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 or call 617-658-9800.


The Benefits of Sensory-based Play

By | NESCA Notes 2021

By: Madelyn (Maddie) Girardi, OTD, OTR/L
Occupational Therapist, NESCA

The importance of play for child development

Play is considered an essential aspect of child development as it contributes to cognitive, physical, social and emotional well-being. As a pediatric occupational therapist, play is an integral part of my job. When children have opportunities to play, this allows them to build their creativity and imagination, resolve conflicts and learn self-advocacy skills. Through play, children develop new abilities that lead to enhanced confidence and resiliency, skills crucial for navigating day to day challenges. Play allows kids to practice decision-making skills, discover areas of interest and engage in passions. (Ginsburg, 2007).

 What is sensory-based play?

Sensory play can be described as any play activity that stimulates an individual’s sensory system. The sensory system includes touch (tactile), smell (olfactory), taste (gustatory), sight (visual), hearing (auditory), balance (vestibular) and movement (proprioception). Common examples include sensory bin or sandbox play, play with shaving cream, finger paint and/or food, use of a balance beam, ball pit, and/or swings, sound tubes, and so much more!

Why is sensory play beneficial?

While we know that play is a critical part of child development, incorporating a multi-sensory approach into play activities can be particularly beneficial. When activities are fun and meaningful – our senses are engaged – we learn best!

  • Promotes learning – children who engage multiple senses to accomplish a task are better able to remember and recall learned information.
  • Facilitates exploration, creativity and curiosity in children who may be seeking, or avoiding, certain types of stimuli.
  • Allows for strengthening of the brain pathways and connections that allow for efficient sensory integration.
  • Promotes self-regulation by allowing for interaction with different mediums that may be calming for the child (Educational Playcare, 2016).

What kinds of OT skills can be targeted through sensory play?

  • Sensory processing skills
  • Fine motor skills
  • Gross motor skills
  • Feeding skills
  • Body awareness
  • Motor planning
  • Visual perceptual skills
  • Communication and play skills
  • Self-regulation and coping skills


Educational Playcare. (2016, October 27). Why Sensory Play is Important for Development.,%2C%20create%2C%20investigate%20and%20explore

Ginsburg, K. R. (2007). The importance of play in promoting healthy child development and
maintaining strong parent-child bonds. Pediatrics119(1), 182-191.

To learn more about Maddie Girardi, watch this video interview between NESCA Occupational Therapists Sophie Bellenis, OTD, OTR/L, and Maddie Girardi, OTD, OTR/L.

About the Author
Madelyn (Maddie) Girardi is a Licensed Occupational Therapist in Massachusetts with experience in both school-based and outpatient pediatric settings. Maddie received her undergraduate degree in Exercise Science/Kinesiology at The College of Charleston in South Carolina and  earned her Doctorate degree in Occupational Therapy from The MGH Institute of Health Professions in Boston.

Maddie is a passionate therapist with professional interest in working with young children with neurodevelopmental disorders, fine and gross motor delays and Autism Spectrum Disorder (ASD).

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


Teens Online: Participation vs. Observation

By | NESCA Notes 2021

By Yvonne M. Asher, Ph.D. 
Pediatric Neuropsychologist

As we enter the beginning of 2021, the COVID-19 pandemic continues to shape our world. More and more, events, activities and interactions are pushed online – onto videoconferencing apps, social media and academic learning  platforms. Online social interactions are not new, and they won’t disappear anytime soon. With this, how do we, as adults, understand and navigate these oddly draining electronically-mediated gatherings, and how do we help our teens do the same?

One unique characteristic of online interaction is the ability to be present without being visible. In traditional social settings, to be present with the group is to be seen and, often times, noticed. Joining a Zoom or Google Meet offers one the ability to listen, watch and take the information presented without offering anything of yourself – no one has to see you, hear you, know where you are or know what you are doing. As many adults have noticed, this gives incredible freedom to the multi-taskers – listen to your meetings while getting the dishes done or the laundry folded.

For some adolescents, though, this is an opportunity to bypass many of the core tasks of social development, while still engaging with the material needed to accomplish one’s academic goals. A high schooler, acutely aware of how they are perceived and what others think of them, can sit silently, invisibly in social studies class. They can hone in on the economic impacts of World War I without the crushing anxiety of worrying about being teased or ostracized. However, that same high schooler may never have to confront the developmentally-expected challenges of venturing out of their “comfort zone” socially. They may not learn to ask someone out on a date, explore a new friendship or show up to the first meeting of a club.

How can we help our teens learn to take the best from online interactions while also pushing them to fully engage with others? There is no one, clear-cut answer – no “10 things…” or similar checklist. In any situation, we must look holistically at the teen, the context and the goals, and, from there, determine the best path forward. Sometimes, the anonymity of the online world is a welcome respite for teens looking to explore a new facet of their identity. Other times, it undercuts the core tasks of adolescence – building deep bonds with peers, taking responsibility for one’s social relationships and developing independence. Having direct, open conversations with our teens helps them understand and begin to own the challenges of the online world. If cameras are always off and microphones are always on mute, maybe it is time for a chat about participation versus observation.


About the Author

Dr. Yvonne M. Asher enjoys working with a wide range of children and teens, including those with autism spectrum disorder, developmental delays, learning disabilities, attention difficulties and executive functioning challenges. She often works with children whose complex profiles are not easily captured by a single label or diagnosis. She particularly enjoys working with young children and helping parents through their “first touch” with mental health care or developmental concerns.

Dr. Asher’s approach to assessment is gentle and supportive, and recognizes the importance of building rapport and trust. When working with young children, Dr. Asher incorporates play and “games” that allow children to complete standardized assessments in a fun and engaging environment.

Dr. Asher has extensive experience working in public, charter and religious schools, both as a classroom teacher and psychologist. She holds a master’s degree in education and continues to love working with educators. As a psychologist working in public schools, she gained invaluable experience with the IEP process from start to finish. She incorporates both her educational and psychological training when formulating recommendations to school teams.

Dr. Asher attended Swarthmore College and the Jewish Theological Seminary. She completed her doctoral degree at Suffolk University, where her dissertation looked at the impact of starting middle school on children’s social and emotional wellbeing. After graduating, she completed an intensive fellowship at the MGH Lurie Center for Autism, where she worked with a wide range of children, adolescents and young adults with autism and related disorders.


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 or call 617-658-9800.


To book an appointment with Dr. Yvonne Asher, please complete our Intake Form today. For more information about NESCA, please email or call 617-658-9800.


Changes in Transitioning from School-based Services to DDS Adult Services during COVID-19

By | NESCA Notes 2021

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

Transitioning from public education to adult human service supports is a complicated process that we have covered in several blogs over the years here at NESCA, including the two recent resources linked below:

As with many aspects of life, the existence of a global pandemic has complicated the transition process even more. In Massachusetts, Chapter 688 referrals (the referrals that help adult agencies to request the appropriate amount of funding from the state for supporting students with disabilities after they turn 22) were down by as much as 75% in September 2020. Additionally, referral processes that often were carried out in 2-4 months are taking much longer. In fact, at a team meeting I attended last week, a special education administrator shared that it had taken approximately 9 months to complete a recent referral to the Department of Developmental Services (DDS) for a student seeking adult autism services.

[For those unfamiliar with DDS, this is the agency that offers services and supports for individuals with intellectual and developmental disabilities including Autism Spectrum Disorder (ASD).]

To better support transitioning families, DDS recently developed an information sheet that highlights some of the potential changes and challenges families may experience when preparing for their transition to DDS adult service supports during COVID-19. In addition to modified referral timelines, the information sheet touches on changes in how families learn about day and residential programs (e.g., virtual tours) and the ways in which programs may have changed their approaches to service delivery as a result of COVID-19 (e.g., changes to community employment, remote and in-person offerings, visitor policies, etc.).

This DDS information sheet is helpful for professionals and families and is available in several languages on the state’s web site:


For families who are struggling to navigate the transition from high school to adult service support, to understand available resources and benefits during or after public education, to create an effective plan for their child during a lapse in service delivery, or with any other transition planning issues, NESCA transition consultation and planning services are here to support you. Visit our transition services page and our transition FAQs or fill out an Intake Form to schedule an appointment with one of our expert transition specialists today.


About the Author:

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

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

Literacy-based Speech Therapy: Winter Edition

By | NESCA Notes 2021

By: Abigael Gray, MS, CCC-SLP

NESCA Speech-Language Pathologist

Books are a great speech-language therapy tool. They can be used to target many different goals for a variety of ages and profiles. With books, children are given context for learning vocabulary, concepts and important story elements. Literacy-based therapy is not only more fun, but research also supports its use in teaching children with speech and language disorders:

  • Teaching story elements has been shown to improve oral language production and reading comprehension.
  • Teaching within a narrative context can make language learning less demanding, more meaningful and more authentic.
  • Students’ comprehension and story retelling/generation skills improved more with contextualized (literacy-based) intervention than decontextualized intervention.

Books can easily be incorporated into life at home, if they are not already a part of the daily routine. Just grab your or your child’s favorite book, or find a YouTube read aloud of it, and have your child help you read it! Be sure to pause throughout the book to talk about the pictures, make inferences about why events are happening and ask a few questions. Don’t be afraid to change the words to match your child’s level of understanding or interests.

My top three favorite winter books to use in speech-language therapy are:

  1. Sneezy the Snowman by Maureen Wright

A story about a cold and sneezy snowman who melts several times while trying to get warm. His human friends help him by rebuilding him and sharing their winter clothes.


YouTube Read Aloud:

Skills that I target and can be incorporated into shared book reading at home:

  • Producing subject-verb-object or complex sentences to talk about what is happening.
  • Predicting what will happen before and throughout reading (e.g., “Sneezy is drinking hot chocolate, what do you think will happen?”).
  • Answering detail (what, where, who, when) and inferential (why) questions.
  • Discussing story parts (e.g., characters, setting, problem, solution) and retelling the story.
  • Writing using different prompts, such as “My snowman melted because…” or “When I’m cold, I…”.
  1. The Mitten by Jan Brett

A traditional story about a boy whose grandmother knits him new mittens. He loses one mitten when he is outside playing, and many different animals climb inside to stay warm.


YouTube Read Aloud:

Skills that I target and can be incorporated into shared book reading at home:

  • Sequencing events by talking about the order of animals that climbed into the mitten.
  • Creating a craft by printing a mitten and animals, coloring the animals and putting them inside the mitten as you retell the story.
  • Watching a different rendition of The Mitten on and comparing and contrasting the two stories using a Venn diagram.
  • Producing past tense verbs to describe what happened.
  • Making inferences about characters’ emotions and motivations.
  1. The Snowy Day by Ezra Jack Keats

A Caldecott Medal-winning book about a boy’s adventures in the snow when he puts on his snowsuit and goes outside to play.


YouTube Read Aloud:

Skills that I target and can be incorporated into shared book reading at home:

  • Telling an original story together by covering up the words on the pages.
  • Finding words that contain the child’s target speech sound (i.e., if your child is working on producing the “R” sound, find all the words that contain “R” and practice those).
  • Describing character traits of Peter, the main character.
  • Discussing cause and effect (e.g., cause: Peter smacked a snow-covered tree, effect: snow fell on Peter’s head).
  • Writing using different prompts, such as “On a snowy day, I like to…” or “I can save a snowball by…”.



Davies, P., Shanks, B., & Davies, K. (2004). Improving narrative skills in young children with delayed language development. Educational Review, 56, 271 – 286.

Gillam, S. L., Gillam, R. B., & Reece, K. (2012). Language outcomes of contextualized and decontextualized language intervention: results of an early efficacy study. Language, speech, and hearing services in schools43(3), 276–291.

Tomasello, M. (2003). Constructing a language. A usage-based theory of language acquisition. Cambridge, MA: Harvard University Press


About the Author

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




To book an appointment or to learn more about NESCA’s Speech & Language Therapy, please fill out our online Intake Form, email NESCA’s Director of Clinical Services Julie Robinson 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 or call 617-658-9800.


When Gaming Is No Longer A Game

By | NESCA Notes 2021

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist and Therapist

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

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

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

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

Some helpful resources include:


About the Author

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


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


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


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

By | NESCA Notes 2021

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

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

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

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

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

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

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

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

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

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

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

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

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


About the Author

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


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


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


The Intention to Thrive

By | NESCA Notes 2021

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

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

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

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

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

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

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

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


About the Author: 

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

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

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

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

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

Teletherapy at NESCA – Benefits and How It Works

By | NESCA Notes 2021

By: Julie Robinson, OT

Director of Clinical Services; Occupational Therapist, NESCA

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

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

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

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

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

How a teletherapy session works

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

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

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

About the Author

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

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