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149

Interoception: The “Hidden Sense”

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L

Occupational Therapist; Real-life Skills Program Manager and Coach

Conventionally, children are taught that there are five different senses, and that these senses help them to experience and understand the world around them. These five senses are sight, sound, smell, taste and touch. Clinically, we refer to these sensory systems as the visual, auditory, olfactory, gustatory and tactile systems. Each system provides unique information and works to alert the brain about the environment around them. Children all develop these systems differently, and all have unique preferences, strengths and interpretations of the world around them. As adults, a sommelier likely has an incredibly refined gustatory system, while a classical musician’s strength lies in their auditory system.

As knowledge about the human body continues to expand, two additional sensory systems have started to make their way into the common lexicon—the vestibular system and the proprioceptive system—both of which describe body awareness. The vestibular system gathers information from the inner ear and tells us where our body is in space. It monitors movement, acceleration and deceleration, balance and any changes in position. A gymnast uses this sense constantly as they flip across a mat or balance on the beam. The proprioceptive system gathers information from our muscles and joints and tells our brains about our position in space and any strength or force that we are using. Proprioception allows us to touch our noses with our eyes closed! These seven senses are all generally acknowledged and frequently assessed by occupational therapists. But what is interoception? And why is it referred to as the hidden sense?

Interoception refers to the perception of information coming from inside the body. Organ systems and the autonomic nervous system provide information about heart rate, hunger, thirst, temperature, respiration and even emotion (Vaitl, 1996). This sense of interoception helps us meet our most basic needs, such as knowing when we need food and water, realizing that it is time to use the restroom and putting on a jacket if it is cold outside. It also helps us to gain a more nuanced understanding of ourselves, such as realizing that an activity is making us anxious by acknowledging heightened heart rate and perspiration. This sensory system is often referred to as the “hidden sense,” because it is completely unique to each individual and no one knows exactly what someone else is feeling internally.

Children develop this sense slowly, with the most basic cues, such as hunger being recognized first. As they continue to grow, different internal signals are more easily understood and start to impact behavior. For example, around the age of two or three, most children start the process of potty training when they begin to recognize what it feels like to have a full bladder. As children continue to grow through their elementary, middle and high school years, this sense continues to be refined. As is expected, this is easier for some children than others.

Recent research shows that there is a strong connection between interoception and emotional/self-regulation. Individuals with low interoception often have more difficulty with both understanding and regulating their bodies and emotions (Zamariola et al., 2019). It appears that the ability to truly understand our body allows us to more intentionally control our responses. Luckily, as with other sensory systems, there are ways to increase interoceptive awareness and help children to notice the information that their bodies are feeding to their brains. In our next OT Tuesday blog, we will discuss some tips and strategies for helping children to perceive, understand and appropriately respond to this internal information.

 

References

Vaitl D. (1996). Interoception. Biol. Psychol. 42 1–27. 10.1016/0301-0511(95)05144-9

Zamariola G., Frost N., Van Oost A., Corneille O., Luminet O. (2019). Relationship between interoception and emotion regulation: new evidence from mixed methods. J Affect Disord  246:480–5. doi: 10.1016/j.jad.2018.12.101

About the Author

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

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

 

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

 

5

There Is No Wrong Decision

By | NESCA Notes 2020

By:  Alissa Talamo, Ph.D.
Pediatric Neuropsychologist

We are living in an unprecedented time. As such, parents are faced with decisions that they have never faced before. For example, families are facing the challenging decision about whether or not to send their children back to school for in-person classes in the middle of the COVID-19 pandemic. Parents have to wrestle with the idea that, on the one hand, sending children to school could increase the risk of COVID-19 among children and family members; while on the other hand, children who don’t return to in-person school may experience disruptions in their education and may miss out on the social interaction and community feeling within the school building. In addition, some families simply don’t have a choice because they need to go to work or a family member at home is immunocompromised.

What is most important is to recognize is that whether or not to send a child to school in the fall means something different to everybody. It is imperative that, as parents, you give yourself permission to feel whatever it is that you are feeling, and that you do what feels right for you and your family. It may be difficult to accept, but we have little control over much of what is happening around us right now. While it is important to acknowledge how you are feeling, it is equally important to remember that, in fact, any reactions are normal under the current circumstances.

How you respond to stress during the COVID-19 pandemic can depend on your background, your financial situation, your health and emotional background, your social support system, the community you live in and many other factors. When it comes to parenting, every day can be a challenge, and the coronavirus has made an already scary world feel even more menacing.  Remember to “ignore the noise” and give yourself credit for taking care of yourself and your family.

 

 

About the Author:

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

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

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

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

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

She is the mother of one teenage girl.

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

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

16

Positive Coping Strategies for Stress, Anxiety and Trauma During Times of Crisis

By | NESCA Notes 2020

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

Amidst the global pandemic, children, their caregivers, their teachers and therapists are naturally experiencing heightened stress and anxiety. We are more likely to be sent into “fight, flight, freeze, mode” – the body and brain’s critical survival strategy to prepare and deal with perceived threat. For example, when you see a Grizzly Bear on your hiking trail, you instinctually run, fight back or hide.

However, we can become “stuck” or more sensitive to this instinctual urge, which is not adaptive and can negatively impact physical, emotional and social health. For example, chronic deployment of the “flight, flight, freeze” response occurs for individuals who experience post-traumatic stress disorder. Chronic deployment of “fight, flight, freeze” responses is also more likely amidst a global pandemic, such as COVID-19. Importantly, chronic deployment of “fight, flight, freeze” responses also occurs for individuals and communities who experience chronic racial injustice and oppression.

Under chronic experiences of stress and threat, our body remains activated and hyper-aroused, even when deploying this response is not helpful. For example, children may shut down or dysregulate when faced with even small stressors – making an error on a math worksheet or even accidentally spilling something on the table. Children and teens may be more irritable, defiant or isolative. Overall, chronic deployment of the “fight, flight, freeze” response heightens anxiety, stress and general feelings of malaise.

So, what can we do? What can we do to “turn off” or lessen this stress response? What are some ways to positively cope during these difficult times?

  1. Research shows that the #1 resiliency factor is the reliable presence of at least one supportive relationship with an adult. Build connection and community through shared activities and conversations about your experiences. Remember to always take care of yourself before taking care of others – self-care is critical.
  2. Focus on validation first; problem-solving second. Validating, acknowledging and accepting pain, distress, hurt and the like builds communication and naturally decreases tension and stress. Validation is the essential first step prior to action, problem-solving and positive coping.
  3. In order to grow positive coping, it is helpful to build mastery and self-expression. Strategies that can help to both organize and “release” feelings and stressful experiences rather than “bottle them up” include:
  • Use your body to heal your mind: play, do yoga, engage with nature, exercise;
  • Engage in shared action to promote communication and change at a community and systemic level. Volunteer or advocate for a cause of importance. Contact your local legislators and express your concerns;
  • Write or draw about your experience. Use collages, images or videos to express your goals, experiences and fears;
  • Engage in therapeutic movement. Create a music playlist for various emotions. Dance or engage in rhythmic actions (e.g. knitting, pottery);
  • Identify your strengths and what you value in life. Happiness is fleeting – goals and values last longer and support positive coping. For a free strengths and values survey, check out: https://www.viacharacter.org/;
  • Connect with community resources available in your area, such as therapists, mentors, religious organizations, support groups, local-nonprofits, etc.; and
  • Be kind to yourself and practice self-compassion.

To learn more about this topic, a helpful webinar is available at “Supports for Students with a History of Trauma and Significant Anxiety,“ presented by Dr. Renee Marchant, PsyD, and Dr. Stephanie Monaghan-Blout, PsyD.

 

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.

 

149

YES! COVID-19 May be Making Basic Daily Tasks More Difficult: The Link Between Executive Function Difficulties and Anxiety/Stress

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L

Occupational Therapist; Real-life Skills Program Manager and Coach

As our country continues to adapt to life in the era of COVID-19, it is quite well established that there has been a rise in anxiety and stress among our population. According to the Centers for Disease Control and Prevention (CDC), the mental health effects of the current pandemic have been substantial and include difficulty sleeping, worsening chronic health problems, changes in eating patterns, fear about personal health and the health of loved ones, and increased use of tobacco and alcohol (CDC, 2020). Many of these fears and new challenges are expected and understandable. They are responses that intuitively make sense to us as humans, as many of us experience them on a small scale throughout a typical year. Most people can name a time when they could not fall asleep before a big test or did not take excellent care of their physical health when they were hugely stressed or anxious. However, one effect of this newly heightened stress and anxiety that is less frequently mentioned is the decrease in executive function skills.

The term executive function refers to the brain processes that allow someone to stay organized, initiate tasks, maintain focus and attention, and manipulative information in their mind. As NESCA Pediatric Neuropsychologist Dr. Alissa Talamo describes in her piece, “What is Executive Function?,” this group of skills can be thought of as the conductor of the brain, similar to the conductor of an orchestra. They are keeping time, telling us when to start and stop tasks and helping us to stay regulated through the ups and downs of the day. You may have noticed that through stay at home orders and social distancing regulations, organizing daily tasks has become increasingly difficult. You may find yourself missing calls or meeting times, forgetting to respond to emails or misplacing items that are usually easy to track. You are not alone. Some people have started to describe a brain fog and a perceived inability to stay focused on a task for more than a short period of time.

While maybe not as intuitive as a lack of sleep, this decrease in executive function is to be expected as we collectively move through this stressful experience. Substantial research has described the correlation between depression, anxiety and stress, and executive function deficits. This seems to be particularly strong for adolescents with depressive and anxious symptoms, who have trouble with cognitive flexibility (Han, Helm, Iucha, Zahn-Waxler & Hastings, 2016). Similarly, university students are another population vulnerable to these effects, as described by Ajilchi and Nejati in 2017, who found specific difficulties with sustained attention and decision making. It is no surprise that one diagnostic criteria for generalized anxiety disorder is “difficulty concentrating or mind going blank” (APA, 2013). When reviewing the literature, it is clear that the brain fog and inability to focus through COVID-19 is not only unsurprising, for many people, it was inevitable.

So, what do we do? How do we soldier on through this incredibly unique time, despite the feeling that everything takes just a bit more time and effort?

It is increasingly important to cut ourselves some slack and stop expecting perfection. Focusing on self-care and taking care of each other emotionally will potentially lead to a natural return to successful executive function. By creating habits and routines that promote positive mental health, we are more likely to mitigate the feelings of being overwhelmed and the potential for burnout. Additionally, using technology and digital reminders to help take over the tasks of initiation and organization can give our over-extended brains a bit of a rest.

Finally, it is imperative that we think about the adolescents and students in our communities who are just starting to build these skills. Building executive function skills comes from a combination of direct instruction and opportunity to practice. Currently, students are being provided ample opportunity to practice, with limited direct instruction and guidance. Consider teaching your children and adolescents the tricks that you have learned to stay organized, prepared and productive. If you feel like teaching these skills is outside of your wheelhouse, or at all daunting, look into the prospect of an executive function coach. With all of the uncertainty about what education will look like this fall, helping students feel ready to tackle learning is one way to mitigate the anxiety and stress of this transitional time.

 

References

Ajilchi, B., & Nejati, V. (2017). Executive Functions in Students with Depression, Anxiety, and Stress Symptoms. Basic and clinical neuroscience, 8(3), 223–232. https://doi.org/10.18869/nirp.bcn.8.3.223

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Center for Disease Control and Prevention. (2020) Coronavirus disease 2019: Coping with stress. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html

Han, G., Helm, J., Iucha, C., Zahn-Waxler, C., Hastings, P. D., & Klimes-Dougan, B. (2016). Are Executive Functioning Deficits Concurrently and Predictively Associated with Depressive and Anxiety Symptoms in Adolescents?. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 45(1), 44–58. https://doi.org/10.1080/15374416.2015.1041592

 

 

About the Author

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

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

 

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

 

5

“Can I Hug You?” – Why the pandemic has us craving closeness

By | NESCA Notes 2020

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

At the end of a testing session last week, my young client and I stood looking at each other through the large glass window of our contactless, adjoined testing rooms. Our hands were newly washed; the fresh scent of antibacterial wipes emitted from the tables; and our face coverings were in place. And while looking at one another from our respective bubbles, inside this necessarily sterile setting, my client looked me in the eye and asked: “Can I hug you?”

The question hung in the air for a moment. In the 15 years that I have worked with children, I have rarely hesitated when a child asks me this. But there we were, mid-pandemic, in this brief, perhaps imperceptible, moment of uncertainty.

One thing I have become keenly aware of since starting to see family and friends for socially distanced visits is how much I, and my children, have to consciously fight the physical urge to embrace the people we love. The urge is palpable. But where does this come from?

There is a great body of research demonstrating the importance of physical touch, particularly hugging. Hugs are not just a simply a way of demonstrating your love or support for someone, but hugging actually causes physiological changes within the body. Stress hormones, such as cortisol, reduce, and the nervous system slows down. Oxytocin – a hormone integral to bonding – is released, increasing closeness and affection. Over time, close physical contact results in improved brain development, heart health, emotional health, relationship patterns and immune function.

In many ways, physical touch is a basic human need that must be met. Individuals who are deprived of these experiences, particularly early in life, can experience detrimental effects. Fortunately, some of these effects can be mitigated once opportunities for closeness are offered. As such, our bodies and brains never fully give up on the urge for closeness, even after long durations of it being unmet. And this urge has a name – skin hunger.

Most people have felt skin hunger at some point – a driving urge for human contact and connection. This may come after a particularly stressful day at work, an argument with a friend or just a general feeling of loneliness. In times of uncertainty, distress or instability, the human need for closeness increases. And yet, for so many who are enduring the COVID-19 pandemic, closeness is the exact thing that they are being deprived of. Even when we are lucky enough to still have access to our families, or perhaps a small group of close friends, our emotional needs are high. Physiologically, psychologically, we need more hugs.

The good news is, there are things that you can do to meet this need:

  • Consciously make an effort to hug those you can, and do it more often than typical.
  • Snuggle up with your dog, your cat or other pet of choice.
  • For those who live alone and do not have pets, a weighted blanket, warm bath or hugging a pillow can simulate the effects of human touch.
  • Maintain social connection through video chat, phone calls and socially distanced visits. Interpersonal contact without hugging is better than no contact.
  • Be careful to not accidentally over-associate hugs or touch with danger. Coronavirus will eventually be managed, but training our children to fear closeness could have enduring, negative effects. Choose words wisely, teaching pragmatic, unemotional caution, not fear.

 

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.

18

Transition Planning Timelines for Students with Disabilities

By | NESCA Notes 2020

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

When families come to NESCA for transition support, a common request is to work with a transition specialist to create a detailed step-by-step transition plan with action items and deadlines that will ensure their child makes a successful transition to postsecondary adulthood. As you can imagine, many hours are needed to create an appropriate plan individualized to the student—their goals and their needs—and this plan requires frequent updating as students progress toward adulthood, have new experiences, stumble at new hurdles and make developmental leaps. However, for families who are interested in creating an individualized transition timeline plan for their student at home, there are a number of readymade timelines and checklists that can be used as starting points. While I am presenting several options below, I would encourage picking the one that you like best and that fits your child best, and using that as a foundation for your planning. Please note that even though the resources below that have been assembled by agencies who specifically support individuals with autism and are therefore described as focusing on autism spectrum disorder (ASD), they may still be important for individuals with other disabilities to review.

Transition from School to Adult Life – Time Lines, by The Arc of Massachusetts, is a two-page brochure that includes bulleted timeline recommendations for students ages 13-22

A Resource Guide for Transition Aged Youth and Young Adults with Autism Spectrum Disorder (ASD), by the Autism Commission, is a 12-page pamphlet compiled to help families and individuals in the state of Massachusetts to better understand the resources available for students aged 14-22 with ASD. If viewing this pamphlet online, it is important to closely follow the page numbers. The Transition Timeline starts on page two and continues through page four.

Transitioning teens with autism spectrum disorders: Resources and timeline planning for adult living, by the Autism Consortium, is a 73-page guide intended to provide resources and information for parents and guardians of children with ASDs in Massachusetts. Pages 64-70 outline critical timelines related to education, guardianship, housing, postsecondary education, employment, healthcare, recreation and more for students ranging from age 11-22.

A Family Guide to Transition Services in Massachusetts, published by the Massachusetts Rehabilitation Commission (MRC) in collaboration with the Federation for Children with Special Needs (FCSN), is a 44-page guide intended to assist parents, students and professionals in understanding the requirements of transition services for all individuals with disabilities that are eligible for special education in Massachusetts. Pages 22-23 offer an easy-to-read timeline covering important steps for youth ages 14-18.

Important Transition Information Every Family Should Know: Transition Information Fact Sheets, by the Massachusetts Department of Developmental Services, is a 44-page compilation of fact sheets with important information for all families of individuals with developmental disabilities in Massachusetts. The fifth fact sheet, on page 9, is a simple but detailed visual timeline covering steps for students ages 14-22.

Turning 18 Checklist, by Autism Housing Pathways, is not a timeline! But it is a detailed and continually updated three-page document with a checklist of critical steps to take when a student with a disability turns 18 as well as a list of useful transition resources that correlate with the checklist. While the document was created by Autism Housing Pathways, the checklist is applicable for many individuals who are turning 18 and who may be seeking human service supports and disability-related benefits.

 

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

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

1

Preparing our Kids to Reenter the Community

By | NESCA Notes 2020

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

For many children, new experiences are frightening and anxiety-provoking. Children thrive on routine and predictability; when these get interrupted, it can be hard for them to understand what is happening. As we all know, the last few months have been fraught with unpredictability and change. Now, we are starting to go back to work, eat at restaurants and visit retail stores. As adults, we might have mixed feelings about this – relief to get out of the house but also fear about the ongoing pandemic. For our children, we are expecting them to reenter their communities with a new set of “rules” after months of being in the safety of their homes. This is going to be a difficult process, especially for children with special needs.

So how do we prepare children for all of the new experiences they are about to face?

One method that has been found to be effective is the use of Social Stories™. Social Stories were first developed in 1990 by Carol Gray, a special education teacher. In essence, Social Stories are used to explain situations and experiences to children at a developmentally appropriate level using pictures and simple text. In order to create materials that are considered a true Social Story, there are a set of criteria that must be used. More information can be found here: https://carolgraysocialstories.com/social-stories/what-is-it/.

While special educators or therapists are expected to use this high standard in their work, it is also relatively easy for parents to create modified versions of these stories to use at home. I was inspired by one of my clients recently who made a story for her son with Down syndrome to prepare him for the neuropsychological evaluation. During her parent intake, she took pictures of me and the office setting. At home, she created a short book that started with a picture of her son, a picture of their car, a picture of my office, a picture of me and so on. On each page, she wrote a simple sentence:

  • First we will get in the car
  • We will drive to Dr. Gibbons’ office
  • We will play some games with Dr. Gibbons
  • We will go pick a prize at Target
  • We will drive home

Throughout the evaluation, she referred to the book whenever her son became frustrated by the tests or needed a visual reminder of the day’s schedule. Something that probably only took a few minutes to create played an important role in helping her son feel comfortable and be able to complete the evaluation.

The options for creating similar types of stories are endless, giving parents a way to prepare their children for a scary experience.

Some examples of stories to create during the ongoing pandemic:

  • Wearing a mask when out of the house
  • Proper hand washing
  • Socially distant greetings (bubble hugs, elbow bumps, etc.)

Some examples of more general stories include:

  • Doctor’s visits
  • Going to the dentist
  • Getting a haircut
  • Riding in the car
  • First day of school

You can use stock photos from the internet or pictures of your child and the actual people/objects they will encounter. If you have a child who reads, you can include more text; if your child does not read, focus on pictures only. Read the story with the child several times in the days leading up to the event. For ongoing expectations (e.g., wearing a mask) – you can review the story as often as needed. Keep it short and simple. And have fun with it!

 

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 evaluation with Dr. Gibbons 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.

149

From School to Summer – Life Rolls Along in the Era of COVID19

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L

Occupational Therapist; Real-life Skills Program Manager and Coach

This past March, families were thrown into the world of remote learning, Zoom classrooms, digital assignments and school at home. With little to no time to prepare, teachers and parents alike have worked tirelessly to provide a sense of routine and academic focus, while handling the social and emotional fallout of the COVID19 pandemic. As schools start to wrap up their years and families start to look ahead at what is sure to be a notably unique summer, there is a bit more time to plan, think proactively and chart a positive course for our children.

As summer camps, childcare options, volunteer opportunities, and internships are either cancelled, transitioning to an online format, or significantly limiting capacity, the need for children to manage and plan self-directed activities is becoming more and more apparent. With such an extended period of time ahead of us, let’s highlight some ways that we can create environments that allow our children autonomy while building important skills and leavings lots of room for fun.

Set Firm Boundaries

There is evidence that tells us our children most successfully build and demonstrate their executive function skills when they are allowed freedom and opportunities to make their own choices, within boundaries and limits set by their parents (Schroeder & Kelley, 2010). Consider what aspects of summer life are non-negotiable for your family. This may be a certain limit on hours of screen time per day, a time that all children are expected to be up and out of bed, or chores and expectations that they must meet as a part of the family unit. Make sure that these are clearly communicated and agreed upon by everyone in the home.

Set Goals

Helping children set and work on completing goals can provide a concrete representation of the accomplishments that they have achieved over the summer. There are many ways to organize and format this process, but one consistent theme should be creating goals that are measurable, achievable and specific. Consider the SMART goal format as a template. One way to help children to choose their goals is to have them focus on three categories: personal, family and community. Some examples are:

  1. Personal Goals – Develop a consistent exercise routine; try out a new form of exercise, such as running, yoga or Pilates; incorporate a mindfulness meditation into a weekly schedule; consistently wake up independently with an alarm; or drink the recommended amount of water per day for their age, etc.
  2. Goal to Benefit the Family – Cook dinner for the family once a week; commit to weeding a family garden; deep clean one room per week; learn which cleaning supplies are used for the bathroom and for the kitchen; add a new chore each week; or teach a grandparent or family friend how to use a new technology, etc.
  3. Goal to Benefit the Community – Collect box-tops from all of the food items in the home to give to their school once it’s back in session; take a walk and pick up trash on a road or beach; do a food drive for a local pantry; mow the lawn for a neighbor; or reach out to vulnerable people in the community and ask if they can do anything to help, etc.

Create an Activity Bank

Pediatric Neuropsychologist Dr. Angela Currie of NESCA recently explained why telling kids to simply, “find something to do,” rarely leads to positive results (Currie, 2020). One suggestion that Dr. Currie gives is to create an activity bank or “menu.” It is often difficult to come up with suggestions in the moment when a child mentions that they are bored or feel there is little to do. Take the proactive step of creating a list of activities that your child can go to when they are having a hard time deciding how to fill their time. This makes it easy to prompt them to independently choose something to do. The response, “Why don’t you go take a look at the activities bank and see if there is something that would be a great choice for today?” gives a child a concrete first step. Some families have used creative ways to help children decide between options, such as an activity dice, an activity grab-bag or a personal activity “menu” with specific options for each child.

Encourage Independent Learning

The old adage states that anyone can be an expert at something, if they spend 10,000 hours practicing. Teach this theory to your children and ask them what truly makes them feel excited and curious. What would they like to explore? Children are used to viewing themselves through the lens of a student; however, they rarely make decisions about exactly what they would like to learn. Help your child explore their personal interests and choose something they would like to learn about over the course of the summer. This could look like a 1st grader collecting sea shells at the beach and bringing them home to draw; a 5th grader spending a couple of hours a week researching underwater caves; an 8th grader learning how to keep a sourdough starter alive and bake bread; or a junior in high school doing a deep dive into the current cultural shift developing in the United States. The topic should be completely chosen by the child, with suggestions and support facilitated by their parents.

 

References

Currie, A. (2020). Why “find something to do” doesn’t work – Teaching independent play skills during quarantine, NESCA Notes. Retrieved from https://nesca-newton.com/why-find-something-to-do-doesnt-work-teaching-independent-play-skills-during-quarantine/

Schroeder, V. & Kelley, M. (2010) Family environment and parent‐child relationships as related to executive functioning in children, Early Child Development and Care, 180:10, 1285-1298, DOI: 10.1080/03004430902981512

 

About the Author

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

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

 

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

 

1

School’s Out For Summer

By | NESCA Notes 2020

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

With everyone home-schooling these last several months, there has been a push towards academics and getting work done. But now it is summer vacation, and the pressure is off. However, this is a summer like no summer we have ever known. Many families are continuing to spend more time at home, many activities are still closed, or at the very least, they are more limited. It can be hard to figure out what to do with all of this time.

The summer can be a great time to engage multiple aspects of our minds. I am often reminded of Gardner’s theory of multiple intelligences. His theory proposes there are eight aspects of human intelligence, each representing different ways of processing information. Without getting into the deep specifics of his theory, I think it is important to consider the many different ways that our brains interact with the world. When trying to plan out activities or experiences for our kids this summer, taking these multiple aspects of functioning into consideration might help to stir up some great ideas.

Visual-Spatial: This can include activities such as drawing and other art activities using maps, puzzles and patterning tasks. Young children can practice making patterns and completing puzzles while our older children can create using Legos or planning out a family outing on a map. The possibilities are endless.

Linguistic-Verbal: This can include reading, writing and speaking. Children and families can enjoy reading books together or creating stories. Even conversations at the dinner table can be a form of engaging these verbal skills.

Logical-Mathematical: Activities that tap into this skillset can involve the use of numbers and relationships using patterns. Science or experiment-based activities can fall into this category. Young children love creating volcanos with vinegar and baking soda. Allowing them to measure materials out and add food coloring is always a fun idea. Older children may enjoy cooking or other activities that involve numbers and measurement.

Bodily-Kinesthetic: These activities engage the body and can involve strength and physical control. During the summer, the options are endless: nature walks, running through the sprinkler, dancing, biking, scootering, etc. Anything that gets the body moving! These activities can be enjoyed by the whole family.

Musical: Think about rhythms and sounds. Activities can include singing and playing musical instruments. While certainly traditional tools like the piano come to mind, you can also turn pots upside down, get some spoons and create a drum circle. Or possibly work as a family to turn the lyrics of a favorite song into something silly or more meaningful to your family. This summer could also be a great time to learn a new instrument with plenty of music instructors offering virtual lessons throughout the summer.

Interpersonal: This one may be a little harder as many people continue to distance themselves. While our health remains a priority, we do have to acknowledge that practicing social skills is important for everyone. This can involve calling or virtually meeting with family members, possibly a distanced activity with others outside, or leaving notes for friends and neighbors. Anything that gets your child thinking about others, their own thoughts and feelings, and finding ways to stay connected is important. Embracing the relationships within your family during this time is also a great idea.

Naturalistic: This means being in tune with nature and exploring the environment. These types of activities involve being outside, interacting with plants and animals. Perhaps you start a family garden or go for regular walks in the woods. Focusing on bugs, sounds and smells within your environment. Outdoor activities are probably the most readily available during this time.

Intrapersonal: Personal enrichment and being in tune with oneself is so important during this time. Taking time to calm our own frustrations and anxieties is essential for our overall health as well as setting a good example for children. Numerous mindfulness activities aimed at improving self-regulation can be found online. Being more aware of what is going on in our bodies and minds is so important to help us get through this time.

The summer is a time to relax and enjoy being a family. This can be a jumping off point to get the creativity flowing then allow the kids to jump in and help find fun ways to spend this summer—one that is unlike any other we have experienced.

 

About the Author:

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

 

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

 

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

 

 

4

Let’s Stop Trash-talking Stress and Anxiety-Part 1

By | NESCA Notes 2020

By:  Stephanie Monaghan-Blout, Psy.D.

Coordinator of Therapy Services; Trauma-informed Therapist

Stress and anxiety have gotten a really bad name in our society. Just ask kids – it is a question we sometimes pose to our clients during testing, and the answers we get usually run along the lines of, “Are you kidding? There’s nothing good about stress!”. So, let’s talk about the purpose of stress, how it functions, and what we can do to manage it.

From a scientific viewpoint, stress is a challenge or stimulus to DO SOMETHING when certain circumstances arise – specifically, when danger is detected. Let’s make this easy – what would your body need to do if a tiger showed up? Let’s start with upping your heart rate and breathing faster to get oxygen into your blood so that you are able to move quickly, and then let’s send some fuel (glucose) to your muscles for strength. This is the process that happens when some kind of danger is sensed – the brain sends down orders to the body that diverts resources to the systems that help us escape from the tiger (fight, flight or freeze) while diverting resources from systems that are less important at that time (rest, digest and think). When the danger is over, the focus changes; our fear response is dampened, our heart rate and breathing slow down and those other systems come back online to get our bodies back to normal.

The feedback between these two systems of getting us prepared for danger (activation of the sympathetic nervous system) and calming down after the event has passed (activation of the parasympathetic nervous system) remain important, even when tigers are no longer a concern. Remember that stress is a stimulus to do something in the face of fear or danger. A little stress in our daily lives helps us get things done, like studying for that big test. It is also adaptive to be anxious at a time like now, when our whole world is under the threat of the COVID-19 virus. There’s lots to be worried about, and this stress can help us remember to take precautions like staying home and keeping physical distance. We’ll get back to this.

But what happens if the threat is more immediate, the danger sensor is too sensitive and/or the body never gets a chance to calm down? In this situation, the person remains activated, looking for danger and ready to respond, even when it is not appropriate or even against their best interests. Remember, during these times of perceived danger, the child does not have access to higher-level cognitive processes, like thinking flexibly, problem solving or even access to language. At these times of high stress, they are not available for learning. Asking a child to “talk about it” or even tell you what the problem is can be beyond their capacity at the time and will only add to their stress. This is the situation in school encountered by many children with learning issues, emotional concerns, autism or other neurodevelopmental disorders. They may find the academic, organizational and social demands of school to be so threatening that their danger alert is set off and only gets the chance to reset when school is finished.

So, what does the overly stressed child look like and how can we help? This is going to be the challenging part, because you are going to be asked to look at common behaviors in a different way. Let’s go back to the Fight-Flight-Freeze responses. Most of us tend to prefer one of these, though we will use all three depending on the situation.

Fight – This version of the response involves active resistance to the threat, but in the classroom or the dinner table, it more likely takes the shape of being argumentative, noncompliant and defiant (“You can’t make me!”).

Flight – This version is characterized by avoidance or getting away from the threat. This could mean needing to go the bathroom, see the school nurse or suddenly remembering that very important pen in their cubby that they absolutely have to have at that moment. However, it could also mean leaving mentally (“spacing out”).

Freeze – This version involves immobilization strategies, like wild animals who “freeze” so as not to attract the attention of a predator. In children, these behaviors are more subtle; they manifest as problems with getting started, switching from one thing to another and/or stopping. Oftentimes these kids are described as “shutting down,” but it is more accurate to describe them as “stuck.”

How do we help our kids get out of this stress response?

Remember, stress is a response to the perception of danger, and anxiety is the feeling of being helpless and out of control.

What “turns off” the threat alert and allows us to feel more capable and ready to try? The perception of being safe. When children feel safe, they can focus and concentrate on the task at hand. They can think and problem solve. And, they are more aware of others and what they are saying and doing.

How do we help our children feel safe and capable of tackling a challenge? Say a child doesn’t like math and does everything to avoid doing their homework. Which of these three approaches would make them feel more safe and ready to give it a try?

  • “Stop acting like a baby and just get that math done. It’s only 10 problems! Don’t even think of playing any video games tonight.”
  • “You poor thing. I know you are bad at math and it’s mean that your teacher is making     you work so hard. I’m going to write to her and tell her you can’t do that much.”
  • “Wow, you really don’t like to do your math homework, do you? That’s hard! Tell you what, I’ll help you with the first two and when you are done with the rest, we’ll play a game together!”

Notice that in the last example, the parent started with validating the child’s feelings, or just recognizing what the child’s emotional experience is like at the moment – not the same as agreeing with him or her. The second thing s/he did was to offer some help, and the third was to offer a fun activity to help the child feel calmer and more connected.

What if the child is really upset and can’t switch gears to start working? Just change the order of the events. Validate feelings, offer a calming and connecting activity and offer some help to get back to work. The calming/connecting activity doesn’t have to be a game – it just needs to be something they makes the child feel cared for and gives them something else to think about, like a cup of tea or a special cookie.

But what if the stress and anxiety is related to something that is bigger than math homework and can’t be easily fixed with a cup of tea and some extra help with those fractions? What if it is something that is out of the parent’s control, like the COVID pandemic? Again, the way to “turn off” the threat alert in our children’s brains is to help them feel safe and to have some control over what is happening to them. How do we do that? Validate their feelings makes them feel heard. Answering their questions (but sticking to their concerns) will tell you what they are really worried about and allow you to correct misperceptions and reassure them. Calming and connecting activities are still really important. Finally, helping them feel more in control by being able to do something to help. Utilize a child’s skills and interests in finding ways for them to help. If your child likes to draw, have them make pictures for family, friends and neighbors. Do you have a budding computer whiz? Help them make a zoom video of their classmates saying hi to their teacher. Is your child someone who loves people and isn’t shy? Have them call grandparents and older neighbors who may not be able to leave their houses. Equally importantly, remind them that they can help others by following the guidelines of washing their hands, keeping physical distance and, as hard as it is, staying home.

In a follow-on blog, we’ll discuss how to build resilience in children.

 

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.

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