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4

Testing the Limits

By | NESCA Notes 2022

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

In the world of assessment, “testing the limits” means essentially bending the rules of test administration in order to see if the change in administration allows the test-taker to demonstrate their knowledge more effectively. For example, some children and adolescents respond impulsively to multiple-choice tests, picking the first choice that appears to be correct without looking at all of the choices. Standardized test administration dictates that the evaluator accepts that impulsive response and, as such, impulsivity will compromise the client’s score.

In the example above, the student was unable to demonstrate their knowledge or skills effectively on tests because of the standardized administration procedures. While it is important to generate these scores, it is also important to gain an understanding of what the student actually knows, and this is where testing the limits comes in. For the impulsive student, the evaluator would test the limits by reminding the student to slow down and look at all the choices before responding. This is non-standard test administration, and so the score is not considered valid but the results give us a great deal of information about the student’s strengths and weaknesses. There is a big difference between the student who is able to achieve the correct score when cued to slow down and the student who still answers incorrectly, even with reminders to slow down. The former student can be said to have much higher potential than the latter student. However, their ability to demonstrate their potential is hampered by impulsivity, a problem that needs to be addressed.

In the course of most neuropsychological evaluations, we are trying to understand the student’s profile of strengths and weaknesses, which often requires testing the limits. This raises the question of the value of the standardized scores. The standardized scores likely reflect the level at which the child or adolescent is functioning in the “real world.” Impulsive test-takers are almost certainly impulsive students; just as they don’t demonstrate their true potential in testing, they are not doing so in school.

Many students are able to fully demonstrate their skills and knowledge with standardized testing and don’t require “testing the limits.” However, at NESCA, we also see many highly complex students whose ability to access their potential is limited by issues of attention, executive functioning, communication, or emotional/behavioral regulation. In these cases, we routinely “test the limits” and report both standardized administration and non-standardized (“testing the limits”) scores and explain what these scores mean for the individual, what the scores tell us about daily functioning as well as untapped potential.

 

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

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

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

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

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

3

My child is nonverbal. Should I still get a neuropsychological evaluation?

By | NESCA Notes 2022

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

The short answer to this question is YES. As a neuropsychologist, I enjoy evaluating students who have complex profiles, including intellectual/developmental disabilities, genetic conditions, and medical complexities. In many cases, these students have been deemed “untestable” and have never had a comprehensive evaluation.

This is problematic for two major reasons.

  • First, we cannot understand a student’s potential if we have no data or assessments available. Following from this, it is very hard to develop realistic and measurable goals without using the student’s innate potential to guide those goals.
  • Second, lack of testing causes practical and logistical problems later in the student’s life. As a child approaches adulthood at 18, it is necessary to have documentation of their cognitive and adaptive skills as well as diagnoses in order to seek adult services. More specifically, the Department of Developmental Services (DDS) requires documentation of intellectual disabilities prior to age 18.

Having assessed thousands of children and adolescents over the years, I’ve learned that I can ALWAYS gather important information from a neuropsychological evaluation. I have evaluated students who are nonverbal, students with severe intellectual disabilities, students with limited to no motor abilities, students with vision and hearing impairments, students with severely challenging behaviors…. In every case, a neuropsychological evaluation has been meaningful and useful in terms of A) understanding the student’s capabilities, and B) developing educational and treatment goals.

It is important to understand that a neuropsychological evaluation with a more developmentally complex student will look different than an evaluation with a neurotypical student. There are standardized tests that I will not be able to administer based on the student’s language skills, motor abilities, and academic knowledge. Some students can only tolerate 20 or 30 minutes of testing at a time, so the evaluation is broken into 9 or 10 sessions. Some students provide their responses using a communication device. Some students need to be supported by a behavior therapist to help them maintain a safe body.

In some cases, students cannot engage in any standardized tests due to multiple disabilities. However, I still have them come into my office at least once so that I can meet them in person and gather information about their communication skills, social interest, and activity levels. I will then spend time observing the student at their educational program, interviewing school-based staff, and gathering information from the student’s caregivers about their skills at home. With all of these data points, I can then provide a thorough set of recommendations for school-, community-, and home-based goals – even though I might not have “valid” standard scores.

For all of the families who think that a neuropsychological evaluation cannot be done with their child for one reason or another, I urge you to reconsider your perception of the purpose of an evaluation. In these cases, the emphasis of the evaluation is not on test scores, but on developing a better understanding of the student’s strengths and weaknesses. More importantly, the evaluation should be used as a reference to guide treatment goals to help the student achieve the highest level of independence of which they are capable based on their potential.

 

About the Author

Erin 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.

 

If you are interested in booking an appointment for the ASD Diagnostic Clinic or an evaluation with a NESCA neuropsychologist/clinician, please fill out and submit our online intake form. 

 

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

14

Changing Habits to Become a More Effective Student

By | NESCA Notes 2022

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

In 1989, Stephen Covey wrote “The 7 Habits of Highly Effective People,” and it continues to be a book that is still relevant today, used by many Fortune 500 companies. He was a change-agent, a best-selling author, educator, and business leader, and through his down-to-earth approach, he created a wave of change. He helped people think about “being good” and create habits from the human race’s best instincts. He was named one of the 25 most influential people by TIME magazine in 1996 and authored numerous books that highlight his “inside out” approach to change. He thought who you are and how you view the world is at the core of how you engage with the world. This is such a simple view yet so powerful and one that holds much truth. He thought change started internally and by developing those 7 habits was the way to create a world that functioned better and in more of an us/we mentality versus a me/my mentality. He developed programs, led workshops and inspired change in children and adults. There are curriculums that have been developed for use with children through young adults in schools and colleges. These programs created individual change as well as cultural and system change.

His work has been changing the world one person at a time through his books and his programs for years. He believed that organizational behavior was individualized behavior. His 7 habits of being are about taking responsibility for oneself and through this creating a community of mutual goals, trust and more. In schools, the programs include developing behavioral change through the development of new habits and 5 core paradigms. The five paradigms are:

  1. Everyone can be a leader; NOT Leadership is for the few;
  2. Everyone has genius; NOT A few people are gifted;
  3. Change starts with me; NOT To improve schools the system needs to change first;
  4. Educators empower students to lead their own learning; NOT Educators control and direct student learning; and
  5. Develop the whole person; NOT Focus solely on academic achievement.

These paradigm shifts guide administrators and educators to see and think differently about how they see their role, student potential and the school culture. It allows all students whether they have disabilities or not to be valued, included and take ownership for themselves and each other, and change the culture of the class and school. The 7 habits of highly effective people are:

Social-emotional learning (SEL) is as important as academics, if not more important. Many schools have goals related to SEL, and the vision statements of many districts reflect that. Most vision statements express something like, “We prepare students to be life-long learners who contribute to a global world and demonstrate respect and acceptance for the diversity of our humanity.” How do they bring their vision to life and practice it day in and day out in through their policies, conversations, classrooms and schools? There are many different tools, programs, curriculums and approaches that address SEL and help schools meet their visions and prepare students to be contributing and caring members of society. Stephen Covey’s 7 habits are an example of one of these approaches. Think about how you, as a parent or caregiver, can embrace and reinforce these 7 habits at home as they can help family members thrive individually as well as within the family unit.

 

References:

Covey, Stephen. R. (2020). The 7 habits of highly effective people; 30th anniversary edition. N.Y., N.Y. Simon & Schuster.

Covey, Stephen. R. (2022). The 7 habits of highly effective families Creating a nurturing family in a turbulent world. N.Y., N.Y. St. Martins Publishing Group.

Covey, Sean (2014). The 7 Habits of highly effective teens. N.Y., N.Y. Simon & Schuster.

Covey, S (2008). The 7 Habits of happy kids. N.Y., N.Y.  Simon & Schuster.

 

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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.

 

37

Transition Planning: The Important Difference Between Postsecondary Goals and Annual Goals

By | NESCA Notes 2022

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

One of the most important aspects of transition planning for students with individual education programs (IEPs)—and for every student—is development of postsecondary goals. These goals are often described synonymously as the student’s postsecondary vision: the outcomes that the student and their IEP team expects the student to achieve after exiting public education. Legally, every IEP in the country needs to include explicit postsecondary goals in the areas of education or training, employment, and independent living, when appropriate. In Massachusetts, students need to have goals for Independent Living as well as Community Engagement. Because this topic is so important, I previously wrote a blog describing the importance of measurable postsecondary goals including a formula for writing such goals.

But, two years later, I am still finding that this is a misunderstood aspect of the IEP process, particularly here in Massachusetts. This is in some ways because our state IEP was not designed with transition planning or student-centered planning at the foundation. Currently, when you read an IEP from Massachusetts, there is only one section of the IEP used for describing the Vision Statement for the student. For students under the age of 14, this section is typically used to describe what the parents and team hope and dream for the student over the next 1-to-5-year period. But then, no later than when the student turns 14, we use the same section of the IEP to write out the student’s vision statement for after high school, and that statement legally needs to reflect the student’s preferences and interests and the student’s desired outcomes (i.e., postsecondary goals) for adult independent living and community engagement, work, and learning or training environments. For reference, this is the language currently in the Massachusetts IEP.

This shift is confusing! Parents are used to coming to IEP meetings ready to share their visions for their children, and students are often unprepared to share their goals for life after high school. But this shift is also absolutely critical for ensuring that students receive appropriate transition services. This is because every student on an IEP is legally entitled to participate in a coordinated set of activities that promotes their movement toward their postsecondary goals (i.e., their vision). These activities can include instruction, related services, community experiences, development of employment and post-school living objectives, and acquisition of daily living skills and functional vocational evaluation.[1] The only way a student can receive appropriate transition services, and an appropriately calibrated and coordinated set of transition activities, is if we clearly identify and define appropriate postsecondary (i.e., post-high school) goals for the student. And, these need to be listed out at the start of the IEP. In Massachusetts, these need to be listed in the vision statement.

Nevertheless, once we have done the important work of defining the student’s postsecondary goals or vision (which always involves transition assessment), then we have more important work to do. We have to make sure that the IEP that is developed includes necessary annual IEP goals, and related services, that will effectively support the student in making progress toward their postsecondary goals. We need to carefully crosswalk between each of the postsecondary goals set for the student and the annual goals we are developing. It is vital to make sure that there is at least one annual goal (or objective/benchmark within an annual goal) that addresses each of the student’s measurable postsecondary goals. We are very good at making sure that each of the services a student receives relates to the annual goals a student is working on. But we rarely pay attention to whether each of the student’s measurable postsecondary goals (i.e., each of the goals listed in the student’s vision statements) is supported by an annual goal. Annual goals for transition-aged students need to be determined from two sources: the student’s disability-related needs AND the student’s measurable postsecondary goals. Annual goals and coursework for a student with autism and language-based issues should be different depending on whether the student intends to be an artist or a veterinarian technician. Goals should be different for a student who intends to be a licensed driver and a student who intends to use door-to-door van transportation. In all cases, the team needs to annually discuss what skills the student needs to build this year in order to be able to attain their postsecondary goals in the future. The team needs to make sure that each postsecondary goal that the student has is supported by the student’s annual goals. If this is not explicitly discussed at the team meeting, we are not effectively planning for the student—and we are not effectively supporting students in being able to plan for themselves.

For more information about postsecondary goals and annual IEP goals in Massachusetts, check out Technical Assistance Advisory SPED 2013-1: Postsecondary Goals and Annual IEP Goals in the Transition Planning Process from MA DESE: http://www.doe.mass.edu/sped/advisories/13_1ta.html

 

[1] https://sites.ed.gov/idea/regs/b/a/300.43

 

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.

2

Managing Stress while Navigating the Initial IEP Referral Process

By | NESCA Notes 2022

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NH Director, NESCA

The special education process is naturally stressful, particularly when submitting a first request for eligibility. It is difficult to watch your child struggle in school, and while the IEP process may bring hope for things improving, there are complex procedures and timelines, as well as feelings of anxiety and uncertainty, that must first be navigated. Luckily, there are some things that families can do to help manage the stress that comes with the IEP eligibility process:

  • Acknowledge from the onset that the process will be stressful and that stress is okay. Stress is telling you that something is important and requires your attention. Try to accept stress as part of the process and use that to help prepare yourself.
  • Build a team. Allow yourself to just be the caregiver, and find professionals who can take on other duties. This may include hiring an educational advocate or attorney who can help you understand special education laws as well as advocate for your child’s needs at meetings. This may also include seeking a private evaluation to obtain an expert opinion on your child’s needs and inviting this individual to participate in the meeting. The goal is to divide responsibilities, focus on your child, and speak to your concerns as the caregiver.
  • If you had an evaluation and are working through a new diagnosis, take in information at a pace that you can handle. Ask your evaluator for clarifying information when needed, and try to reduce your Googling and online research. Do not get yourself stuck in a rabbit hole of online information that may or may not pertain to your child. If you feel uncertain about things, use your team and ask questions.
  • Maintain effective communication with your IEP team. Know your goal for each meeting and plan your input ahead of time. Be concise but include observations or history to support your point, and state your specific goals for each meeting.
  • Manage your expectations. Concerns and requests may not be entirely resolved within one meeting, and there may be many steps you have to go through before a plan is in place.
  • For children who “fly under the radar” at school, take some basic notes of what you observe at home, such as difficulty with homework, “meltdowns” after school, etc., which you can share with the team. That said, only take these notes for a manageable time frame (e.g., two weeks), allowing you to maintain your sanity.
  • Lastly, engage in self-care. While this may sound cliché, it is indeed important to take time to yourself and do activities that bring you some peace and enjoyment while navigating through these stressful procedures.

 

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.

5

Anxiety-based Procrastination: Tips for Getting over the Hurdle

By | NESCA Notes 2022

By: Lyndsay Wood, OTD, OTR/L
NESCA Transition Specialist & Occupational Therapist

Despite our best efforts, procrastination happens. There are many reasons that you may be putting off that large paper, important phone call or those dishes that are stacking up. You may not have the motivation, you may be tired, you may have more fun plans, or maybe it makes you feel anxious. In fact, one of the top reasons people procrastinate is anxiety. Anxiety rates have increased since the start of the COVID pandemic in 2020, and tasks that previously felt easy can now be daunting to think about. It is important to both treat yourself with kindness AND build up your toolbox so that you can tackle the day ahead. Below is a list of nine tips on getting over the procrastination hurdle when anxiety is taking over.

  1. Five minute max – For this strategy, set a five-minute timer and start the activity you have been putting off. Tell yourself that you can stop the activity after five minutes. More than likely, once you start, you will be able to keep going, but you have the option to stop after just five minutes. This strategy helps with perfectionism and all-or-none thinking that can stop you from starting your tasks.
  2. Task breakdown – Big tasks can often feel overwhelming, so breaking your big project, chore, etc., into small steps can help you get going. Tell yourself you will complete step one today and move on to step two tomorrow.
  3. Seek help – Take a step back. Do you have the skills to complete this task? Is there someone you could ask for help if needed? Do not be afraid to seek the help of others to get started!
  4. Reduce the standard – Identify one task that you would be less likely to avoid if you make it easier. For example, have you been putting off exercise because you are worried about going to the gym? Start with a 10-minute walk and build up to a longer exercise period once you are ready. This method is especially helpful to combat an all-or-none mindset.
  5. Notice negative predictions – Be aware of your thoughts and how they can impact, or even control, your actions. Are you making a negative predication about the outcome? If so, it can be helpful to go through the following questions in your mind to reframe your thinking:
    1. What is the worst outcome?
    2. What is the best outcome?
    3. What is the most realistic outcome?
    4. What might I learn if I am willing to take a risk?
  6. Recognize your strengths and challenges – If you find initiating, planning or sequencing tasks difficult when compared to your other skills, don’t misattribute procrastination to laziness or poor motivation. Mislabeling yourself as lazy can lead to further procrastination and decrease self-confidence. You may instead decide to seek extra support or tools to develop your executive function skills.
  7. Visualize – Visualize the finished product AND the feeling associated with completing the task. It is easier to start a task if you feel like you have already succeeded at it.
  8. Accomplishment journal – Keep a running list of accomplishments (even small ones) and check back in to boost your self-confidence for the tasks ahead. It is much easier to start a task when you are in a positive head space and see that you are capable of meeting your goals.
  9. Treat yourself with small rewards – Sometimes a small reward can help you get over a big scary hump. Perhaps after scheduling all of the health care appointments you have been putting off, you sit down and watch the movie you have been wanting to see.

There is no perfect strategy that works for everyone in every situation, but add these strategies to your toolbox and test them out. See if you can find just one tool to help you in those moments when anxiety is impacting your ability to get moving. You’ve got this!

 

About Lyndsay Wood, OTD, OTR/L

Lyndsay Wood, OTD, OTR/L, is an occupational therapist who focuses on helping students and young adults with disabilities to build meaningful skills in order to reach their goals. She has spent the majority of her career working in a private school for students with ASD. She has also spent some time working in an inpatient mental health setting. Lyndsay uses occupation-based interventions and strategies to develop life skills, executive functioning, and emotional regulation. While completely her doctoral degree at MGH Institute of Health Professions, Lyndsay worked with the Boston Center for Independent Living to evaluate transition age services. She uses the results from her research to deliver services in a way that is most beneficial for clients. Specifically, she focuses on hands-on, occupation-based learning that is tailored the client’s goals and interests.

 

To book coaching and transition services at NESCA, complete NESCA’s online intake form. 

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

4

Yoga Therapy for Children and Adolescents

By | NESCA Notes 2022

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

As a pediatric neuropsychologist, I often recommend yoga therapy for children with anxiety, impulse control, and/or motor/coordination/sensory issues, as well as issues that alienate them from their body (e.g., eating disorders and trauma). Another group for which a body-focused therapy like yoga would be helpful is children with language challenges who are not equipped to manage the challenge of “talking” therapy.

Yoga is a 4,000-year-old practice that originated in what is now known as India. The word means “yoke” or “union,” and the practice of yoga aims to quiet the mind in order to find the unity within ourselves and with the world around us. This ancient practice was developed to facilitate development and integration of the human body, mind, and breath to produce a strong and flexible body free of pain, a balanced autonomic nervous system with all physiological systems functioning optimally, and a calm, clear, and tranquil mind (1). As we make this transformation in ourselves, we hope to affect the larger world. This is done through a variety of elements, but the western world tends to focus on movement (asanas), breathwork (pranayamas), and meditation (dhyanas).

Yoga was introduced to the west in the 19th century and has become a popular form of physical fitness and injury rehabilitation. More recently, we have begun to investigate its impact on physiological function, specifically the autonomic nervous system which controls vital life functions and regulates our stress response and return to equilibrium. Research has shown that chronic activation of the stress response (“fight/flight/freeze”) is strongly associated with increased risk of cardiovascular problems and autoimmune disorders (including diabetes), as well as psychiatric conditions, such as anxiety and depression. Yoga has been found to be effective in damping the stress response and allowing the body to return to equilibrium (“rest and digest”), resulting in lower heart rate and blood pressure, improved hormone regulation and gastrointestinal processes, lowered levels of anxiety, and better emotional and behavioral control. It is now included in cardiac rehabilitation programs, chronic pain programs, and psychotherapeutic treatment modalities.

Recently, I became curious with what exactly happens in yoga therapy and decided to talk with the new yoga therapist at NESCA, Danielle Sugrue, M.S. An athlete throughout high school and college, Danielle became involved with yoga about 15 years ago because she was looking for something that “would get me back into movement.” She quickly fell in love with yoga and completed her 200-hour Yoga Teacher Training. In the meantime, she also completed her master’s degree in Marriage and Family Studies at Salem State University. With this combination of expertise, she is able to help children and adolescents become more in touch with their bodies and find their words through movement, breathing, and relaxation.

I asked Danielle what a yoga therapy session with a child would look like. She quickly assured me that interventions with young children hold little resemblance to adult yoga classes. Danielle described her sessions with children as a playful movement exercise to learn to come to their breathing when things get challenging. If a child becomes dysregulated, she helps them tap into their senses to ground them and begin to put words on the feelings. A session may start by spreading cards with animals doing various poses out on the floor and asking the child to pick the card that looks like how s/he is feeling. Based on the cards selected, Danielle may develop a flow of postures based on those selections. The poses and concepts are taught through stories and games using mythical characters, like Ganesh, the Hindu elephant god who clears obstacles and paves the way for us to move forward in life.

The sessions for adolescents tend to take a more direct approach to the issues of concern as described by the teenager. Learning breathing techniques tends to be a key element; because of body issues, many teenage girls don’t breathe deeply (belly breathing) because it makes their stomach stick out. This kind of shallow breathing activates the stress response, making the person feel more anxious, while deep breathing “turns on” the rest and relax function. Moving freely without self-consciousness is another big challenge for teens—and developing a flow that allows them to feel themselves moving with ease but also makes them feel capable of holding a pose just a little longer than they thought they could—helps with developing self-confidence. Directly addressing mindset (self-love and self-compassion) also tends to be an important focus of work with teens and may involve activities such as a mirror challenge of looking at oneself and identifying what s/he likes about themselves.

Yoga therapy usually involves purchasing a 10-session package of once weekly meetings of an hour’s length. If you are interested in having your child work with Danielle, please contact her directly at: dsugrue@nesca-newton.com or complete an online Intake Form at: https://hipaa.jotform.com/220393954666062.

In addition to her work at NESCA, Danielle also teaches yoga at Power Yoga Evolution in North Andover. Dr. Monaghan-Blout is in the process of completing her own 200-hour yoga teacher training.

  1. Kayley-Isley, L., Peterson , J, Fischer, C, and Peterson, E. Yoga as a Complementary Therapy for Children and Adolescents, Psychiatry 2010; 7(8): 20-32.
  2. Nourollahimoghadam, E., Gorji, S., Ghadiri M., Therapeutic Role of Yoga in Neuropsychological Disorders., World Journal of Psychiatry 2021, October 19; 11 (10): 754-773
  3. Permission to Unplug: the Health Benefits of Yoga for Kids. https://www.healthychildren.org, the American Academy of Pediatrics
  4. Barkataki, Susanna. Embrace Yoga’s Roots; Courageous Ways to Deepen Your Yoga Practice 2020, Orlando, FLA, Ignite Yoga and Wellness Institute

 

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 one of our many 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.

6

Changes to the Developmental Milestones Guidelines Cause Confusion and Conflict

By | NESCA Notes 2022

By Olivia Rogers, MA, CF-SLP
Speech-Language Pathologist, NESCA

Recently, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) updated guidelines for developmental milestones in the Learn the Signs. Act Early program for the first time since its initial release in 2004. This program provides free checklists of developmental milestones and outlines warning signs of developmental delays in the following areas: social/emotional, language/communication, cognition, and movement/physical.

One of the biggest CDC developmental milestone changes involves language development. Since 2004, the CDC has stated a 24-month-old should have a vocabulary of 50 words. Now, that milestone of 50 words has been pushed back to 30-months-old. This new standard clashes with the American Speech-Language-Hearing Association (ASHA) guidance, which states that saying fewer than 50 words at 24 months is a potential red flag for a language delay or disorder.

Confusion regarding the recent changes may impact the (already) difficult decision that many parents are faced with in the first few years of their child’s life: whether or not to seek professional support for their child.

Despite the changes to the outlined milestones, the intentions behind this checklist remain consistent—early identification and intervention is key. When it comes to your child’s speech and language development, we suggest not taking the “wait and see” approach. The first three years of your child’s life—when the brain is developing and maturing—is the most intensive period for acquiring key speech and language skills.

Though children vary in their development of speech and language skills, they do follow a natural progression for mastering these skills of language. If you’re worried your child isn’t meeting milestones and wondering when the right time or the best age is for speech/language therapy, take action sooner than later. Contact a local speech-language pathologist. The earlier a child is identified with a delay, the better, as treatment and learning interventions can begin.

We urge parents to follow their instincts and seek guidance when there is a concern. You will either get much needed help for your child or peace of mind, and your local speech-language pathologists are happy to help.

If your pre-school-aged child is having difficulty with any of the following, concerns can be addressed through a speech/language assessment and/or therapy:

  • Saying first words or combining words into sentences
  • Using gestures
  • Naming and describing objects, ideas, and experiences
  • Pronouncing words or being understood by family or others
  • Interacting socially or playing with others
  • Understanding words, concepts, or gestures
  • Listening, following directions, or answering questions
  • Knowing how to take turns when talking or playing with others
  • Using correct grammar, such as pronouns and verb forms

Resources:

Centers for Disease Control and Prevention. (2022, January 31). CDC’s Developmental Milestones. Centers for Disease Control and Prevention. Retrieved February 24, 2022, from https://www.cdc.gov/ncbddd/actearly/milestones/index.html

The National Institute on Deafness and Other Communication Disorders. (2000). Speech and Language Developmental Milestones. NIH Publication No. 00-4781.

 

About the Author

Olivia Rogers received her Master of Arts in Speech-Language Pathology from the University of Maine, after graduating with a Bachelor of Arts in Communication Sciences and Disorders and concentrations in Childhood Development and Disability Studies.

Ms. Rogers has experience working both in the pediatric clinic setting as well as in public schools, evaluating and treating children 2-18 years of age presenting with a wide range of diagnoses (e.g., language delays and disorders, speech sound disorders, childhood apraxia of speech, autism spectrum disorder, social communication disorder, and Down syndrome). Ms. Rogers enjoys making sure therapy is fun and tailored to each client’s interests.

In her free time, she enjoys listening to podcasts and spending times with friends and families.

 

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.

 

To book an appointment with Olivia Rogers, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

158

Executive Function and Goal Setting

By | NESCA Notes 2022

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

Personal, professional, and academic goals are a large part of what drives us as we transition from one stage of life to the next. They also provide direction as we choose and maintain the habits and routines that we feel are important to daily life. Determining what our goals are is a big step, one that students are often working on with their families, school supports, and friends as they start to figure out their next steps in life. But once these goals are solidified, what’s next? How  do we get there? As an executive function coach working with high school and college students, I can attest that this can unexpectedly be the most difficult step in the process. Let’s talk about some ways that we can support students in these endeavors.

  1. Break down goals into manageable chunks. Many goals tend to be large or long-term and can feel daunting and amorphous. For example, a common goal for high school seniors might be, “I will apply to five colleges by their application deadlines.” We can help students by breaking a goal like this down and creating step by step lists, such as: put together a list of preferences for my ideal school, research schools that fit these preferences, meet with guidance counselor to review my research, finalize list of five schools, ask teachers for letters of recommendations, fill out each section of the Common App, write personal essay, have English teacher or other support person review personal essay and give feedback, etc. This list is not comprehensive, but it does show how much goes into the seemingly simple initial goal.
  2. Help them prioritize. Once students have created a comprehensive list of steps, help them to understand what steps need to be attended to right away and which can wait. Continuing with the example of applying to college, figure out what steps need to happen before the Thanksgiving or winter break! It may also be helpful to figure out which steps seem difficult for your specific student. For some, this may be writing the personal essay; for others, it may be building up the courage to ask a favorite teacher to write them a recommendation. Busy students who are already taking multiple classes may have trouble figuring out how to add the steps needed to reach another goal into their schedule.
  3. Put together a plan. Set a timeline. Put internal deadlines into a calendar. Figure out specific times to work towards the goal. Find people who can be solid supports and help to make things happen.
  4. Check in on them. Offer to check in along the way. Some students will love having a partner to track their progress with, while others simply need help setting the foundation.

While this example is very concrete and includes working towards a specific predetermined deadline, not all goals need to be. Whether your student’s goal is to find a summer job they enjoy, get an average of a B in all of their classes, or find a new hobby that makes them happy, using these strategies can help to make a goal feel more manageable.

Finally, you might notice that these steps are quite similar to some of the strategies for completing specific academic tasks, and you would be right! Take, for example, writing a research paper. We want students to break that task down into smaller pieces, such as finding sources, creating an outline, writing a rough draft, and developing a final draft. We then help them to prioritize which steps will need more time to complete and eventually put together a plan so they dedicate sufficient time to each section and submit a final draft on time. Many of the academic executive function tasks that we learn in school create processes and roadmaps for how to tackle life skills that require similar executive function skills. However, not all students can transfer these skills to setting goals without some direct support or help seeing the similarities in the process.

 

To learn more about Executive Function from Dr. Bellenis, join her along with Dan Levine from Engaging Minds, for a free webinar, “Executive Function in the Covid Era: Managing School and Life (Kindergarten through High School),” on March 8 at 7:00PM ET.

Register now: https://engagingmindsonline.zoom.us/webinar/register/WN_vWNlilZkS36imBqvr4IMZQ

 

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.

 

4

Neuropsychological Evaluation Results: What, When and How to Share with Children and Teens

By | NESCA Notes 2022

By: Moira Creedon, Ph.D. 
Pediatric Neuropsychologist, NESCA

During intake and feedback meetings with families, I find the same question comes up often from parents: what do I tell my child about all of this? NESCA’s Dr. Erin Gibbons gracefully tackled how to prepare your child for their neuropsychological evaluation. After an evaluation is done, you as a parent now have more than 20 pages of historical information, test descriptions, tables, summaries, and recommendations. How do you translate that information into something a child or teen will actually understand? It does not need to be a secret code or a hidden message. Feedback about a child’s strengths and weakness can be an incredibly powerful intervention.

Let’s take a page from Carol Dweck’s work and use a growth mindset to frame the experience. A growth mindset tells us that skills can be learned and neural connections can be strengthened. I advise parents to tell children and teens that testing is a chance for a “healthy check-up” for our brain and our learning, just the same way that the pediatrician performs a yearly healthy check-up for our bodies. The same way that a doctor pays attention to how all of our systems grow and interact with each other, a neuropsychologist can see how a child or teen is growing and how parts of the brain can talk to each other. I shape the dialogue right away that this kind of evaluation can tell us how strong some of the parts of our learning are, like a super strong muscle that has been exercised and practiced with gusto. The evaluation can also tell us what muscles or parts of our learning are a little weaker and need some more “exercise.” Pulling in a growth mindset, we can set the frame that any weakness can be made stronger if we have the right types of exercise, the right amount of practice, the right coaches, and a willingness to work hard. Most children and teens are pretty savvy and can often predict what their weak muscles are (e.g., “math is so hard!”; “I can’t spell!”; or “I can’t pay attention in school and I’m always in trouble for getting out of my seat!”).

Now, back to those 20-plus pages of dense text. It’s rarely helpful for a child or teen to read each page. There are parts of the normal curve, standard scores, confidence intervals, on and on that children and teens have not even learned yet! Those scores are an incredibly important source of information for schools, pediatricians, psychiatrists, therapists, and other neuropsychologists. They are not nearly as helpful when sharing information with children and teens, so do not stress about trying to translate it for kids. It is also not as helpful to have this conversation with your children when you are late for a meeting or they cannot find a soccer cleat on the way to practice. Plan your conversation for a time when your stress level is low as a parent and your child or teen is also more relaxed.

Your neuropsychologist can help you in your personal feedback meeting to identify a few important strengths to share with your child or teen – from your child’s positive attitude, to their strong decoding of new words, to their memory for things they see, to their ability to make and keep friends. With a sense of confidence about their strengths, I share what the “weaker muscle” is using language like, “I can see that word problems can be harder for you,” or “Keeping your anxious thoughts quiet when you are at school so you can concentrate on schoolwork is really hard.” Most of the time, children and teens find this validating rather than shaming – finally someone sees that their struggle is not their fault, not because their brain is wrong or bad, not because they are not trying hard enough. They just need more of the right kind of practice.

Knowing their strengths and their weaknesses, it is much easier to shape the game plan for the future. I tell children and teens that the good news is that we know what strategies can help make that weaker area even stronger. So choose your metaphor: coaches have different plays or practices, music teachers have different pieces for someone to play, artists can try out a new medium or set of supplies, or gamers practice different strategies and read tips and tricks from other gamers. By choosing a relatable experience for your child or teen in that moment, we can make the information both relevant and accessible. Your neuropsychologist can speak with you about how you as a parent can share this information with your child, or they can arrange a time to share the information directly from neuropsychologist to client. It is helpful for you to listen, too, so you can hear the language used by the neuropsychologist. Be prepared that these meetings are not very long to suit a child or teen’s attention span. Children and teens need time to process the information the same way adults do. You might expect a child to return to you a few days later with questions, or for the topic to more organically arise when your teen faces a challenge. Feedback is a unique chance for your child to feel validated, encouraged, and empowered!

 

About the Author

Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.

 

If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, please fill out and submit our online intake form. 

 

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

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