Real-life Skills Coaching Alert!

NESCA now has two Occupational Therapists offering in-person, community-based Real-life Skills Coaching in the Newton area. To learn more or book sessions, complete our Inquiry/Intake Form.

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157

Occupational Therapists and Transition Assessment, A Natural Fit!

By | NESCA Notes 2021

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Real-life Skills Program Manager and Coach, NESCA

Being an occupational therapist (OT) often means working in a profession that many people do not have extensive experience with or knowledge about. It can be hard to give one definition of this profession when OTs are at hospitals and schools, working on advocacy in DC, running mental health groups, and in some cases even responding to natural disasters. We are all around! Despite the broad range of settings, OTs are all guided by the Occupational Therapy Practice Framework: Domain and Process (AOTA, 2020), an ever-evolving framework that describes the central concepts, foundational views, and basic tenets of the profession. As an occupational therapist who has worked in schools with a huge focus on access to the curriculum, functional skill building, and increasing students’ overall participation, I frequently reference the document to ensure I am staying true to my profession and using my lens to help support clients’ goals in the most effective ways possible. As a member of the transition team here at NESCA, I have been fascinated by the natural fit between occupational therapy and transition assessment. Both of these require a holistic lens, consideration for the client as well as their environment, and an ability to focus on multiple different aspects of a person’s life simultaneously.

While occupation is sometimes considered a synonym for “job,” OTs focus on the broader definition of occupations as, “the everyday activities that people do as individuals, in families, and with communities to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to, and are expected to do” (WFOT, 2012). We consider nine separate “areas of occupation,” which include: Activities of Daily Living (bathing, showering toileting, etc.), Instrumental Activities of Daily Living (driving, financial management, meal preparation, etc.), Health Management (medication management, social and emotional health promotion, physical activity, etc.), Rest and Sleep, Education, Work, Play, Leisure, and Social Participation. We want to make sure that individuals have balance, are meeting their personal goals, and feel fulfilled by the activities of life. OTs both assess and provide direct intervention around all of these areas.

Similar to occupational therapy, transition assessment is complex and broad, and it is best thought of as an ongoing process incorporating a wide range of formal and informal assessment of a student’s strengths, interests, and preferences. When developing recommendations for transition assessments, we work in accordance with the federal law (as well as the Massachusetts Student-Driven Transition Model core areas of transition planning) to relate our findings to the demands of transition planning areas: Education/Training, Employment, Independent Living, and Community Participation. Each of these areas needs to be considered as a part of the transition planning process and plays a substantial role in putting together a comprehensive vision for a student.

As I compare the areas of occupation with the core areas of transition planning, I am struck by the similarities and constant overlap. There is an emphasis on functional independence, especially in daily living skills. There is the belief that connection and community are integral parts of life. There is also a need for purposeful activity, whether that be through work, continuing education, play, or all of the above. Each of the areas that OTs so passionately feel guide our work are areas that should be assessed and considered during transition assessment and planning. The lens through which OTs are taught to assess and evaluate clients lends itself perfectly to assessing students as they plan for their futures and transition out of high school. While there are many different ways that I could have applied my OT training, I am glad to be able to apply my expertise to transition assessment at NESCA as one of the ways we help youth and young adults achieve their goals and carry out fulfilling lives.

References

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), Article 7412410010. https://doi.org/10.5014/ajot.2020.74S2001

Massachusetts Department of Elementary and Secondary Education. (2021). Massachusetts student-driven transition model. Retrieved from https://www.doe.mass.edu/sped/secondary-transition/resources-materials.html.

World Federation of Occupational Therapy. (2012) Definition of occupational therapy. Retrieved from https://wfot.org/about/about-occupational-therapy

 

About the Author
Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

 

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

 

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

 

14

A Social Life – What is it Exactly?

By | NESCA Notes 2021

By Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Services, NESCA

Many parents want their children to have friends and a social life, yet are concerned about the quality of their child’s social life. They often describe their child’s afterschool hours as being occupied with screen time, which may actually include others. Other children may be engaged in structured activities, such as scouts, sports, school-based clubs (i.e., robotics), music lessons, gaming clubs, and more. Then there are the children that tire easily when around many people and prefer alone time or being around one or two friends. When children are asked if they have friends, they often say yes and that they are online friends. These children who are engaged in structured social activities, online gaming, and other online activities say they have satisfying social lives. So, who’s to judge? A person’s definition of a satisfying social life is for each of us to decide (so long as they are doing so safely and responsibly).

When it comes to defining friends and a social life, there is often a disconnect between a child or teen’s definition and that of their parents. Today, there are so many more ways to have friends, a social life and socialize than there were “when we were kids.” Having a social life is now defined more broadly, such as online friends, gaming friends, the number of followers on Instagram/Twitter, and so much more.

A “virtual friend” or “online friend” is someone who one connects with online. These virtual friends are often very connected to others and can even become BFVs (best friends virtually). In the “old days” before the internet, these friends would have been called “pen pals,” whereby letters were written and exchanged. These pen pals of old sometimes heard all the trials and tribulations of one’s life. Virtual friends (VF) may stay as that – you may or may not ever meet them, which doesn’t diminish the relationship or make it less important and meaningful. IRLs (in real life friends) are people who one connects with in-person or in real-time. Many times, children and teens have better and stronger VFs than IRL friends. And sometimes they do meet up at different events, such as: E3 Expo, PAX, gaming clubs, Comic-Con and many more.

Socializing is different for each of us. How do we respect our children’s personalities and choices regarding socializing while encouraging them to explore more and different friendships and experiences? There are “introverts” and “extroverts” amongst us. Many extroverts love socializing both in real life and virtually and have many friends. They get energized by being around others. They’ll text a friend(s) and invite them over with no plan on what to do other than hang out. They care little about planning, predictability, and are okay going with the flow, handling ambiguity and uncertainty. Introverts are more comfortable with alone time, structure, predictability, clear boundaries, and rules/guidelines when engaging with others. Often times these kids are more comfortable with VFs and the online world with its structured platforms, anonymity, and being able to participate/not participate on their terms. Many of these kids are often the leaders and moderators on virtual platforms – something you may not suspect given their presentation in real-time/real life.

In this new world of online social connection, it is best to not try to force your child into being an “in real life socializer,” and involved in many social activities but instead make sure they have the social skills and knowledge to be successful in the real world of school, work, and community. Be aware of what and whom your children are connecting with online and accept who they are as a person. Trying to force them to be someone they are not may lead to more mental health challenges than them only having VFs or only engaging with IRL friends occasionally or on their terms. A satisfying social life is a personal choice and one that can’t be forced. There are many adults who are happy with one or two IRL friends and have structured activities they participate in (i.e., book club, trivia night, etc.); yet have many more VFs in their online platforms.

There has been much written about introverts in an extroverted world and how trying to force them to be someone they are not can backfire. Being happy with one’s social experiences and friends – whether virtual or in real life – is what it’s all about.

References

https://www.parents.com/kids/development/shy/raising-an-introvert-in-an-extrovert-world/

https://www.pewresearch.org/internet/2015/08/06/chapter-4-social-media-and-friendships/

https://www.pewresearch.org/internet/2018/11/28/teens-friendships-and-online-groups/

 

 

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

 

To book a consultation with Ms. Lucci or one of our many expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician/consultant in the referral line.

 

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

 

1

How to Tame Holiday Stress

By | NESCA Notes 2021

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

The holidays are supposed to bring joy, but they also bring a lot of pressure, expectations, and stress. Planning and preparing can take months, and balancing this planning with school events, holiday parties, and our every day demands can be a lot to handle. That said, there are some basic things that we can to do manage holiday stress and focus on the things that matter most, including the following:

Identify and prioritize your values. Reflect and decide ahead of time what is most important to you this holiday season. Whether it is being with family, following through with traditions, giving back to others, or something else, knowing what you care most about will help you know where to put your time and energy.

Simplify where you can. Once you know your priorities, cut out things that are not in line with these. We tend to go a bit above and beyond at the holidays, and we often find ourselves doing things just because we always have done so, not because we want to. Invest your time where it matters most. This year, I cut out holiday cards. While cute, they are time consuming and the majority likely go straight to the trash. Creating cute waste is not my priority. Sorry, grandparents – maybe next year.

Take focus off of gift giving as much as possible. Overindulgent gift giving is not only financially burdensome and time consuming, but it is also likely not in line with your intrinsic holiday values. Streamline your gift giving where able. For example, adults draw names instead of buying for everyone, set a limit for the number of gifts per person, or buy group gifts and experiences. In our house, when buying for the kids, we try to stick with: one thing you want, one thing you need, one thing to wear, and one thing to read. Sometimes we stray a bit, but it helps keep our priorities focused and manage the children’s expectations.

Communicate expectations. Tell your family or friends what they can expect from you this holiday season. This should include talking with your children about how your family will celebrate the holidays, and how it may be different from what others do. If you know you’ll be invited to three holiday dinners, or if someone may expect your visit to be longer than you desire, get ahead of it and tell them your anticipated schedule and plans.

Pick your battles. The holidays are overwhelming for everyone, including children. They may try to manage their stress by exerting control, including pushing back against holiday traditions or expectations. Before asking things of them, remind yourself of your priorities and values. If you don’t really care whether your child wears slacks versus sweatpants during Christmas dinner, don’t pick that battle.

Provide familiarity. To help manage the uncertainty and stimulation of holiday festivities, do what you can to provide children with some familiarity, such as having some preferred foods in the dinner buffet or giving them a designated break away from the chaos to play alone without the pressure to socialize.

In sum, holiday stress is a given, but identifying your holiday values and priorities will allow you to make decisions and create expectations that will help mitigate some of this stress and allow you and your family to enjoy the season.

 

About the Author

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

To book an evaluation with Dr. Currie or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician in the referral line.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

157

Therapeutic Toy Guide to Promote Skill-building

By | NESCA Notes 2021

By: Jessica Hanna MS, OTR/L
Occupational Therapist, NESCA

It’s that time of year when parents and loved ones are looking for the perfect gift. As pediatric occupational therapists, we are often asked about our recommendations for the best toys and activities that encourage learning and the development of specific skills. During an occupational therapy session, toys and games are used with people across the life span for many reasons. The biggest reason is to bring joy and develop confidence while simultaneously working on skill-building in areas that require getting and maintaining attention in an effort to improve and develop independence in functional tasks.

Play and exploration of games and toys are for those of all ages. The right toy and game can be used to develop new skills and strengthen and refine learned skills.

Skills addressed through play and active exploration:

  • Attention and concentration
  • Balance
  • Coordination skills
  • Core strength
  • Executive functioning
  • Emotional regulation
  • Fine motor skills
  • Gross motor skills
  • Handwriting
  • Imaginative play
  • Motor planning
  • Sensory motor needs
  • Visual perceptual skills

How many times have you endlessly scrolled online looking for the best-fit gift, wondering if it will be one more item that ends up collecting dust on a shelf? How often do you wish a toy store existed like when we were kids, instead of walking down the same small toy aisle at the local department store and leaving with nothing? Or having to weed through page after page of online stores and catalogs?

Below is a helpful guide to therapeutic games and toys that focus on a couple of specific skill areas. Most of the games included can fall into more than one skill area, depending on how it’s used.

Coordination Skills – Skills that help develop body control and awareness. Bilateral coordination is the ability to use both sides of your body together in a coordinated way, and hand-eye coordination is when the eyes guide the hands in movement.

3 + years

  • EleFun (Hasbro)
  • Feed the Woozle
  • Kids Magnetic Fishing Games (iPlay, iLearn)
  • Instrument toys
  • Marble Run
  • Target activities
  • The Yoga Garden Game
  • Wooden Balance Board
  • Zoom Ball

6 + years

  • Bob it
  • BucketBall
  • Kan Jam
  • Klask
  • Rev balance board
  • Ring Toss
  • Simon
  • Spike Ball
  • Throw the Burrito
  • Twister

Executive Functioning Skills – The ability to sustain attention, organize and plan, initiate and complete, problem solve and regulate emotions.

3 + years

  • Bee Genius (MUKIKIM)
  • Bunny Hop (Educational Insights)
  • Cootie
  • Create-A-Burger (Lakeshore)
  • Dino Escape
  • Don’t Break the Ice
  • Frankie’s Food Truck Fiasco Game
  • iPlay, iLearn Kids Magnetic Fishing Games
  • Hoot Owl Hoot
  • Movement Memory

 6+ years

  • Battleship
  • Checkers
  • Chess
  • DogPile
  • Distraction
  • Gravity Maze
  • Life Junior
  • Monopoly
  • Outfoxed
  • Rush Hour (Think Fun)

Fine Motor Skills – The ability to control the small muscles of the hands and fingers. Fine motor development contains many components. Some of those areas include pincer and pre-writing grasp development, hand strength, wrist stability, motor control, and separation of the sides of the hand.

3 + years

  • Alphabet Learning Locks
  • Bee Genius
  • Duplo Sets
  • Forest Friends Playset (Lakeshore)
  • Light table pegs and pegboard (Lakeshore)
  • Magnet Alphabet Maze
  • Noodle Knockout!
  • Pegcasso Build and Drill
  • Poke-a-Dot: Old MacDonald’s Farm
  • Pop the Pig
  • Woodpecker feeding game (iPlay, iLearn)
  • Snap Dinos (Lakeshore)

6+ years

  • Frankie’s Food Truck Fiasco Game
  • LEGOs
  • Light Brite
  • LiquiPen (Yoya Toys)
  • Mancala
  • Kanoodle
  • Operation
  • Perfection
  • Pictionary
  • Scratch Art
  • Shelby’s Snack Shack Game
  • Trouble

Sensory Play – The opportunity to receive sensory input through play. It can foster listening skills and body awareness, encourage tactile exploration and risk-taking, and promote a calming and alert state of being.

3+ years

  • Bean bags
  • Kinetic Sand
  • Monkey Noodle
  • What’s in Ned’s Head?
  • Playdoh
  • Pop Fidgets
  • Squishmellos
  • Scooter boards
  • Sit and Spin
  • Trampoline

6 + years

  • Aromatherapy
  • Bubble tubes
  • Color mix sensory tubes
  • Doorway Sensory Swing Kit (DreamGym Store)
  • Thinking Putty (scented/glow in the dark)
  • Tent
  • Tunnel
  • Water Beads
  • Weighted blanket
  • LiquiPen (Yoya Toys)

Visual Perception Skills – The ability to make sense of what is being seen. Skills are used to copy information from a board, manipulate items, identify, read, recall info, visually locate things, and write.

3 + years

  • Alphabet Bingo
  • CandyLand
  • Chutes and Ladders
  • Fox in the Box
  • Honeybee Tree
  • Magnatiles
  • Spot-it
  • Pete the Cat- I Love My Buttons Game
  • Puzzles
  • Zingo (Think Fun)

6+ years

  • Connect Four
  • DogPile
  • Guess Who
  • Jenga
  • Kanoodle
  • Klask
  • Let’s Go Code
  • Mancala
  • Perfection
  • Pixy Cubes

This list is just the tip of the iceberg of the many toys and games you will come across. Many toys and games can be therapeutically and easily graded to any individual, no matter the age. The trick is to find the just-right challenge to work on the skill area desired through fun and motivating means. We recommend reaching out to your occupational therapist if you require assistance with either new or older games and toys and how to create the just-right challenge for your child.

 

About the Author

Jessica Hanna has over 10 years of pediatric OT experience in conducting assessments and providing treatment of children and adolescents with a broad range of challenges and disabilities, including autism spectrum disorders, sensory processing disorders, visual impairments, cerebral palsy, executive function deficits and developmental disorders of motor function. Prior to joining NESCA, Jessica trained and worked in a variety of settings, including inpatient and outpatient hospital settings, private practice, schools and homes. She has served on interdisciplinary treatment teams and worked closely with schools, medical staff and other service providers in coordinating care. In addition, Jessica provided occupational therapy services at Perkins School for the Blind and Spaulding Rehabilitation Hospital pediatric inpatient unit, where she conducted comprehensive evaluations and interventions for children with a broad range of presentations.

 

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

 

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

 

4

Assessing Social Skills Challenges: A Developmental Perspective

By | NESCA Notes 2021

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

As parents and teachers, we want the world for our children, and one of the biggest worries is around social development and friendships. This worry is particularly acute when our child has a learning, emotional, or behavioral challenge that affects their functioning in school, the community, and at home. Knowing more about the developmental process and developmental expectations can help to identify challenges and develop appropriate interventions to support growth.

Human Development: A Dynamic Interactional Process

Human development is a dynamic and ongoing process between three factors:

  • the “hard-wired” general road map that governs the emergence and refinement of brain and body systems for all humans
  • the environment in which that development occurs, including relational components, such as availability of consistent attachment figures, threats to physical safety—including war, toxins in the water, etc., and access to resources, such as food, housing, education, and supportive family and friends
  • Unique constellation of the individual learning, temperament, and emotional style that provides resources as well as vulnerabilities

The ways in which these three factors interact can be hard to predict—just look at the difference between siblings who grow up in the same home. Some children are more vulnerable than others by virtue of a temperamental that “runs anxious,” in the words of one of my parents, which causes them to perceive unexpected events as threatening. Another’s vulnerability comes from their difficulties with understanding how social interactions actually work. How much difficulty each one encounters is likely to be calibrated by other elements, such as a consistent, predictable learning and social environment that makes developmentally appropriate demands and provides clear, reasonable (for the child) expectations. This can be a little trickier because vulnerable children are often delayed in their social-emotional development. For this reason, it is important to know more about the stages of friendship to know where your child is and how to help them grow.

The Laboratory of Childhood Social Development: Stages of Children’s Friendships (Robert Selman) This is one of many schemas for the meaning of friendship changes as a child grows and develops. Again, remember that there is a wide range of normal development, and that children with other challenges may move more slowly.

Level 0: Momentary Playmates (approximately 3-7 years old) Proximity is key; friends are people who are nearby and with whom you can have fun. The child assumes that “everyone thinks like me” and assumes that if a playmate has a different opinion, “s/he doesn’t want to be my friend anymore.”

Level 1: One Way Assistance (approximately 6-12 years) Friends are people who do nice things for you, like share a snack. Having a friend is very important, more important than someone being nice to you. Friendship can be used as leverage (“I will/won’t be your friend if…”).

Level 2: Two-Way Fair-Weather Cooperation (approximately 6-12 years) The child can take another’s perspective as well as his/her own—but not at the same time. Fairness and reciprocity become really important in a rigid way (“If I do something nice for you, you must do something nice for me”). Children are very judgmental about themselves and assume that others think the same way about them. Fitting in is also really important, and jealousy can become prominent. It is the time for cliques and secret clubs.

Level 3: Intimate, Mutually Shared Relationships (approximately 11-15 years) Friends are people who help you solve problems and will keep your secrets. They do kind things for you and don’t keep track because they care about each other. Best friends become really important and spend all of their time together. They can feel betrayed if their friend spends time with someone else.

Level 4: Mature Friendship (approximately 12 years-adulthood) Friends place a high value on emotional closeness. Trust and support maintain the relationship, not proximity. Friends accept and even appreciate their differences, and for this reason, they are not as threatened by other relationships.

You will notice as you read through these stages that there some key cognitive skills needed for social development. These include:

  • Self-regulation—the ability to inhibit impulses, control emotional reactions and manage behavioral responses . It also includes the ability to respond flexibly to changing demands.
  • Awareness of Others/Theory of Mind—the ability to recognize the difference between self and other; that other people do not share your thoughts and feelings.
  • Understanding of Norms, Rules, and Conventions—these are the agreed upon boundaries of expected behavior.
  • Perspective taking—the ability to not only recognize that other people do not think the way that you do, but to actually try to understand things from their point of view (“stand in their shoes”).
  • Mutuality-shared appreciation of each other and the reciprocal nature of the relationship.

Assessment: Before trying to intervene to help a child be more successful in making friends, it is important to distinguish between social skills and social competence. Social Skills are the discrete techniques for managing specific social interactions. These could range from maintaining eye contact to starting a conversation. Social Competence has to do with the overall ability to manage the variety of social demands in one’s environment. While we teach social skills, we are aiming for social competence. The criteria for social competence changes as children get older and the demands of their environment increase. This means that while a child may do perfectly well in one social environment, their mismatch in another could cause problems. Therefore, getting a general idea of how your child is thinking about friendship in relation to his peers is an important first step.

A second step in helping children become more socially competent is to figure out what the problem is. These problems can be divided into three general categories:

  • Skill Acquisition—Does the child know what to do? For instance, does the child know the steps to take to initiate conversations?
  • Skill Performance—Does the child have the motivation to perform the steps, and do they know when to do so (context)? For instance, does the child want to start a conversation, and do they know when to do so—like on the playground and not when the teacher is talking.
  • Skill Fluency—While they may know what to do to start a conversation and when to do it, how good are they at it? Can they do it in a timely manner without obvious awkwardness? Is there something else, like anxiety, getting in their way?

The final impediment to learning and using social skills to achieve social competency is the interference caused by anxiety. Anxiety is the experience of feeling unsafe and helpless to control a situation. It sparks a cascade of physiological changes that facilitate the process of escape by stimulating the sympathetic nervous system—when the danger is over, a complementary system takes over (parasympathetic nervous system) to calm things down and return to equilibrium. However, when a child is continuously stressed by, say, an unfriendly school environment, their system never calms down. They become stuck in “threat alert” where any unexpected stimuli is given a negative interpretation and the survival reflexes of “fight/flight/freeze” take over. How to “turn off” the threat alert? Make a child feel safe through a supportive relationship and then teach them the skills they will need to gain more mastery over the situation.

 

About the Author:

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

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

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

22

Anxiety Reducers for Children and Teens with ASD

By | NESCA Notes 2021

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

Research indicates that children and teens with Autism Spectrum Disorders (ASD) are more sensitive to heightened physiological sympathetic arousal (the “fight or flight” response), including increased heart rate, breathing rate, feeling “on edge” and body-based tenseness. Heightened physiological arousal is neurologically connected to sensory processing and emotional responses. This is why some children with ASD have “high startle responses” or sensitivities to specific sensations, such as touch or sounds. This is also why some children and teens with ASD are vulnerable to feelings of anxiety, particularly within social situations and settings.

There is growing research focusing on possible strategies and interventions that reduce anxiety and “buffer” the “fight or flight” response that can be activated for many children and teens with ASD.

5 Research-driven Anxiety Reducers:

Animals: Include companion or therapy animals in social groups or social outings (particularly new social events). In one study, children with ASD showed a 43% decrease in skin conductance responses during free play with peers in the presence of animals, as compared to toys (O’Haire, McKenzie, Beck, & Slaughter, 2015).

Exercise: Make a plan to engage in a “warm up” body-based activity right before a social event when anxiety levels are increasing (e.g., jumping jacks, burpees, squats). Research indicates that exercise calms the amygdala and decreases physiological arousal.

Relax or Distract: Practice progressive muscle relaxation (PMR). Recent research has indicated that regular and routine engagement in PMR sessions can be a useful strategy for individuals with ASD. Distract yourself from the anxiety-producing situation for the short term (e.g., count by 3s, name three things you can see and hear in the room, repeat words from your favorite song in your head).

Plan to Take a Break: Children and teens can benefit from having a healthy “escape plan” to take a break from socially-demanding and sensory-demanding settings (e.g., a large event like a play or concert, a college lecture, an interview for a job). Research indicates that “rest breaks” during mentally demanding tasks result in increased alertness, decreased fatigue and heightened relaxation.

Social Stories: Social stories provide the opportunity to practice and prepare for stressful situations, decreasing “fight or flight” responses. Read more about examples and applications of social stories in my colleague, Dr. Erin Gibbons’ previous blog post.

 

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. Click here to learn more about NESCA’s ASD Diagnostic Clinic.

 

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

 

153

Buyer’s Guide 101: How to Shop for a Pediatric Occupational Therapist

By | NESCA Notes 2021

By: Julie Robinson, OT
Director of Clinical Services; Occupational Therapist, NESCA

As a parent of a child who has just been referred for Occupational Therapy (OT) services, the prospect of what to do next and where to go can be quite confusing. With so many providers in the area, it can be difficult to know who would be the right fit for your family. Typically, when you reach out to express interest in OT services at NESCA, Julie Robinson, OT, our department director, will have a personal phone call with you to help you through the process. As you conduct your search for the right fit for your child and family, here are some good questions you might ask to help you determine what works best. We’ve offered answers regarding NESCA’s services to let you know more about how we provide OT services.

What type of insurance do you take for occupational therapy?

Here at NESCA, we are in-network for BCBS and Allways, and we bill them directly on behalf of our patients.

How long are your OT sessions?

We spend 45 minutes directly with a child and another 5 – 10 minutes at the end of the session to consult with the caregiver. Other practices provide 30 or 38 minute sessions to compensate for decreases in insurance payments since the outset of Covid-19.

How long do we have to wait for an OT session? 

We can initiate an evaluation within 2 – 3 weeks of initial contact. If you have availability to bring your child in for treatment during the school day, there is no waitlist at this time. If you require sessions in the afterschool hours, there is a very small waitlist.

How many patients does a clinician typically see per week?

Some practices require their clinicians to perform as many as 30 or 32 patient hours per week to maximize their income. Here at NESCA, we cap patient hours at 26 per week. It is very important for us to focus on providing excellent clinical care to our clients with staff who are not burnt out or struggling to manage paperwork, treatment planning, and administrative activities, such as phone calls and emails to support our families. We are proud to offer research-backed services and want to provide our clinicians with ample time for continued opportunities for learning, allowing them to reach their highest level of potential and skill as a therapist – which they then pass on that knowledge and skill to our families.

What does your OT practice focus on?

At NESCA, our focus of therapy is based on a holistic view of a child to encourage life-long functional skill acquisition. We use a combination of sensory motor, sensory integration, developmental, and trauma-informed techniques, as well as practice and repetition of those techniques. We offer coaching on daily living skills to address weaknesses across a variety of areas: self-regulation, executive functions, self-care skills, such as dressing and bathing, handwriting and fine motor development, feeding, academic readiness, organization and attention. Other practices may utilize sensory integration or applied behavioral analysis as the basis for their program, for example.

Does the practice provide OT services in a clinical setting, remotely, at home, in school, or in the community?

Our primary service provision at NESCA is in the office or over teletherapy. In some instances, where schedules can be accommodated, we will provide services in the home, schools, or in the community. There may be additional travel fees involved for services outside of the office.

Does your OT practice offer comprehensive or second opinion evaluations for academic programming if needed?

NESCA does provide this service.

Will your practice consult with teachers or other caregivers if needed?

Yes. Sometimes additional fees are required, as insurance does not cover this service. We believe that consultation with outside providers is a critical part of our success!

Does your practice provide any specific programs outside of traditional sensory-motor based Occupational Therapy services?

At NESCA, we provide several specialty services in addition to traditional OT:

  • Feeding therapy
  • Safe and Sound Protocol for auditory sensitivity and self-regulation
  • Handwriting Without Tears
  • Trauma-informed Sensory Integration

What makes our clinicians so special?

One of the things that makes our occupational therapists an ideal match for your family is our love for children, the work we do, and our commitment to lifelong learning and the development of our clinical skills. Our entire OT department has known each other for at least four years, and we all came together as a team from another practice, with clinicians that are hand-picked by our director. We meet together on a weekly basis to share ideas and information, as well as to support each other in our clinical development.

For more information about NESCA’s Pediatric Occupational Therapy services, please visit: http://nesca-newton.com/occupational_therapy/ or submit an online Intake Form: https://nesca-newton.com/intake-form/.

 

About the Author

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

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

 

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

 

18

Why Does My Child Have to Read 20 Minutes Per Night After Being in School All Day?

By | NESCA Notes 2021

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

Reading 20 minutes per day has been shown to have many positive benefits. Did you know…?

  • Children who read 20 minutes a day/5 days a week are exposed to 1.8 million words in one school year. Compare this to students who read 5 minutes per day – they will be exposed to 282,000 words per school year.
  • Reading helps foster empathy – a child experiences “walking in someone else’s shoes.”
  • Children are exposed to different ideas and cultures.
  • Reading also improves critical thinking.
  • Reading increases knowledge of correct syntax and grammar, along with robust vocabulary knowledge, resulting in improved writing skills.
  • Students who read 20 minutes per day score significantly higher on standardized tests of reading.
  • Reading with your child, or having them read independently before bed, can help them to relax and wind down from their day.

It is important to recognize that despite all our good intentions, sometimes students are reluctant to read on their own. This reluctance can come from different reasons, such as difficulty reading, not yet knowing the types of books they would enjoy, or even that they would simply rather be playing video games or be on social media. To help make reading more attractive to your child, there are several things you can try:

  • Let the child choose what they are reading – help them find books that are about an area of high interest to them (anything from sports to fashion to history – all is fair game!).
  • If the book they are interested in is above their reading level, you can read to them (model the page) and then have them read it back to you.
  • Allow them access to audio books, and they can follow along with the text.
  • Encourage different types of reading material (comics, graphic novels, magazines, traditional books, etc.).
  • Look for book series – once they enjoy one, they will often want to read the rest!

Getting your child to read is not always easy. However, allowing them to read high interest material, asking them questions to help them interact with the text, and modeling that reading can be fun is a great start!

If your child demonstrates difficulties improving their reading skills, reach out to their teacher and discuss if there are any underlying concerns (visual issues, such as difficulty tracking; reading challenges, such as reduced phonemic awareness, etc.). If you continue to have concerns, consider having your child evaluated by a reading specialist or pediatric neuropsychologist to ensure that such an important skill is supported and developed as your child continues through school and beyond.

Sources

https://www.honorsgradu.com/importance-of-reading-20-minutes-a-day/

The Surprising Benefits of Reading 20 Minutes a Day

https://www.k12reader.com/why-read-20-minutes-a-day/

https://www.understood.org/articles/en/14-ways-to-encourage-your-grade-schooler-to-read

 

About the Author

With NESCA since its inception in 2007, Dr. Talamo had previously practiced for many years as a child and adolescent clinical psychologist before completing postdoctoral re-training in pediatric neuropsychology at the Children’s Evaluation Center.

After receiving her undergraduate degree from Columbia University, Dr. Talamo earned her doctorate in clinical health psychology from Ferkauf Graduate School of Psychology and the Albert Einstein College of Medicine at Yeshiva University.

She has given a number of presentations, most recently on “How to Recognize a Struggling Reader,” “Supporting Students with Working Memory Limitations,” (with Bonnie Singer, Ph.D., CCC-SLP of Architects for Learning), and “Executive Function in Elementary and Middle School Students.”

Dr. Talamo specializes in working with children and adolescents with language-based learning disabilities including dyslexia, attentional disorders, and emotional issues. She is also interested in working with highly gifted children.

Her professional memberships include MAGE (Massachusetts Association for Gifted Education), IDA (International Dyslexia Association), MABIDA (the Massachusetts division of IDA) and MNS (the Massachusetts Neuropsychological Society).

She is the mother of one teenage girl.

 

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

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

37

Vocational Aptitude Testing

By | NESCA Notes 2021

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

Over the past month, my colleague Tabitha Monahan and I have been dedicating our blog entries to vocational assessment as a critical tool for helping students learn about employment and set career goals for themselves. Previous blogs have provided an overview of vocational assessment as well as an in depth look at career interest inventories and real-life experiences, such as informational interviews and job shadows. Many of these tools provide opportunities for students to learn more about the world of work and types of jobs that match with their interests and things that they know they like. Today, I am going to share information about a different type of assessment, vocational aptitude testing.

It is not uncommon for middle and high school students to have job aspirations that do not fully align with their physical and cognitive strengths or even their general preferences for daily work (e.g., being seated, indoors, casually dressed, etc.). When you have had very little exposure to employment and you spend most of your time in a structured educational environment, it is hard to picture yourself as a worker and fully appreciate the skills, knowledge, education, abilities, and experience needed for a particular job. Vocational aptitude testing is formal testing of a set of abilities known to impact an individual’s potential for success and satisfaction in a variety of occupations.

Similar to intelligence or cognitive assessment tools, vocational aptitude tests vary in format, activities, and the defined abilities or factors that are tested. For instance, at NESCA three of the most common vocational aptitude tests we use are quite different from one another—an online computer-based assessment tool that is designed for self-administration, a paper-based assessment tool that is formally administered in an office or classroom with both a test booklet and scantron answer sheets, and a functional hands-on set of performance activities that simulate actual work activities (e.g., sorting mail by zip code, alphabetizing post cards, assembling pipes, tightening screws, etc.). However, most vocational aptitude tests include tests designed to evaluate the following aptitude factors (i.e., abilities):

Verbal Aptitude – The ability to understand and use words effectively, to comprehend verbal concepts and language, and to express ideas clearly in words. People who score highly generally do well in school, particularly in subjects where verbal concepts are important.

Numerical Aptitude – The ability to do arithmetic and other numerical computations quickly and accurately. People who score highly on this aptitude may do well in such school subjects as math and physics.

Spatial Aptitude – The ability to visualize two-dimensional objects in three-dimensional space, and to mentally manipulate objects through different spatial orientations. People who get high scores have the aptitude to perform well in school subjects and work involving drafting, art, architecture, clothes designing, and so on.

Perceptual Aptitude – The ability to compare and discriminate words, numbers, symbols, or other graphic material to see if slight differences exist between them. People who score highly in this area should do well in proofreading, copyediting, and nonverbal tasks that require attention to detail and rapid visual discriminations.

Manual Dexterity – The ability to coordinate eye and hand movements and perform manual tasks rapidly and accurately. High scores indicate the ability to manipulate tools and objects with speed and precision.

General Ability – The ability to learn and achieve in training or academic situations. People who get high scores “catch on” quickly in new situations, and are proficient in making judgments and in grasping underlying principles and solving problems. (This is often computed through summing or averaging an individual’s verbal and numerical aptitudes.)

Definitions provided by/taken from the Occupational Aptitude Survey and Interest Schedule Aptitude Survey (OASIS-3: AS) Examiner’s Manual.

If a student has participated in other kinds of standardized testing over time, especially intelligence testing and occupational therapy testing, it is likely that quite a bit of information is already known regarding the students’ aptitudes for employment. However, there are many vocational aptitude tests that are bundled with interest inventory tests, enabling a quick and clear comparison of the student’s vocational aptitudes and interests. For example, the OASIS-3 Aptitude Survey mentioned above is part of a testing kit that includes the OASIS-3 Interest Schedule and an Interpretation Workbook for easily comparing jobs within a student’s interest areas with their current career abilities.

Career aptitude testing can give a student a clear sense of their relative strengths and areas of challenge as well as a sense of how their current abilities compare with the abilities required for jobs of interest. However, it is important to caution that career aptitude testing does not predict the kind of work that a student should do. Results of career aptitude testing may differ considerably based on many factors, including new learning and work experiences. Results of testing should change as a student gains education and work exposure and can certainly be used to help us understand what skills might need remediation for a student to have a better chance of participating in certain kinds of employment.

One final thought regarding career aptitude testing is that while it can sometimes be an option to administer standardized testing with accommodations, I would encourage only providing accommodations that would reasonably be provided on a work site. For example, offering a student who has comprehension or processing speed difficulties the opportunity to take aptitude testing with unlimited time may not help the student to get a sense of how their aptitudes truly match up with the demands of a particular job. The reality is that most employers are not able to give employees unlimited time to do their jobs. Using text-to-speech during computer-based administration of a test may be far more relevant as long as test results are interpreted with the need for this accommodation in mind.

To read more about vocational assessment, check out the following blog entries:

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

 

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

 

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

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