child/adolescent did wonderfully using examples from the testing to explain these strengths and how they might show these skills in real life. Then we move on to also talking about some of the activities that were more challenging and how we envision teachers, providers, or other supports helping them to make progress. For example, a child might do extremely well on tasks of visual problem solving such as recreating block designs or on verbal tasks that ask them to define words, but have greater challenges on tasks that assess processing speed. These findings suggest a child is able to think and problem solve at a high level, yet processes information more slowly and might need more time to show off their strengths when they are expected to produce output. This important difference is so essential to explain to even younger children. Children often value speed over all else, and explaining to them that working slow but producing amazing ideas is a real asset. The same type of careful explanation can be taken when explaining learning disabilities, attentional issues, social difficulties and emotional vulnerabilities. There is a calculated effort to include the child/adolescent in a conversation about their own ideas on how to improve areas of need and I feel this really empowers them to work for the change and positive growth. Plus, these sessions are a great way to gain closure over the experience of testing and allow them to understand what was accomplished and learned through all of their hours of hard work.

About the Author:

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

 

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

 

 

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

 

 

Addressing Anxiety through the IEP Process

By | NESCA Notes 2019

By: Erin Gibbons, Ph.D.
Pediatric Neuropsychologist, NESCA

Anxiety disorders are becoming more and more common among children and adolescents. Recent data from the National Institute of Mental Health (NIMH) reported that 31.9% of adolescents between 13-19 have an identified anxiety disorder. Although fewer statistics are available, it is clear that students who have a developmental, learning, or attention disorder are at high risk for developing clinically significant anxiety in light of their struggles with academics, learning, and/or social development. Given the rising numbers of affected children and adolescents, it has become increasingly important that a student’s emotional health is addressed both at home through private counseling, as well as through the provision of school-based services. When students experience a high level of unmitigated anxiety throughout the day, they are less able to learn and meet their potential.

When parents are seeking services for anxiety through their school system, there are different levels of support. First, teachers can provide classroom supports and address emotional health with all students, whether or not they have an identified anxiety disorder. Some examples of useful classroom strategies include:

  • Create predictable routines and clear expectations.
  • Provide warnings about upcoming transitions.
  • Have a “cool down space” available in the classroom or another room in the school.
  • Incorporate movement into lessons throughout the day.

There are also programs designed to address emotional regulation that can be used throughout the school or district. For example:

If these supports are not sufficient to meet a student’s needs, then it is necessary to develop goals through the IEP process. In order to make needed progress, it is important that the goals and benchmarks in the IEP are specific. For example, a benchmark might state: “Johnny will show better emotional regulation in stressful situations.” A more specific benchmark might state: “When Johnny starts to shut down or refuse to participate during a math class, he will identify his current emotion(s) in 4 out of 5 opportunities.”

When parents seek supports for their child’s anxiety through the IEP, they should consider whether their child needs accommodations, specialized instruction or both.

Examples of accommodations for anxiety include:

  • Extra time in testing situations.
  • Opportunities to take tests in a quiet setting.
  • Access to breaks as needed.
  • Access to the school counselor as needed.
  • Student does not need to sign out of class to use the bathroom.
  • Student is prompted to take breaks when showing signs of distress.
  • Student has modified homework.
  • Teacher will check in with student before independent work blocks.
  • Specialized instruction can be provided in the classroom (push-in) or in a different setting (pull-out).

Push-in services might include:

  • Provision of an instructional aide to support emotion identification and regulation.
  • The school counselor/psychologist works with the entire class once or twice a month to discuss emotional health.

Pull-out services might include:

  • Regular sessions with the school counselor/psychologist.
  • Social skills groups.

Consultation services are also important, especially if a student participates in private therapy outside of school. Parents should consider giving permission for the private therapist to speak with the school counselor to discuss common treatment goals and ways in which the student’s coping skills can be supported and reinforced in school.

About the Author:

GibbonsErin Gibbons, Ph.D. is a pediatric neuropsychologist with expertise in neurodevelopmental and neuropsychological assessment of infants, children, and adolescents presenting with developmental disabilities including autism spectrum disorders, Down syndrome, intellectual disabilities, learning disabilities, and attention deficit disorders. She has a particular interest in assessing students with complex medical histories and/or neurological impairments, including those who are cognitively delayed, nonverbal, or physically disabled. Dr. Gibbons joined NESCA in 2011 after completing a two-year post-doctoral fellowship in the Developmental Medicine Center at Boston Children’s Hospital. She particularly enjoys working with young children, especially those who are transitioning from Early Intervention into preschool. Having been trained in administration of the Autism Diagnostic Observation Schedule (ADOS), Dr. Gibbons has experience diagnosing autism spectrum disorders in children aged 12 months and above.

Dr. Gibbons recently began serving clients in NESCA’s newest location in Plainville/Foxborough, MA. She is thrilled to bring her expertise in evaluating and supporting children with a wide range of abilities to this area of the state.

 

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

 

 

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

 

Why does my neuropsychologist need that? What do the tests measure and why is previous testing important?

By | NESCA Notes 2019

 

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

When a family books an intake for neuropsychological evaluation, they are typically asked to complete a few pieces of paperwork and to bring previous testing and other educational documents such as an Individualized Education Program (IEP) for their intake appointment. Despite this request, many parents will come to the intake session with empty hands. Understanding that parents have an enormous number of tasks on their plate, one could expect that paperwork was left at home due to timing or organization difficulties. However, when I ask parents about the missing paperwork decision, the reasons for leaving it behind generally fall into two groups: (1) lack of knowledge about the purpose of testing; and (2) concerns about creating some form of bias in the examiner’s mind. Some parents don’t share prior testing with me because they don’t have a clear idea of what the testing is and how it is going to be used for my evaluation. This is very common with families who are new to the special education or mental health process. Some parents are reluctant to share past testing because they want a “fresh view” and are concerned that looking at someone else’s work may create a bias. This often comes up when there is disagreement between parents and their school or past provider as to the nature of the child’s difficulties. Sometimes the parents and child have had a bad previous experience with testing and/or with the examiner, and they do not feel that the test results accurately (or at least empathetically) describe their child. In any of these situations, I find that parents feel more comfortable if they know more about how the tests we use are developed and why we find it helpful to view previous testing.

Purpose of Testing: The purpose of neuropsychological testing is to find out if a child (or adolescent or adult) is developing skills at a rate and capacity commensurate with their age and ability level. In order to do this in an efficient, equitable, and consistent manner, test developers identify skills they think are important in learning, devise a task that appears to quantifiably measure that skill, give that task to children in different age groups and then transform the raw scores attained by the children into a common scale. This allows them to compare different children within an age group, and this also allows them to compare the same child at different ages. Some common measurement scales are standard scores, scaled scores, Z scores, T-scores and percentiles. All of these formats are based on a normal distribution (remember the bell curve?) in which the majority of scores fall within a certain area with increasingly fewer scores falling at either end. The “bump” where most scores fall is described as average (between 25th and 75th%ile) with the tails receiving an above or below average description. While these descriptions do not begin to capture the whole child, they do convey information about how a child is performing relative to developmental expectations based on what we know about children of the same age. They can also tell us if the child is making age expected progress according to their unique learning curve. Furthermore, most people are good at some things and not so good at others, and the pattern of their scores can often give us valuable information about their learning profile.

Question of Bias: The concern about bias is important, given that neuropsychological tests are often used to classify people and make decisions about providing or denying services. There are a number of ways in which we try to control for bias, starting with trying to make sure that the group of people that are used as test subjects when developing norms are representative of the population at large. Test makers are getting better at this, but we have a long way to go, which means that it is important that evaluators know how each test has been developed and normed. Test selection is also extremely important; some tests are not appropriate for some groups. Think about giving a Calculus test to someone who has not completed Algebra 1; this kind of mismatch is going to result in a spuriously low score on math ability.

The main way that neuropsychologists and psychologists try to control for bias is through what is referred to as standardized administration—giving the test in the same way to each child. A good deal of the training of graduate students, interns, and post-doctoral fellows involves learning and practicing these skills so that the test is given to every child in the same way, regardless of who gives it. At the same time, children are children, and sometimes they need something different. It is up to the evaluator to decide when to engage in “non-standardized administrative procedures.” One example of non-standard administration could be starting a child who has trouble catching on to novel tasks at a lower age starting point in order to help them master the task demands. Another example would be stopping a task before a ceiling of errors is reached because the child is very anxious and is having a hard time staying with the activity. It is important to make note of that break in protocol in the report; while it may somewhat reduce the validity of the scores, it also tells us something very valuable about the child’s learning style and tolerance.

Value of Having Previous Testing: Having the opportunity to review all previous testing is extremely valuable to neuropsychologists because it gives up some insight as to a child’s developmental trajectory. Scores that are higher than in previous testing may suggest improvement in a skill set. Scores that are consistent with previous testing indicate that a child is making age-expected progress along their unique learning curve. However, they may be falling farther and farther behind their same-age peers or progressing more quickly. Scores that are significantly weaker than in previous testing need to be closely examined. This could be a result of an imbalance between the environmental demands and the child’s internal resources. For instance, smart kids with executive function deficits are often not prepared for the organizational challenges of middle and high school. Significantly lower scores could also indicate stalled development due to ineffective educational interventions. It could also be a sign of emotional distress that is interfering with a child’s functioning. Rarely, it could be a sign of a medical or neurological problem. There are also some times when a change in average scores reflects a change in the exact tests or subtests used for the child. For example, when a teenager turns 16, it is common to begin administering adult intelligence scales and these tests may place higher value on slightly different skills (e.g., mental math). Without reviewing previous testing, a current evaluator may be able to provide a snapshot of a child’s current functioning, but might miss a critical developmental pattern important for understanding if/how the child is learning, what is needed to enhance their performance, and what can reasonably be expected over time for the child.

 

About the Author:

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

 

 

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

 

 

 

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

 

More Than An Inkblot: Measuring Problem-Solving and Critical Thinking Skills with Projective Tests

By | NESCA Notes 2019

Image Cred: SlidePlayer.com 2019

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

What might this be? A saxophone player? A woman’s face? A bunch of black and white paint? Or is it something else entirely? This classic optical illusion engages the parts of the brain responsible for perception, critical thinking, and problem-solving so that humans can “make sense” of a somewhat ambiguous picture. We know that everyone perceives and experiences the world differently. In order to best support a child’s growth and development, parents, educators, and professionals need to understand a child’s “lens” or “brain habits” that guide how they think, how they feel and how they behave. Projective testing assesses these “brain habits” and sheds light on a child’s problem-solving style.

If you google or look up “projective test” in the dictionary, an array of definitions pop up. The general theme is: a projective test is a test designed with ambiguous stimuli upon which a person presumably “projects” hidden, unconscious emotions and conflicts. Yes, a person’s internal thoughts, feelings, and assumptions sometimes outside of conscious awareness do influence your response to projective tests and your behavior in everyday life. However, projection is only one piece of the puzzle. A broader, more accurate definition is:

A projective test is a “performance-based” test that requires the respondent to perform a task that has little structure, direction or guidanceThese tasks might, for example, involve completing a sentence, telling a story, or describing inkblots (i.e. the famous Rorschach Inkblot Test).

So why do we care about assessing a child or teen’s ability to make sense of an unstructured, ambiguous task? In addition to measuring a child’s concrete knowledge and skills (e.g. academics, intellectual functions, memory capacity etc.), it is oftentimes crucial to understand how a child problem-solves a situation “in action” – when they must rely on themselves to formulate a solution. This is particularly true for children who have difficulties managing their emotions, children who have trouble making reasonable decisions, and children who can’t seem to make or keep friends. For youth with these challenges, understanding how “in the moment” problem-solving and critical thinking skills work or don’t work gives parents, educators, and professionals insight into learning style, challenges and strengths, and most importantly, guides individualized therapeutic interventions.

A growing number of business and education leaders have begun to recognize the importance of performance-based assessments to evaluate student learning in the classroom and the workplace. Creativity, ingenuity, “thinking on your feet” and the capacity for critical thinking and analysis are clearly key skills in today’s innovative world. Therefore, to set kids up for success, it is understandably helpful to evaluate a child’s thinking and feeling “brain habits” that affect their choices, behaviors, and aspirations. As assessors, teachers, professionals, and parents, we want to better understand how each child applies knowledge to solve problems they face now and in the future – social problems, work problems, emotional problems and beyond. Projective testing provides not only a current evaluation of a child’s capacity to problem solve “on their feet” but provides a direction for how those “brain habits” might pose a strength or a challenge for that child as they grow.

Are you thinking about referring a child, teen, or young adult for projective testing? Here are 5 “fast facts” to guide you:

  1. Projective (also known as performance-based) tests are powerful diagnostic tools when administered and interpreted in conjunction with observation and other standardized test results by a skilled, experienced practitioner. It is important to ask a potential evaluator about their training in projective testing and how they utilize the results.
  2. Projective testing is helpful for children and teens with various complex, social and emotional challenges. Common referrals include questions related to: thinking problems/emerging psychosis, trauma, attachment-related concerns, depression, anxiety, bipolar disorder, developing personality traits and disorders, high-risk behaviors such as suicidal or homicidal thoughts and actions, substance abuse, poor emotion regulation, and self-injury.
  3. Projective testing provides information about a child’s thinking patterns, how they experience emotions, self-esteem, and their habits of interacting with others. For example, is a child more likely to “keep everything inside” and avoid or do they dysregulate and “explode” when they experience anxiety? Are a child’s difficulties making and keeping friends because they get “stuck” on the details of a situation, is it because they “miss the big picture”, or are they in a constant state of worrying that others will let them down? Answering these questions results in a more individualized intervention plan for therapy, at home and at school.
  4. Projective testing is not for everyone. There is little research on the use of projective testing with children and adolescents with low visual acuity, below average verbal and/or non-verbal IQs, impairments in visual-spatial processing, social-communication challenges, or language disorders. Be cautious of practitioners who do not inquire and evaluate these important aspects of a child’s functioning, as they are crucial components to determine the appropriateness of a projective evaluation.
  5. Projective testing sheds light on not only a child’s areas of difficulty, but can also provide an individualized analysis of a child’s strengths. For example, projective testing can identify capacity for insight into choices and behaviors, ability to engage effectively in a therapeutic relationship, capacity for empathy and perspective-taking, as well as a child’s inclination towards imagination, creativity, and ingenuity.

About the Author:

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

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

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

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

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

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

 

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, MA, 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.

 

Just What the Doctor Ordered: A Director’s Update on Personal and Social Coaching (PSC)

By | NESCA Notes 2019

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

So many wonderful things have happened at NESCA in the past year including our recruitment of many talented interns, post-doctoral fellows, and staff members, the opening of an office in the Foxborough/Plainville Area, and the promotion of several staff. As Founder and Director, I continue to be both proud and humbled by the incredibly talented staff I go to work with each day and the community of families and professionals who allow us the privilege of being part of their lives.

As the New Year often brings about health resolutions, including the desire to increase one’s physical and mental fitness, I am taking this opportunity to spotlight one of our most exciting new staff and services at NESCA: Certified Personal Trainer and Autism Fit Instructor Billy Demiri who leads our Personal and Social Coaching (PSC) Program.

When I arrived to check on how things were going with his first training session,  I heard Liam (not his real name) say, “I make muscular dystrophy look easy!”  This proclamation from a 10 year old boy who had, just hours before, during his evaluation, protested loudly that he would “never work with a coach, no matter what!”    Following his diagnosis of muscular dystrophy, a progressive, degenerative disorder, Liam had become clinically depressed.  Over the past few years, he was often irritable, oppositional, volatile, and completely sedentary.  While a specialized school placement, psychopharmacological intervention and therapy had all been helpful, Liam was still struggling.  His mother and I both viewed physical activity as being an important intervention for him, for medical and psychological reasons.

They were scheduled to have their intake session with Billy Demiri, who heads NESCA’s PSC program, after lunch on the day of Liam’s testing.    Clearly, getting Liam to “sign on” was going to be a challenge.    So, I hatched a plan that I explained to Billy and to Liam’s mother.  Liam’s mother was to tell him that he didn’t have to work with the coach but that she herself wanted to talk with him.  I suggested that Billy focus only on talking with Liam’s mother and not give any attention to Liam.  While Billy and Liam’s mother chatted, Liam was reading a book but regularly glancing over at them, clearly interested.  Eventually, he couldn’t resist joining the conversation.  Billy invited Liam’s mother to look at the exercise room and Liam indicated that he wanted to go too.  Liam succumbed to Billy’s gentle encouragement and was soon navigating an obstacle course and doing hurdle steps…with a huge smile on his face, a smile that I had not seen in the course of our evaluation.  His mother’s smile was even wider.

Liam came back eagerly the following week for his training session.  When he and Billy took a break, Liam told Billy, “I like this!  I can use the stuff that we’re doing, like when I’m feeling mad or upset, to make me feel better.”  He then shared with Billy how hard it’s been for him to know that he has muscular dystrophy and to be depressed.

Billy is not a psychotherapist but he is warm and an empathic listener, a young man who children and adolescents like, respect and trust.  He has done a remarkable job forging a strong connection with each of his clients and skillfully uses that relationship as the basis for getting them to take risks, move out of their comfort zone, and persist in the face of challenge, which are all ingredients in developing “grit.”  Billy’s clients make impressive progress not only physically but also emotionally.  Many of Billy’s clients struggle with self-esteem and the concrete, measurable improvements that they see on a regular basis in their physical capabilities is a huge self-esteem booster.    In addition, through the Physical and Social Coaching program, his clients reduce their level of anxiety, increase coping skills and learn about setting and achieving goals.

NESCA takes a highly integrative approach to the delivery of therapeutic services.  In the case of PSC, Billy coordinates care with the neuropsychologists who have evaluated his clients or the psychotherapists who are treating them so that he understands the underlying social-emotional concerns to be addressed in his sessions.  After an initial assessment of movement patterns, he develops an individualized physical training program that will result in improved physical well-being and serve as a vehicle for social-emotional growth for the client. As NESCA’s Founder and Director (and also a client of Billy’s!), I am tremendously proud to be able to offer this unique and ground-breaking service to our clients.

 

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.

 

Want to learn more about PSC? PSC will initially available for clients who are part of the NESCA family and have already participated in testing, consultation, or therapy at one of our Massachusetts or New Hampshire offices. To learn more about services, please email bdemiri@nesca-newton.com. Or, to book an intake with Billy, please complete NESCA’s Intake Form at https://nesca-newton.com/intake-form/ and select “Personal and Social Coaching (PSC)” as your reason for referral.

 

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

 

 

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville/Foxbourough, 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.

 

 

Smart and Slow: What is a processing speed deficit? How can evaluation help?

By | NESCA Notes 2019

By Jessica Geragosian, Psy.D.
Pediatric Neuropsychologist

Emilia is in the 7th grade. Teachers have always found her to be an intelligent and academically motivated child; however, she has historically been quite slow in completing classwork and tests. Homework, particularly now in middle school, has been a highly laborious process, taking her far longer than her peers. Emilia’s parents were also concerned when receiving her SSAT results, as the scores did not seem to reflect the capabilities of their smart kid. But what is most concerning to Emilia’s parents is that Emilia has recently been coming home saying she is “dumb” and hates school.

Processing speed is the rate at which an individual can process information and produce an output. Although it is measured as part of many standard intelligence tests, it has nothing to do with how “smart” an individual is. Processing speed challenges can be visual, oral, and graphomotor in nature. They do not have to be related to a learning disability or ADHD, though they can be. Also, processing speed can be easily impacted by many things. For example, while an individual may not have a primary processing speed deficit, depression and anxiety can temporarily cause deficits in processing speed.

It is not uncommon for children to have strengths and weaknesses in their cognitive profile. Weaknesses in processing speed, however, can be particularly frustrating, especially when children are very bright. This is because these children may have many ideas, but cannot produce them efficiently or effectively. Children with processing speed deficits tend to experience a high level of frustration, as they are not able to demonstrate their knowledge and keep up with their peers in the classroom. Sometimes, processing speed deficits do not become apparent until middle or high school when work demands ramp up, or the student begins taking standardized exams with strict time limits.

For students like Emilia, who experience increased academic challenges as they progress in school, neuropsychological evaluation can be extremely useful and effective. In this case, the purpose of neuropsychological testing aims to better understand the nature of the processing speed challenges, the impact on the child, and how to utilize strengths to overcome challenges. Students with processing speed deficits are often entitled to academic accommodations and can be quite successful with such supports in place. Testing can also be important for ruling in, or out, emerging mental health issues.

For Emilia, the following recommendations were particularly important to address in her educational planning:

-extra time on tests (including standardized exams such as the SSAT)

-the use of a computer to minimize graphomotor output demand (and access to voice-to-text software)

-help with notetaking in the classroom (copy of teacher’s notes)

-learning tools to circumvent processing speed challenges (i.e. use of a Livescribe pen which records audio as she is taking her own notes)

-putting value on quality rather than quantity of school work (e.g., when given a homework assignment in math, Emilia was required to complete every other item)

However, the most effective approach, and one of the most important outcomes made possible by neuropsychological evaluation, was explicitly teaching Emilia about her unique strengths and challenges. Children (especially middle schoolers) tend to be black and white—if they finish their test last, then they must be “dumb.” When Emilia was able to see that this was a challenge that could be overcome, especially in the context of her very impressive intellectual abilities, she was able to re-engage in school without frustration. Moreover, parents and teachers were able to better understand and address her academic challenges in a thoughtful and effective way.

 

About the Author:

Dr. Jessica Geragosian is a Licensed Psychologist in Massachusetts and New Hampshire. She has a wide range of clinical experience – in hospital, school and clinic settings – working with children and adolescents presenting with a wide range of cognitive, learning, social, and psychological challenges.

Dr. Geragosian operates under the primary belief that all children want to, and can be, successful. The primary goal of her work is to identify the child’s innate strengths, and find any underlying vulnerabilities preventing a child from achieving success. Whether the primary problem is an inability to acquire academic skills, maintain friendships, control emotions, or regulate behavior to meet expectations; she takes a holistic approach to understand the complex interplay of developmental, neurological, and psychological factors contributing to a child’s presenting challenges.

Dr. Geragosian earned her doctoral degree from William James University, before completing postgraduate training in pediatric neuropsychology at the Massachusetts General Hospital for Children at North Shore Medical Center, where a focus of her work was neuropsychological assessment of young children with developmental challenges.

To book an evaluation with Dr. Geragosian 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, MA, 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.

 

A Tale of Two Social Styles: Classical and Jazz Socializers (Republished from Nov. 27, 2017)

By | NESCA Notes 2018

By Jason McCormick, Psy.D.
Pediatric Neuropsychologist

I work with a number of parents concerned about the quality of their child’s social life.  Lamenting that their child has no true friends, many parents I see note that that their child doesn’t “hang out” with peers.  However, when asked about how their child does spend time with peers, many parents report that their child is involved in several different structured after-school activities, such as a church youth group, scouting, or a gaming club.  In other words, while not getting together with peers in less structured settings, these students often do, despite parent misgivings, have satisfying social lives.

I find it useful to think about socializers as lying in one of two camps: Jazz and Classical.  Jazz socializers are all about improv.  They’ll head downtown with a friend and see where the afternoon takes them, invite a friend over with no particular plan or agenda, or wander the mall in a herd.  They care little about predictability and in fact relish spontaneity and surprise.  Classical socializers, by contrast, are most comfortable with structure.  They crave predictability, wanting to know the specific parameters of a social activity, including the start and end times, the purpose, and the rules of engagement.  Classical socializers, then, tend to do best with organized social activities.

It’s important to note that one type of socializing is not better than the other; it’s about a match.  I say that as many parents of Classical socializing children worry that their children will grow up to be friendless and alone.  To those concerns, I observe that there are plenty of socially-satisfied Classical socializing adults: they have their book club the first Monday of every month, poker night every other Thursday, weekly chorus practice, and bar trivia on Wednesdays.

Thus, rather than trying cram to their Classical socializing child into a Jazz paradigm – which in fact runs the risk of leading to more social isolation due to anxiety stemming from the mismatch – I encourage parents to embrace the kind of socializer that their child is.  For parents of Classical socializers, that means supporting their child’s social satisfaction and growth through the encouragement of their participation in a variety of structured after-school activities (of course without over-scheduling).  In addition to giving their children a chance for a rich and rewarding social life now, participation in such activities serves as an important practice and preparation for adult life, as in college and as adults in the working world, that is how Classical socializers will be most socially satisfied.

 

About the Author:

McCormick

Dr. Jason McCormick is a senior clinician at NESCA, sees children, adolescents and young adults with a variety of presenting issues, including Attention Deficit Hyperactivity Disorder (AD/HD), dyslexia and non-verbal learning disability. He has expertise in Asperger’s Disorder and has volunteered at the Asperger’s Association of New England (AANE). Dr. McCormick mainly sees individuals ranging from age 10 through the college years, and he has a particular interest in the often difficult transition between high school and college. As part of his work with older students, Dr. McCormick is very familiar with the documentation requirements of standardized testing boards. He also holds an advisory and consultative role with a prestigious local university, assisting in the provision of appropriate academic accommodations to their students with learning disabilities and other issues complicating their education.

 

To book a consultation with Dr. McCormick 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, MA, 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’m Too ____ or _____ for Yoga: Yoga Myths Dispelled

By | NESCA Notes 2018

 

By: Ann-Noelle McCowan, M.S, RYT
Guidance Counselor; Yoga Specialist

As yoga continues to expand its popularity and presence many people still worry that there is something that prohibits their beginning a yoga practice. Yoga increases strength, balance and flexibility while decreasing stress. Yoga increases athletic performance, improves respiration, and promotes better sleep quality. It has been used successfully as a complementary therapy for mood disorders such as anxiety and depression, addiction and chronic pain.  As an “inflexible” yogi who has worked with a broad range of yogis, both as a student and a teacher I have seen that yoga truly is for anyone. May this review of some if the most common misconceptions to yoga reduce the roadblocks and invite you to step onto a mat in 2019.

  1. I’m too inflexible for yoga.  This may be the most common reason many people give, perhaps due to the images of bendy people in yoga poses on social media or in print. But do beginner Spanish speakers say they can’t take Spanish lessons because they don’t speak Spanish? Yoga classes will include multiple props (blocks, straps,  blankets) to help modify for all different bodies and continued practice will build greater flexibility. I love props and continue to use blocks in certain poses because that works for my body.
  2. I don’t have special yoga clothes or the right mat.  Having practiced in studios, homes, and schools you don’t need particular clothes to do yoga, just clothing that allows you to move is sufficient. Many yoga studios or gyms also offer rental mats, or mats to borrow which is the case at NESCA.
  3. I don’t have the right body/ want to lose weight first…  Similar to point 1 yoga is adaptable and designed for anybody. Blocks, blankets, and props are available. There is  a broad range of classes to try from beginner, or Yin to help increase your comfort in a yoga class.  A yoga practice can also help you be more accepting of your body and build healthy habits.
  4. I’m too old/young/ wrong gender to do yoga.   A quick Google search provides instructors of all ages and genders, from Tabay Atkins, an 11-year-old male yoga teacher, to  Tao Porchon- Lynch, at 100-year-old female instructor. There are resources and books designed for people age 1 to 100 and classes where parents can bring their baby to modified classes in chairs or entirely on the floor. My own teacher training there was a wide range of trainees, from their 20’s to grandmothers and they are the examples you may see leading your class. While yoga was originally taught by men to men, the focus has switched and classes now include both men and women.
  5. Yoga is too spiritual/ I don’t want a clash with my beliefs.  Yoga is taught in a broad range of locations and by different teachers. By reading the teacher bios you will get a sense of how they approach yoga. Classes range from a purely physical experience to ones that may include some chanting.  Many students find their yoga practice enhances their own compassion and in focusing on your own breath and experience you can take your practice in the direction you want, and not where you want.

Wishing you a happy holiday and that 2019 may be the year you add some yoga to your life!

 

About the Author:

Ann-Noelle provides therapeutic yoga-counseling sessions individually designed for each child. NESCA therapeutic yoga establishes a safe space for a child to face their challenges while nourishing their innate strengths using the threefold combination of yoga movement, yoga breath, and yoga thinking.

Ann-Noelle has worked with children and adolescents since 2001 and practiced yoga and meditation since 2005. Since 2003 she has been employed full time as a school counselor in a local high performing school district, and prior to that was employed in the San Francisco Public Schools. Ann-Noelle received her dual Masters Degree (MS) in Marriage, Family and Child Therapy (MFCC), and School Counseling from San Francisco State University in 2002, her BA from Union College in New York, and her 200 hour-Registered Yoga Credential (RYT) from Shri Yoga. Ann-Noelle completed additional Yoga training including the Kid Asana Program in 2014, Trauma in Children in 2016 and Adaptive yoga for Parkinson’s in 2014.

If you are interested in therapeutic yoga with Ms. McCowan,  please complete NESCA’s intake form today and indicate interest in “Yoga”

 

For more information on the therapeutic yoga at NESCA, please visit  https://nesca-newton.com/yoga/

 

 

 

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.

 

Preparing for the College Visit – for Juniors and Their Parents

By | NESCA Notes 2018

 

 

By: Dina Karlon, M.A.
NESCA Transition Specialist

So often students feel pressure to come up with a plan of what they want to do with their lives; college is expensive and it’s a big decision. I will say to you that while it feels overwhelming, there are things you can do to limit the stress. During the winter holiday season, college is likely one of the last things you want to think about as a junior or parent of a high school junior. But now is a great time to plan your college campus visits!  

While knowing what you want to do (and study) is important, it is not necessary to know that before deciding on a college. If you know you are going to college, you need to make sure it’s a place you can see yourself living at. Therefore, the feeling you get when on a campus is very important. That’s why I am suggesting you spend some time on it.  

Here are some tips for planning your winter and spring college visits: 

  1. School breaks are a perfect time to visit colleges. This is because colleges are in session when high schools have their breaks. You can always visit in the summer, but you will not get the same “feel” of how busy the campus is when the students are not there. 
  2. Register through the school website for the visit. Colleges do keep track of positive contacts from students (i.e., “points of contact”); it will demonstrate to the college that you are interested enough in the school to go and see it. If you just do a drive by or a self-directed visit, it doesn’t count with the college. You want them to know that you were on campus, so register!  
  3. What schools to look at? If you have narrowed your college list, you will know what schools to look at. If you have not, don’t worry. Just getting out there to see schools can help – you will be narrowing your search by visiting campuses as well. Remember, the feeling you get when you are on campus is just as important, probably more important, than anything else. If you are traveling out-of-state for the breaks, visit a college when you are out there. If you are staying home, do some local or in-state colleges – both 2- and/or 4-year schools.
  4. Remember when you go on a visit that they are trying to sell you the school. They should; that is their job! Your job is to be an educated consumer, so do your homework. Do a little bit of research before you go to the school. Treat it like a job interview – have a couple of questions that you want to ask. For example, ask: What kind of tutoring is there for students? Is it free? Who tutors? These are questions that may be of particular importance to you. One of my favorite questions is: How big is your commuter population? You may wonder, why is this important? Well, if it is a high number, that means that most people are not there during the weekend. If you are planning on being there on weekends, you don’t want to be alone. You want other students there. Schools that have a lot of people leave for the weekend are referred to as “suitcase colleges”. They are not as good for people who live on campus on weekends. 
  5. Go off the beaten path if you can. The student ambassadors giving the tour love the school and are likely being paid for the tour. They are often students with lengthy resumes about their involvement with the school (which is awesome but can feel intimidating). So if possible, talk with other students and ask them about their experience. 
  6. Eat in the cafeteria. You will likely be eating there for every meal (at least freshman year), so you want to know what that experience will be like. Are there a lot of options? Is it very busy? 
  7. Don’t schedule more than two visits in a day. Visiting schools can be exhausting and schools can all start to look alike after a while. Here is the itinerary: Visit one in the morning, eat lunch to debrief the first one (keep a notebook or digital notes/pictures), visit the second school in afternoon, and debrief that school during dinner or on the drive home. If you can do one a day, even better. But doing two in one day can be more time effective. Just don’t so more than two; you won’t remember them! 

So you went on a visit and you didn’t like the school. What a waste of time! You would never go there! Congratulations! You just started whittling your list and didn’t waste money going to a school that you wouldn’t be happy at. Also, you know more about what you do want to look for on your next college visit.  

On a personal note, I have two adult children of my own and have survived the college process. One of the college visits that stood out to me the most was one we attended on a cold, rainy, Friday afternoon. It was a college in a different state from where we live, so my daughter would be living there. Many people didn’t show up for the college visit (probably due to the timing and the weather). Because of that, we had our own tour guide. During the visit, the campus was very busy – students were walking around the campus on a late Friday rainy afternoon. It was clear that students were engaged and planning on being there for the weekend. My daughter ended up going there and enjoyed her college experience. There were obviously other factors that helped her with her choice, but that visit had a significant impact on her decision. 

 

 

About the Author:

Dina DiGregorio Karlon, M.A.  is a seasoned counselor specialized in transition issues. She has worked over 15 years as a school counselor in public high schools and has additional experience as a GED program coordinator, career center coordinator, and vocational assessment specialist. She has additionally worked for New Hampshire Vocational Rehabilitation as a rehabilitation counselor and also for the New Hampshire Department of Education.

At NESCA, Ms. Karlon offers coaching services as well as transition planning consultation to students, families, and fellow professionals in New Hampshire. In addition to her work at NESCA, Ms. Karlon is a Program Specialist for the New Hampshire Department of Education, specializing in the development of employability skills and job readiness skills for at-risk youth.  

When providing transition services, Ms. Karlon most enjoys the relationships that she is able to create with her clients and/or students and their families. She loves being part of helping them figure out their strengths and challenges and helping them realize their goals and dreams. Ms. Karlon knows that often the path after high school is not traveled from A to B, but rather it is A to E, to C, and then back to A. She works hard to help her clients view each setback as an opportunity for growth rather than a failure, to recognize their own strengths, and to overcome the barriers that may get in the way of setting goals, solving problems, and making progress. She brings extensive experience supporting clients with career and college planning and she is able to shift fluidly with clients along their paths in each of these domains. 

 

If you are interested in a consultation, pre-college coaching, or transition planning with Ms. Karlon, please complete NESCA’s intake form today and indicate interest in “Transition Consultation and Planning”

 

 

 

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.

 

Enjoying the Holidays with Sensory Needs

By | NESCA Notes 2018

 

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

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

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

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

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

 

About the Author:

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

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

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

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

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

 

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

 

 

 

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