To accommodate requests for neuropsychological evaluations after the start of the new school year, NESCA has added evaluation dates in its Newton, MA office. Immediate openings are now available for scheduling. Please complete our Inquiry/Intake Form for more information or to start the scheduling process.

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4

When No One Looks Like Me

By | NESCA Notes 2020

By:  Stephanie Monaghan-Blout, Psy.D.

Coordinator of Therapy Services; Trauma-informed Therapist; Pediatric Neuropsychologist

We form our sense of identity by “trying on” aspects of other people to see how their ideas, tastes and values “fit,” keeping those things that seem to resonate and discarding those that don’t. We find those models for identification in our families, schools and community. We also find those sources in the books we read, the news we catch and the movies we see – the larger community in which we live. This larger community offers many models who may offer something that resonates with us.

This process of identification is complicated in adoptive children whose connection to their families is through relation and not genes. The challenges are even more torturous when those issues are coupled with the “othering” that occurs when a child does not fit into the American standard of being white. In my neuropsychological practice assessing adoptive children, my own little bubble of white privilege has been pricked many times by a child saying, sometimes to me or sometimes through their parent, that “no one looks like me.” The loneliness of this statement is palpable, but the cost goes beyond to indicate impediments to the healthy development of identity, which includes that of racial identity.

In an article for Time Magazine written by the parent of a transracially adopted child and with the help of adoptees and their parents, the following four “comforting but dangerous” myths about race and difference were identified:

Myth 1: Color doesn’t matter. Oh, but it does; just ask the child who has been called the “N” word or the one who is assumed to be a math whiz because they are Asian. Adopted children who are raised by a Caucasian family and in a Caucasian community will tend to think of themselves as white – sort of – until they hit the wall of the way others perceive them. People have expectations about others based on race and ethnicity and insisting that people “should” be colorblind is ignoring reality. It leaves no room for the child to ask questions about what makes them the person that they are and prevents the parent from giving them what they most need – a caring listener when they are hurt or confused.

Myth 2: If I talk to my kids about race, I’m just creating an issue. As parents, we cannot protect our children from the verbal and physical assaults of others, but we can prepare them for how to handle it if it happens. One adoptee and current adoption advocate asks parents if they would not teach their children how to safely cross a street because they may become frightened of being hit by a car. This includes having “the talk” with our African American boys about how to handle themselves with police officers and other authority figures.

Myth 3: No matter what, a “good” school is best for my child. This is the source of the “No one looks like me” plaint of many of my clients but it is the toughest of all myths to unpack for most white parents to whom education has been touted as pretty much the solution for everything. A “good school” may be the one with high test scores and good real estate value, but it is unlikely to be the school with a diverse student and teacher population that could provide a non-white child with a rich source of role models and narratives to use in the development of their own identity. Other sources of identification include churches, community groups and cultural organizations, such as language schools and adoptive family groups. Lacking these sources, the child’s options for racial identity are determined by those who know nothing about their culture.

Myth 4: You are the hero of your child’s story. As someone who has heard many terrible and tragic origin stories and stood in awe of the efforts adoptive parents have made to help their children, I have often been guilty of encouraging this kind of thinking without considering the consequence to the child who has been rescued. The burden of “forced gratitude” is emotionally crippling and prevents the child from asking questions about their biological parents or fantasizing (in the way that all children do) about what it would have been like to be in a different family. Conversely, the concept of “saving” a child feeds into the parental fantasy that if we just love our child enough and do all the right things, we can protect them from being hurt by the loss of adoption and the ugly reality of racism. This is also an ultimately futile effort. As Martha Crawford, psychotherapist and mother of two transracially adopted children, stated, “An adoptive parent’s job is to be a sturdy scaffold for kids to do their own work, not to tell them how to construct their own identities.”

 

About the Author:

Dr. Stephanie Monaghan-Blout is a senior clinician who joined NESCA at its inception in 2007. She specializes in the neuropsychological and psychological assessment of children and adolescents with complex learning and emotional issues and enjoys consulting to schools on these issues. Her responsibilities at NESCA also include acting as Clinical Coordinator, overseeing therapeutic services, providing therapy and psychoeducational counseling and, in the time of the COVID-19 crisis, providing teletherapy to parents and teens.

In her early career as an adolescent and family therapist, Dr. Monaghan-Blout became very interested in the needs of those contending with traumatic experiences. She brought that interest to her work as a pediatric neuropsychologist and continues to be passionate about treating this population. She has developed an expertise in working with adoptive children and others who have experienced early trauma. She is a longtime member of the Trauma and Learning Policy Initiative (TLPI) associated with Massachusetts Advocates for Children and the Harvard Law Clinic and presents nationally and regionally on assessment and treatment of children with complex/developmental trauma.

Dr. Monaghan-Blout graduated from Bowdoin College and received a Master’s Degree in Counselor Education from Boston University. She obtained her Doctorate in Clinical Psychology from Antioch New England Graduate School with a dissertation entitled, “A Different Kind of Parent; Resisting the Intergenerational Legacy of Maltreatment.” She completed an internship in pediatric neuropsychology and child psychology at North Shore University Hospital in New York, and a postdoctoral fellowship at HealthSouth/Braintree Rehabilitation Hospital.

She joined Dr. Ann Helmus at Children’s Evaluation Center in 2003, and again at NESCA in 2007. A member of the Massachusetts Neuropsychological Society Board of Directors from 2010 – 2013 and from 2014-2017, Dr. Monaghan-Blout served in many capacities, including as President. Dr. Monaghan-Blout is the mother and stepmother of four children and the grandmother of six. She is also an avid ice hockey player, cook, gardener and devotee of urban fantasy.

 

To book therapy services with Dr. Monaghan-Blout or 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.

150

Movement Breaks – Part 2

By | NESCA Notes 2020

By: Julie Robinson, OT

Director of Clinical Services; Occupational Therapist, NESCA

In our last blog, we delved into ideas and suggestions to help preschoolers stay on track with remote and hybrid learning through movement breaks. In this week’s OT Tuesday blog, we move up to our elementary school-aged kids. How do we keep them focused on online learning throughout their long days at home in front of a computer?

Again, here are some suggestions that require minimal equipment, generally using things you can find around your home.

 

Gross Motor for Elementary-age Children

A movement break for 5- to 10-minutes every hour and a half to 2 hours is recommended.

Hopscotch – Draw with chalk or use painter’s tape and play this old school game! Begin by throwing a beanie baby, rock or bean bag so it lands in the first square. Hop over it and jump on all the other squares. At the end, turn around and come back and try to pick up the object while trying to balance on one foot! The next time, throw the object to square 2 and repeat through all the numbers!

 

Photo Credit: sciencebuddies.org

Homemade Hockey Sticks – Use a long wrapping paper roll or tape together paper towel rolls as the handle. Cut a long strip of cardboard and tape to the handle or use an old plastic water bottle. Enjoy playing this game with a balloon or tennis ball. Mark goals with tape, chalk or use empty cardboard boxes.

 

Stack the Cardboard Boxes – Got empty boxes? Have the child stack them up high and knock them over by running into them, or rolling/kicking a soccer ball into them. To make it a little silly, place a tennis ball in the leg of a pair of stockings and the waistband over your child’s head. Use the tennis ball to knock over boxes or cans, with their head upside down.

 

Photo Credit: Hands On As We Grow®

Stair Bean Bag Toss – Try to get bean bags to land on different steps. More points for the higher they land!

 

Tic Tac Toe – Make a big board with sidewalk chalk or painter’s tape. Use bean bags, frisbees, paper plates or crumpled up paper and throw into boxes for a fun spin. Get creative with items around the house – even food!

 

Photo Credit: OT Plan

Belly Catch – Have your child lay on their belly with feet or legs resting on a couch and hands on the floor (plank style). Roll balls or balloons and have them play catch with you, a great exercise to work on core and upper extremity strength.

 

 

 Fine Motor for Elementary-age Children

Photo Credit: Hoglets.org

Monster Feet – Grab some old tissue boxes or cardboard and make your own monster feet. Decorate the toe nails with markers, pom poms or however else you’d like! For an added challenge, try wearing them by using string to tie the child’s feet to them. Or tape their shoes to them and walk around like a monster!

 
Photo Credit: kidsactivitiesblog.com

Homemade Tennis Racquets – Cut slits in a paper plate or punch holes. String yarn through the holes and attach to a paper towel roll, spatula or wooden spoon/popsicle stick. Use it to keep a ball or balloon in the air!

 

Hangman! – Or for an added twist, play Melting snowman! Draw a snowman, and each time someone guesses a letter incorrectly, erase a part of the snowman until he is fully melted!

 

Make Your Own Quicksand – Mix roughly equal parts cornstarch and play sand. Add water until it is the desired consistency.

●       If you don’t have play sand, add 1 cup of water to a bowl and slowly add 1-½ cup of cornstarch and stir.

●       Put toys into quicksand and watch them sink!

 

Paint Pinecones – As the weather gets colder, collect some pine cones or rocks and paint them! Make kindness rocks by writing messages on them with a Sharpie. Leave them out along a wooded trail for others to find.

 

 

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, 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.

 

5

The Holiday Blues Coupled with Covid

By | NESCA Notes 2020

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

The holidays can be a time of great joy, but they can also be a time of great stress. Celebrations and merriment can be contrasted with pressure to amaze, long to-do lists, financial constraints or reminders of those we have lost. For many, it is a time of mixed emotions or strong internal conflict about why they cannot feel happy during a season that practically dictates it.

Holiday blues have been felt my many people for a long time, but now during a global pandemic, those feelings may be amplified and more prevalent than previous years. Families are trying to provide children with a positive holiday experience during a time of high stress and significant restriction. Family gatherings and holiday traditions are being cancelled, and many families are mourning the loss of loved ones. Adults are not the only ones feeling increased stress as we enter the holiday season. Children likely feel excited about the holiday but sad about not seeing family, not having holiday parties in school, and not being able to attend their traditional holiday events. This holiday season is simply different in ways that can bring great strain.

So, what can we do as adults to emotionally support children this holiday season? Do we allow them to observe our stress or do we keep it to ourselves in an effort to provide them with the happy holiday season that they deserve?

In June 2018, I wrote a blog post titled: “The Struggle is Not only Real, It is Necessary,” which discusses the importance of embracing uncomfortable, unwanted emotions as being necessary for personal growth and resiliency. By acknowledging, accepting and using unwanted feelings in a functional manner, we teach children to be competent and confident in their ability to navigate a stressful world. Of course, when I wrote the article, I could not have imagined the extent or duration of stress or discomfort that we would be facing in 2020. But does that change anything?

To put it simply, no, not really. Entering into the holidays with the expectation that we can protect our children from life’s stress is unrealistic. Attempting to do so will only add pressure while ignoring the mixed emotions that children are likely feeling as well. During this emotionally high-stakes time, acceptance of the struggles we face is even more critical. Adults and children both need “permission” to feel sad, frustrated, lonely or scared while also still allowing themselves to feel excited, thankful, and, yes, even joyful.

Here are some suggestions for how to help your family navigate the holiday blues this unique holiday season:

  • Talk about your feelings – wanted and unwanted ones – throughout the day, modeling and encouraging regular emotional discourse (e.g. “I love giving gifts, but getting all the shopping done is kind of stressful.”).
  • Help children label and interpret the emotions they may be having, as they may not have the right words or language for expressing them (e.g. “It sounds like you’re really disappointed we can’t go to Grandma’s house.”).
  • Be careful to not accidentally dismiss children’s feelings (e.g. “No need to be sad; we will find another fun way to celebrate.”), instead reflecting their emotion (e.g. “I know you’re sad that we can’t have a holiday party; I am, too.”).
  • Normalize the experience of mixed emotions (e.g. It’s okay to be excited for children while also feeling sad that we won’t see our family.).
  • Find new, safe holiday activities or events (e.g. holiday light drive, virtual gift exchange, etc.) and adapt previous traditions when able (e.g. virtual family gatherings).
  • Don’t romanticize the traditions that were lost this year (e.g. avoid such things as, “Our parties were always the most magical part of the holiday.”).
  • Help children understand new holiday plans as an opportunity to “celebrate” or “experience” the holiday, but be careful to not impose emotional expectations (e.g. “Enjoy the holidays!”) that can add pressure.
  • Reassure children that these changes are temporary, and traditions and visits will continue when it is safe to do so.

 

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.

9

Transition Planning for Adulthood—It Starts at Birth

By | NESCA Notes 2019

 

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

There are many transitions throughout a person’s life, but as a transition specialist working at a pediatric neuropsychology practice, my focus is most often on helping students who have struggled with learning, social and/or emotional difficulties to plan for and successfully navigate the transition from secondary school to whatever comes next in life (e.g., employment, transition program, community college, apprenticeship, etc.). I focus on helping young people envision their future selves and set short- and long-term goals for themselves—putting them into the driver’s seat for their own lives and helping them manage the risks and responsibilities that come with making choices for themselves.

When a family walks into my office for the first time, it is common for one parent or caretaker to worry aloud that they are starting transition planning for their child “too late.” I consistently respond that it is never too late to start planning and to begin transferring responsibility from one generation to the next. But today, I also want to emphasize that “it’s never too early” to start to plan for your child to be a more independent and competent adult—the best transition planning starts at birth.

Some common examples of transitions that start at a very early age that many parents and caregivers can relate to are: a child sleeping through the night for the first time unsupported, holding a cup and drinking without spilling, feeding oneself with a spoon, and/or riding a bicycle. Each of these activities is an example of a child building competence and independence while their parents simultaneously relinquish some amount of control. Often times, mistakes, messes and even pain are a natural part of the process.

From a young age, there are many skills that children can learn that will make a big difference for them later in life. Some examples include:

  • Picking out clothes for the next morning
  • Putting dirty clothes in a hamper
  • Loading the washing machine
  • Putting clean clothes away in drawers
  • Washing hands before eating, after using the bathroom and after playing outside
  • Setting the table (maybe not plates or glasses, but perhaps napkins, forks and spoons)
  • Carrying dishes to the counter and placing them next to the sink after dinner—or even in the dishwasher
  • Putting their own garbage in the trash
  • Collecting small trash bins to dump into a larger bin/bag on trash day
  • Helping to pack their own lunch
  • Helping to prep a meal (e.g., washing veggies, pouring ingredients, etc.)
  • Getting condiments from the refrigerator and putting them away after dinner
  • Getting a snack for self or a sibling from the refrigerator or pantry
  • Wiping down the table after a meal
  • Feeding/providing water for pets
  • Weeding
  • Raking leaves
  • Shoveling snow
  • Helping to get the mail
  • Brainstorming for/making a shopping list
  • Finding assigned items at the grocery store
  • Carrying light grocery bags
  • Helping to pack belongings for a family trip
  • Making gifts/cards for a celebration
  • Budgeting a few dollars to buy inexpensive but thoughtful gifts for family members

Some of these will apply to your child and some of them will not. And some of these may require adding time to your schedule, allowing a child to complete tasks at their own pace, or doing some household reorganization, allowing a child to access items necessary to complete tasks. Finally, a lot of deep breathing and patience—for both you and your child—will be required!

At any point in time, you can identify a task  you regularly do for your child and consider where there are pieces they can do for themselves. If your only role in the task is to prompt your child, consider whether there might be a low-technology tool (post-it, photograph) or high-technology tool (alarm, phone reminder) that could take the place of your prompt. If you are not sure how to make a change, it may be a good time to get help from a teacher, pediatrician, behavioral therapist, special educator, etc.

The important thing is that you are starting to think about where there is a potential for increasing competence, independence, confidence and self-esteem for your child. You are starting to plan for your own obsolescence in your child’s life, or at least in their carrying out every day self-care activities and chores. While that is a scary thing, it is also a beautiful and empowering thing!

*This blog was originally published in August, 2019.

 

If you are interested in working with a transition specialist at NESCA for consultation, planning or evaluation, please complete our online intake form: https://nesca-newton.com/intake-form/.

 

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 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 seven and eleven. 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 or call 617-658-9800.

 

2

Early Detection of Autism: NESCA’s New ASD Diagnostic Clinic

By | NESCA Notes 2020

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

Children with autism spectrum disorder (ASD) vary widely in terms of the intensity of their symptoms as well as the age at which symptoms emerge. In some cases, signs of autism are apparent during infancy. For other children, concerns about autism might not arise until toddlerhood or even early childhood.

As neuropsychologists, we have become increasingly adept at detecting and diagnosing ASD using a combination of developmental history, clinical observation and standardized assessments. We are constantly learning more about ASD and fine-tuning the tools we have available to us to make a diagnosis.

One of the most important things we have learned through longitudinal research over the past 10 years is that early detection of ASD is a crucial part of a child’s prognosis. Young children who receive intensive services are much more likely to develop language, play and social skills. Because their brains are still in a state of rapid development, they are much quicker to acquire new skills and make progress in the areas where they are struggling. Children who receive early intervention for ASD are typically better able to participate in inclusion settings with same-age peers once they enter elementary school.

Unfortunately, many parents are told to “wait and see” when they express concerns about their child’s development – especially with children who are not yet in preschool. This is a risky and sometimes harmful approach as it leads to children with developmental disabilities not receiving the services they need.

In light of our understanding about the importance of early detection of ASD, NESCA is proud to introduce its ASD Diagnostic Clinic. The clinic offers testing that is targeted specifically at identifying ASD in children between the ages of 2 and 5. For children who do receive a diagnosis of ASD, the report will allow parents to start accessing services immediately. As with all of our families, we hope to establish a lifelong relationship and will be available for follow-up consults and additional evaluations at any time.

 

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.

150

Movement Breaks – Part 1

By | NESCA Notes 2020

By: Julie Robinson, OT

Director of Clinical Services; Occupational Therapist, NESCA

Many parents are overwhelmed, juggling homeschooling, childcare and work from home. And now that the cold weather has arrived, many parents are looking for activities they can do indoors with their children as movement breaks to support online learning or just to pass some time and get the wiggles out. Here are some suggestions that require minimal equipment, generally using things you can find around your home.

In this week’s OT Tuesday blog, we provide suggestions on both gross and fine motor activities for preschoolers. In our second part of the blog series, we will offer ideas to target fine and gross motor activities for elementary school-age students during movement breaks.

 

Gross Motor Activities for Preschoolers

A 5- to 10-minute movement break is suggested every hour to hour and a half for children in this age group.

Balloon Games – Blow up and see how many times your child can hit the balloon in the air! Use a fly swatter or tennis/badminton racquet to mix it up a little.
Mazes – Use painter’s tape indoors or sidewalk chalk outdoors in the driveway to make mazes for your child to follow. You can even use the lines as a balance beam for added balance practice, draw feet to jump in, make curly lines to indicate twirling around, etc.! If you are looking for ideas, research sensory paths online. You can also draw crazy roads for toy cars or ride-on toys.
Bowling – Fill up old plastic water or soda bottles and have kids knock them over by rolling a ball towards them! You can add stuffed animals on top to make it more enticing.
The Floor Is Lava – Pretend the floor is lava and have the child walk around without touching the ground by walking on pillows and other objects!
Shape Games – Draw shapes, letters or numbers with sidewalk chalk or painter’s tape and try throwing stuffed animals into the shapes an adult calls out. Make it more challenging by increasing the number of shapes, throwing from further away or trying to balance on one foot while throwing.

 

Fine Motor Activities for Preschoolers

Hide Beads In Playdough! – Grab some putty or playdough and hide beads in it. Once all the beads are hidden, encourage your child to try to get them out! This is a great exercise to work on hand strength. It can also be fun to put raw spaghetti into the dough and “string” the beads onto them for working on fine motor precision.
Make Your Own Stamps! – Use household items, such as wine corks, water bottle caps, toilet paper rolls or anything else you can find. Dip them in paint and press onto paper. Enjoy the different shapes you create! For picky eaters, it can be fun to use foods, such as applesauce, yogurt or dips for paint.
Clothespin Activities – Use clothespins to pick up pom poms and put them in containers, such as an ice cube tray. This is a great activity for practicing a tripod grasp.
Shaving Cream Play – Use a tray or large plate and put shaving cream or other messy play materials on it. Allow your child to practice writing their letters with their fingers and have fun with it! To simplify, you can encourage your child to imitate shapes, letters or numbers after you have written them.
Noodle Necklaces – String noodles onto string to make a noodle necklace. Use noodles and put on a string or a pipe cleaner to make a necklace. Color or paint noodles, or soak cooked noodles in food coloring and allow them to dry for more interesting patterns.

 

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, 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.

 

3

Good Night, Sleep Tight: What if I Can’t Sleep Right?

By | NESCA Notes 2020

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

The American Psychological Association recently issued a press release about the impact of the COVID-19 pandemic on our dreaming. Not surprisingly, the information in four published articles indicates that people are having more anxious dreams now. This seems obvious given the emotional toll and high levels of stress as everyone juggles work, virtual school, health and safety, and family needs in a pandemic. We have an overflowing plate of stress on our hands with distant notions of when this stress will end. While these articles describe the anxious dreaming and sleep of adults, it’s not a stretch to consider that children and teens may have disrupted sleep right now. Their plates are overflowing, too, as they manage virtual and hybrid learning, confusing social demands, less movement and exercise than usual, and less contact with both adults and kids.

We cannot underestimate the importance of sleep to our system. Sleep is when our body restores itself, builds important immune functions and consolidates memories and learning. When children do not get enough sleep, we can see a whole host of problems, including issues with attention, concentration, learning, irritability, poor emotion regulation and risky behaviors in addition to the physical health outcomes.

What do we do to help our kids and teens get more and better sleep? It’s time to get sleep hygiene back on track. It’s possible to do even if the pandemic has caused the norm to drastically shift. Here are some tips for promoting sleep for children and teens:

Establish a consistent schedule. I cannot emphasize this one enough. Establish consistent times for settling down for bed and waking up that are the same every day of the week. Try to stick to this schedule whether your child is having an in-person learning day or remote, whether it is a weekend or weekday. This can be tricky with teenagers who tend to sleep in on weekend days. Try to stick within an hour, if possible, to get your body on a more consistent schedule. Avoid naps during the day if you can, even if there has been a rough night of sleep (or limit naps to less than 30 minutes). Daytime napping can interrupt night sleep patterns.

Develop a routine to settle for bed. Children and teens need to settle down for bed gradually. We can’t go from wide awake to peaceful slumber in a few moments. Limit screen time 30 minutes before bed as the light that is given off by televisions, phones or other devices confuses our systems and causes delays in releasing melatonin (the magic sleep hormone). Choose the same relaxing activity each night. Children and teens can read (or listen to a story read aloud by a parent), listen to an audiobook, color in special coloring book, listen to music or a podcast, or take a warm bath or shower. Include your child or teen in conversations about what relaxing activity to try before bed. Keep the same activity for several weeks before trying other ones. The brain does not want variety when you are trying to settle for bed, or it can become more alert in the face of a novel activity. The routine promotes relaxation.

Schedule talk time. Children and teens tend to think about their day as they are laying down. This can lead to “just one more thing” that kids have to tell us or one more question. They can also anticipate what is happening next, which can lead to an increase in anxiety. Schedule a “talk time” with your child or teen to discuss the day and think ahead to tomorrow. Do this at least 30 minutes before bedtime (ideally closer to dinnertime) to avoid a lengthy conversation that can activate anxiety. Use this time to validate feelings and model problem-solving about any issues coming up.

Provide comfort after dreams. We can expect that everyone may wake up at some point after an anxiety dream. If we can predict it, it can make it feel less overwhelming. Teach children and teens what to do when they wake up feeling anxious, including seeking the support of their parent for the very upsetting ones. Offer comfort and a tuck back into bed. Encourage your child to talk about how to resolve the frightening dream in a way that is silly, funny or triumphant to shift the focus away from what felt upsetting. Have a scary dream about a monster? Imagine him having to perform a ballet while balancing hot sauce on his head. Have an anxiety dream about a teacher yelling at you for forgetting your homework? Imagine turning it in and your teacher leading the rest of class in a celebratory song. You can also encourage children or teens to think of their favorite movie or book, and ask them to close their eyes and replay the movie or book to refocus the mind.

Practice breathing. To soothe our overactive anxiety systems, practice taking deep breaths. Imagine your breath filling up the back of your lungs and visualize the air going through your body. Practice circle breathing where air comes in one nostril and out the other (of course it comes in and goes out both!).  With younger kids, a little modeling helps. You can also encourage kids and teens to tense different parts of their body, hold for a count of 10, and then release to feel more relaxed.

Reach out for help. If your child or teen has persistent trouble with sleep, contact your pediatrician. It may be time for a more thorough evaluation to rule out sleep disorders, medical causes or behavioral patterns that signal a bigger sleep problem.

 

For more information, please check out these resources:

American Psychological Association (APA) press release related to dreaming:  https://www.apa.org/news/press/releases/2020/09/upsetting-dreams-covid-19

Fantastic APA resource on sleep: https://www.apa.org/monitor/2020/07/ce-corner-sleep

What To Do When You Dread Your Bed: A Kid’s Guide to Overcoming Problems with Sleep (2008) by Dawn Huebner, Ph.D.

 

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.

11

Building Gratitude in our Kids

By | NESCA Notes 2020

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

Would it be November without a blog post about gratitude? Gratitude feels both more important and harder to come by this year with the slew of events bombarding people’s personal lives and something different appearing what feels like every news cycle. But there must be something to all this gratitude if everyone from Forbes Magazine to Psychology Today is writing about it?

So what does the science say?

Basically, gratitude makes us happier and healthier. Being grateful and expressing gratitude can increase our social circle and have others be more willing to seek you out. Gratitude also seems to improve not only mental health but physical health as well. Studies show that grateful people take care of themselves better. They are more likely to exercise and more likely to follow up with medical personal. Studies show that writing in a gratitude journal before bed can even help you sleep better! (Morin, n.d.)

How can I help my child build gratitude?

Young people with disabilities, especially speech and language challenges, may have a hard time sharing their experiences at the end of the school day. Before my students left for the day, I would always ask them to go around the room and share one thing they enjoyed during their day. This way, no matter how challenging the day was, they ended it on a good note. Over time, the students began to look forward to sharing a positive experience from their day. Whether it was getting a compliment at their worksite or overcoming a challenge, they began to go looking for the positives.

Another wonderful way to build gratitude is to turn it into a scavenger hunt. Give each day a topic and share your gratitude topic at dinner. 

While we often think of a gratitude journal as something written, it doesn’t have to be. Have fun with it! Instead of writing down what you are thankful for today, take a picture with your phone or have your child make a drawing relating to the topic. Pinterest is full of great ideas, like the image below. Doing this for a month may turn you and your child a little more gleeful and find a brighter outlook on tomorrow.

Image Credit: Woman of Purpose (thepurposedwomanmag.com)

What are you grateful for today?

 

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 info@nesca-newton.com or call 617-658-9800.

 

150

Getting Through Thanksgiving Day

By | NESCA Notes 2020

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

Occupational Therapist, NESCA

Setting Expectations

Thanksgiving may be different this year, but it can still be a long day full of sensory stimulation, new social interactions and possibly unfamiliar faces and experiences. By providing clear expectations, this can help prepare the child for upcoming events, minimize surprises and set the child up for success. Talk openly about events, review pictures of anticipated people/events, and/or watch a video describing an experience beforehand. Use a calendar or visual schedule at home to display the sequence of upcoming holiday events. A social story is a great tool to prep the child for the day (Lewis, 2016).

Open Communication – Being transparent with family members/friends can allow for greater understanding and a more positive experience for those involved. Help those present understand if there are certain obstacles/triggers that can be avoided, or if there are particular tools/language that can be incorporated throughout the day (Lewis, 2016).

Devotion of Time – For parents, we know that much of Thanksgiving is devoted to cooking and meal preparation. Make sure to communicate with family members beforehand about the plan for the day. Will there be other children or adults around to play with the child, or should my child be expected to play independently if I am occupied? If so, have a few preferred toys/activities accessible. Or involve the child in the meal preparation process as appropriate.

Consider the Environment

How will your family be celebrating Thanksgiving or other holidays this year – in-person or virtually?

In-person – Festivities this year may take place with modifications. Will it be less crowded this year? Will events be taking place in a different set-up this year (outside, in the garage, socially distanced)? If so, prepare your child by communicating expected changes beforehand.

  • Is my child expected to wear a mask or keep a distance from others? If so, use a social story or designate a “code word” to act as a reminder for proper mask/social distancing etiquette. Allow the child to practice wearing a mask beforehand. Model expected behavior (Lewis, 2016). Provide mask breaks as appropriate.

Virtually – With current social distancing guidelines, Thanksgiving interactions may instead take place virtually. If possible, it can be helpful to make children aware of this change beforehand. Many children may experience difficulty attending to a Zoom call. Here are some tips to help:

  • Provide a tool to help with heightened arousal: fidget toy, squeeze ball, putty, fidget band (at feet), chewing gum/oral tool, etc.
  • Consider the environment: Eliminate distractions as much as possible (visual plus auditory), ensure adequate lighting and proper seating, etc.
  • Rehearse events beforehand, identifying potential “rough spots” and positive coping strategies (Lewis, 2016). Proactively establish talking points if helpful.
  • Establish guidelines for both the beginning and end of a videocall. Use a timer if necessary.

Sensory Environment – Thanksgiving Day will likely be full of stimulation for the senses: sight, smell, touch, sound and taste.

  • Food sensitivity: Many children may experience sensitivities to food textures, tastes or smells. Ensure access to “safe,” or preferred foods beyond traditional Thanksgiving dishes. If attending a celebration outside of the home, make sure to pack a few options for meals/snacks. For children who experience sensitivity to smell, consider bringing a comfortable nose plug.
  • Sensory overload: Ensure access to calming tools in the case that overstimulation, or sensory overload, occurs. Some options include a weighted or compression vest/blanket, chewy, squeeze ball, pushing/pulling activities, noise canceling headphones or a mini trampoline for a movement break. Create a calming jar with the child beforehand. Ensure that the child has a safe space they can go to, such as a dark, quiet room, when feeling overwhelmed. For children who may experience challenges self-regulating, help to guide the child in identifying states of arousal before a meltdown occurs. Use visuals as needed.

 

References

Lewis, K. S. (2016). Full Inclusion Holidays: An SLP offers tips to prepare clients for a season full of social and sensory stimuli—and people who may not understand their communication and behavioral challenges. The ASHA Leader, 21(12), 52-56.

 

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 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.

 

21

Key Facts about Early Diagnosis of Autism Spectrum Disorder (ASD)

By | NESCA Notes 2020

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

Early diagnosis is a catalyst for propelling children on positive trajectories. If a family and child identify and focus on areas of growth earlier rather than later, there is more time and more possibility of change and improvement. This tenant is particularly critical for diagnosing ASD in toddlerhood and early childhood.

Here are critical facts about the diagnosis of ASD in early childhood and the positive impact of early diagnosis on youngsters as they age into adulthood.

  1. Most children with ASD are not diagnosed until approximately 4 years-old, yet ASD can be reliably identified by the age of 2. There is also expanding research on early identification of infants who may be at risk for ASD. Early detection is possible.
  2. Genes play an important role in ASD. A child’s odds of having an ASD diagnosis increases if he/she has a sibling or parent with ASD, attention deficit hyperactivity disorder (ADHD), intellectual disability, schizophrenia, depression, bipolar disorder or anxiety. Family medical history is an important factor for families considering a diagnostic evaluation.
  3. Co-occurring disorders (such as anxiety and depression) are more likely in individuals with ASD than the general population. Identifying emotion regulation issues in early childhood is thus essential.
  4. Neuroplasticity matters. Because ASD is a neurodevelopmental disorder, early treatment improves neuroplastic brain functioning and subsequent behavior. As a child develops, his/her brain becomes less plastic.
  5. Interventions geared at a child’s “first relationships” with their caregivers may exert a strong positive effect on the developmental trajectories of toddlers at high-risk of ASD and also have a positive impact on a child’s social skills with peers as they age.
  6. Research indicates that parent-child interactions in early childhood predict long-term gains in language skills into adulthood for individuals with diagnoses of ASD. Acquiring communicative, pragmatic and useful language by kindergarten has also been identified as a strong predictor of adaptive or functional “real life” skills, which are needed to navigate the environment in adolescence and adulthood.
  7. Social skills instruction in a child’s early years increases competency with peers in school. This social competency is associated with greater adaptive independence in children with ASD.
  8. Working with a “diagnostic navigator” early in your child’s life improves outcomes. Research clearly indicates that social support is vital to relieve stress associated with caregiving for a child with ASD and that a positive parent–professional relationship is helpful in alleviating family stress.

If you suspect your child has or is at higher risk for ASD and you are looking for a “diagnostic navigator” for your child, consider an evaluation with NESCA.  While early diagnosis of ASD can make a positive impact on a child’s trajectory, obtaining the accurate diagnosis and recommendations for interventions at any age is critical.

 

References:

Elder JH, Kreider CM, Brasher SN, Ansell M. Clinical impact of early diagnosis of autism on the prognosis and parent-child relationships. Psychol Res Behav Manag. 2017;10:283-292. Published 2017 Aug 24. doi:10.2147/PRBM.S117499.

Dawson G, Jones EJ, Merkle K, Venema K, Lowy R, Faja S, Kamara D, Murias M, Greenson J, Winter J, Smith M, Rogers SJ, Webb SJ. Early behavioral intervention is associated with normalized brain activity in young children with autism. J Am Acad Child Adolesc Psychiatry. 2012 Nov;51(11):1150-9. doi: 10.1016/j.jaac.2012.08.018. PMID: 23101741; PMCID: PMC3607427.

Jokiranta-Olkoniemi E, Cheslack-Postava K, Sucksdorff D, Suominen A, Gyllenberg D, Chudal R, Leivonen S, Gissler M, Brown AS, Sourander A. Risk of Psychiatric and Neurodevelopmental Disorders Among Siblings of Probands With Autism Spectrum Disorders. JAMA Psychiatry. 2016 Jun 1;73(6):622-9. doi: 10.1001/jamapsychiatry.2016.0495. PMID: 27145529.

Kasari C, Siller M, Huynh LN, Shih W, Swanson M, Hellemann GS, Sugar CA. Randomized controlled trial of parental responsiveness intervention for toddlers at high risk for autism. Infant Behav Dev. 2014 Nov;37(4):711-21. doi: 10.1016/j.infbeh.2014.08.007. Epub 2014 Sep 26. PMID: 25260191; PMCID: PMC4355997.

Mayo, J., Chlebowski, C., Fein, D.A. et al. Age of First Words Predicts Cognitive Ability and Adaptive Skills in Children with ASD. J Autism Dev Disord 43, 253–264 (2013). https://doi.org/10.1007/s10803-012-1558-0.

Siller, M., Swanson, M., Gerber, A., Hutman, T., & Sigman, M. (2014). A parent-mediated intervention that targets responsive parental behaviors increases attachment behaviors in children with ASD: results from a randomized clinical trial. Journal of Autism and Developmental Disorders, 44(7), 1720-1732.

Xie S, Karlsson H, Dalman C, Widman L, Rai D, Gardner RM, Magnusson C, Schendel DE, Newschaffer CJ, Lee BK. Family History of Mental and Neurological Disorders and Risk of Autism. JAMA Netw Open. 2019 Mar 1;2(3):e190154. doi: 10.1001/jamanetworkopen.2019.0154. PMID: 30821823; PMCID: PMC6484646.

 

About the Author:

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

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

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

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

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

 

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

 

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