NESCA’s Newton, MA location has immediate availability for neuropsychological evaluations. Our MA clinicians specialize in the following evaluations: Neuropsychological; Autism; and Emotional and Psychological, as well as Academic Achievement and Learning Disability Testing.

Visit www.nesca-newton.com/intake for more information or to book an evaluation.

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4

How Language Difficulties Impact Math Development

By | NESCA Notes 2018

 

By:  Alissa Talamo, Ph.D.
Pediatric Neuropsychologist

Did you know research shows that 43-65% of students diagnosed with Dyslexia also struggle with math at a level that meets criteria for a Specific Learning Disability in Math? This is in comparison to the general population, where 5-7 % of the population meet criteria for a Specific Math Disability (Dyscalculia – difficulties with number sense, number facts, or calculations).

I recently attended a lecture given by Dr. Joanna A. Christodoulou, assistant professor in the Department of Communication Sciences and Disorders at Massachusetts General Hospital and leader of the Brain, Education, and Mind (BEAM) Team in the Center for Health and Rehabilitation Research at MGH. The topic of discussion? How language difficulties can negatively impact math development.

How do language difficulties impact math development?

When asked to learn math, a student with language problems may: 

  • Have difficulty with the vocabulary of math
  • Be confused by language word problems
  • Not know when irrelevant information is included or when information is given out of sequence
  • Have difficulty understanding directions
  • Have difficulty explaining and communicating about math including asking and answering  questions
  • Have difficulty reading texts to direct their own learning
  • Have difficulty remembering assigned values or definitions in specific problems

It is helpful to have an understanding of typical math development in children. With this information, a parent can monitor their child’s development relative to grade level expectations.

Math difficulties often looks different at different ages. It becomes more apparent as children get older but symptoms can be observed as early as preschool. Here are some things to look for:

Preschool: 

  • Has trouble learning to count
  • Skips over numbers long after kids the same age can remember numbers in the right order
  • Struggles to recognize patterns, such as smallest to largest or tallest to shortest
  • Has trouble recognizing number symbols (knowing that “7” means seven)
  • Unable to demonstrate the meaning of counting. For example, when asked to give you 6 crayons, the child provides a handful, rather than counting out the crayons

In grades One to Three, a child should: 

  • Begin to perform simple addition and subtraction computations efficiently
  • Master basic math facts (such as 2+3=5)
  • Recognize and respond accurately to mathematical signs
  • Begin to grasp multiplication (grade 3)
  • Understand the concept of measurement and be able to apply this understanding
  • Improve their concept of time and money

Clearly, as a child continues through school, demands to understanding abstract math concepts increases. For example, in middle school, a child will be expected to understand concepts such as place value and changing fractions to percentiles, and when in high school, a child will be expected to understand increasingly complex formulas as well as be able to find different approaches to solve the same math problem.

What should I do if I suspect my child has challenges with math?

If you suspect your child is struggling to gain math skills, have your child receive an independent comprehensive evaluation so that you understand your child’s areas of cognitive and learning strengths and weaknesses. This evaluation should also include specific, tailored recommendations to address your child’s learning difficulties.

What if I am not sure whether my child needs a neuropsychological evaluation?

When determining whether an initial neuropsychological evaluation or updated neuropsychological evaluation is needed, parents often choose to start with a consultation. A neuropsychological consultation begins with a review of the child’s academic records (e.g., report card, progress reports, prior evaluation reports), followed by a parent meeting, during which concerns and questions are discussed about the child’s profile and potential needs. Based on that consultation, the neuropsychologist can offer diagnostic hypotheses and suggestions for next steps, which might include a comprehensive neuropsychological evaluation, work with a transition specialist, or initiation of therapy or tutoring. While a more comprehensive understanding of the child would be gleaned through a full assessment, a consultation is a good place to start when parents need additional help with decision making about first steps.

To book a consultation with Dr. Talamo or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate “Consultation” and your preferred clinician in the referral line.

Sources used for this blog:
– Dr. Joanna A. Christodoulou
– www.understood.org

 

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.

 

4

First Recommendation: Take up Golf

By | NESCA Notes 2018

 

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

A five-year old boy, whom I will call Marcel, was referred by his parents for evaluation to determine if he had Autism Spectrum Disorder (ASD) because he isolated himself socially. With a great deal of effort, I got Marcel through the neuropsychological evaluation process and observed him at his pre-school. Results of the evaluation revealed a significant communication disorder but no other symptoms of ASD. He was socially isolated because he didn’t have the language skills to interact easily with others. Although his verbal abilities were limited, Marcel’s visual-spatial skills were superior, based on testing results. During my school observation, I was struck by his ability to focus intently, seemingly immune to distraction, on building an extensive highway system for his cars for more than an hour.In thinking about treatment for Marcel, my top priority was to conceive of a plan for luring him out of his “own world” where he retreated much of the time to avoid the communication demands inherent in engaging his surroundings. Because the language skills of young children develop most rapidly in social contexts, increasing Marcel’s opportunities for interaction with others would be expected to improve both his language skills and his social confidence. Since people can be most readily induced to change by leveraging their strengths, I asked myself, “What activity requires superb visual-spatial skills, and the ability to concentrate for hours on visual stimuli?”, both conspicuous strengths for Marcel. I also wanted an activity that would provide ample opportunities for interactions with others but not demand it.Deciding that Marcel was too young to become a pool shark, I recommended golf to his parents, explaining my reasoning. I told them that, in addition to using Marcel’s natural strengths to build a skill that would enhance his self-esteem, golf would provide a “controlled social arena”. Marcel could get away with socializing primarily about the game, which would require him to use a limited vocabulary (e.g. birdie, bogey, slice) whereas socializing in less controlled environments involves a broader range of topics and associated language demands.Marcel excelled with golf, quickly mastering the game and often playing more than 36 holes during weekends, such that he was interacting with others throughout the day, instead of engaging in solitary pursuits, but still “having a break” from other people while he focused on his game. He and his family were rightfully proud of his tournament trophies and Marcel established relationships with his teammates and coaches. As he spent more time interacting with others, Marcel’s communication skills and self-confidence blossomed.

When I saw him recently for his two-year follow-up evaluation, Marcel told me that he wanted to switch from golf to tennis “because its more social”.

Leveraging a child’s strengths can be one of our most potent tools for remediating weaknesses.

 

About the Author:

NESCA Founder/Director Ann Helmus, Ph.D. is a licensed clinical neuropsychologist who has been practicing for almost 20 years. In 1996, she jointly founded the  Children’s Evaluation Center (CEC) in Newton, Massachusetts, serving as co-director there for almost ten years. During that time, CEC emerged as a leading regional center for the diagnosis and remediation of both learning disabilities and Autism Spectrum Disorders.
In September of 2007, Dr. Helmus established NESCA (Neuropsychology & Education Services for Children & Adolescents), a client and family-centered group of seasoned neuropsychologists and allied staff, many of whom she trained, striving to create and refine innovative clinical protocols and dedicated to setting new standards of care in the field.

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

 

To book a consultation with Dr. Helmus 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.

 

4

Transition Planning: Let’s Talk about Graduation Dates for Students on IEPs

By | NESCA Notes 2018

 

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

On March 26, the Massachusetts Department of Elementary and Secondary Education (DESE) sent out an important administrative advisory regarding transition services and graduating with a high school diploma (Administrative Advisory SPED 2018-2: Secondary Transition Services and Graduation with a High School Diploma). This much-needed advisory clarifies when and how students with IEP’s should be issued a high school diploma and also touches on best practices for planning both student graduation and appropriate secondary transition services.

As a transition specialist who is often contracted by schools and families, it is not uncommon to be asked to help determine whether a student is ready to graduate. The challenge in answering this particular question is that there is no universal set of skills or level of knowledge that deems a student on an IEP “ready” to graduate. In fact, students on IEP’s, just as with mainstream students, graduate all the time without being ready for many adult activities (e.g. apartment hunting, changing jobs, applying for a bank loan, comparing health insurance plans).

The truth is, there are a number of skills that we need for “adulting,” but do not need in order to graduate with a high school diploma. As this important advisory points out, the special education process is not simply about completing local graduation requirements. It is also about transition planning and services that uniquely equip a student for reaching their goals after leaving public education. Therefore, we need to rethink the question, “Is my child/student ready to graduate?” And instead, the critical question to ask when a student approaches the end of 12th grade is, “Has the child/student received a free and appropriate public education (FAPE)?”

As I discussed in a previous blog (Transition Planning: The Missing Link Between Special Education and Successful Adulthood), FAPE as guaranteed by the Individuals with Disabilities Education Act of 2004 (IDEA 2004) includes transition planning and services. Under IDEA 2004, a federal law, transition planning must start by the time a student turns 16. Here in Massachusetts, we have even stronger regulations, and secondary transition services may begin “no later than the age of 14.” This means that the IEP has to be carefully constructed to help students build skills “in a stepwise and cumulative manner” toward completing their high school program while also making progress toward their desired post-secondary learning, working, and independent living activities including community engagement.

The foundation for this process is an individualized and coordinated transition assessment process that carefully evaluates a student’s needs, strengths, preferences, and interests beginning before the age of 14. Just as with all IEP goals and services, assessment informs the team’s discussion and decision-making; it helps the team to know how to plan for the long-term, prioritize for the coming school year, and to track progress.

In each annual meeting for a transition-aged student, the IEP team needs to explicitly discuss whether the student is progressing towards their measurable postsecondary goals and whether the educational program and related transition services are calibrated in such a way that the student will continue to make progress. Anticipated graduation date (listed on the top of the Transition Planning Form and recorded in the Additional Information section of the IEP) is a critical part of this discussion each year. When a student, parent, teacher, or other team member is uncertain about a student’s ability to complete local requirements and receive appropriate transition services “on time,” this needs to be discussed directly.

If there is confusion or disagreement about the graduation date, additional assessment may be needed to clarify the student’s needs. However, if the team starts the transition planning process when a student is 14, and carefully plans out the instruction, community experiences, and employment related activities necessary for progressing toward the student’s post-high school goals, and closely tracks the student’s progress, then students, parents and educators will rarely need to ask whether the student is “ready to graduate.” Instead, they will know if the student has received FAPE because the student’s IEP has included well-calculated transition services and there will be clear measures of the student’s progress with annual goals and transition-related services indicating whether this particular student requires support beyond the traditional 12 years of education.

I am grateful for the recent administrative advisory from DESE and have found each of their advisories on the topic of transition to be tremendously helpful in supporting a shared understanding of the transition planning process among families, schools, and the professionals supporting them. At NESCA, we have seen great progress in the delivery of individualized transition services across the state of Massachusetts since the Massachusetts Legislature approved the amendment to the Massachusetts special education statute in 2008 to require transition planning services “beginning age 14 or sooner” and DESE put out Technical Assistance Advisory SPED 2009-1: Transition Planning to Begin at Age 14. With the recent advisory, I am certain that we will continue to see more teams embrace the transition planning process early. Students, families, and districts will experience less confusion and distress as a student approaches the end of 12th grade, because there will be a clear plan for exiting or continuing special education based on effective transition planning and a collaborative and communicative team process.

Transition Resources and Advisories from MA Department of Elementary and Secondary Education 
· MA DESE Secondary Transition Page – http://www.doe.mass.edu/sped/secondary-transition/default.html
· Administrative Advisory SPED 2018-2:Secondary Transition Services and Graduation with a High School Diploma – http://www.doe.mass.edu/sped/advisories/2018-2.html
· Technical Assistance Advisory SPED 2017-1: Characteristics of High Quality Secondary Transition Services – http://www.doe.mass.edu/sped/advisories/2017-1ta.pdf
· Technical Assistance Advisory SPED 2016-2: Promoting Student Self-Determination to Improve Student Outcomes – http://www.doe.mass.edu/sped/advisories/2016-2ta.pdf
· Technical Assistance Advisory SPED 2014-4: Transition Assessment in the Secondary Transition Planning Process – http://www.doe.mass.edu/sped/advisories/2014-4ta.html
· Technical Assistance Advisory SPED 2013-1: Postsecondary Goals and Annual IEP Goals in the Transition Planning Process – http://www.doe.mass.edu/sped/advisories/13_1ta.html
· Technical Assistance Advisory SPED 2009-1: Transition Planning to Begin at Age 14 – http://www.doe.mass.edu/sped/advisories/09_1ta.html

While this blog includes some specific content that applies only to families of students in IEPs in Massachusetts, the requirement of transition services for students on IEPs is a federal mandate. For families living in New Hampshire, guidance from the New Hampshire Department of Education can be found athttps://www.education.nh.gov/instruction/special_ed/sec_trans.htm. The NH DOE has additionally helped develop a website with resources for increasing the college and career readiness of NH Students that can be found at https://nextsteps-nh.org.

 

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, EdM, CAS, is NESCA’s Director of Transition Services, overseeing planning,  consultation, evaluation, coaching, case management, training and program development services.  She 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 also 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. 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. She is also 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.

 

 

 

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

 

4

The Role of Pediatric Occupational Therapy

By | NESCA Notes 2018

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Community-Based Skills Coach

In order to fully understand the role that occupational therapy can play in pediatric health and wellbeing, it is first important to understand the term “occupation.”  The World Federation of Occupational Therapy (WFOT) defines occupations as, “the everyday activities that people do as individuals, in families, and in communities that occupy time and bring meaning and purpose to life.”  As we know, these activities look different at every age, and our routines, habits, and responsibilities are continually growing and changing.

During childhood, the development of these skills moves more quickly than any other period of life. For example, a two-year old little girl, Katie, is learning to put on her shirt independently, kick a ball, and sort by color.  Within ten short years, Katie may be getting herself ready for the bus, writing a three-paragraph essay, and learning to play the saxophone.  The transition to adolescence comes with even more new experiences and expectations.

So where does occupational therapy come in?

Occupational therapy focuses on the child, the activity at hand, and the environment around them.  By considering all of these factors, OTs work to determine the correct modifications, adaptations, and strategies that may be necessary for success.

What is the goal?

Due to the fact that occupations are incredibly personalized, the goal of OT is often to simply increase independence and participation in valued activities.  One child may be working on learning to independently tie his shoes, while another may need help developing a morning routine to consistently follow.  These goals are only worth focusing on and problem-solving if they are important to the child and his or her family.

How do we get there?

Consider the child’s strengths and limitations. These may include physical, emotional, cognitive, sensory abilities, and much more.  A child’s particular interests, level of motivation, and understanding of themselves all play a role in their ability to engage in the things that are important to them.

Consider the environment. The environment in which a child lives and grows is physical, spiritual, social, and cultural. It is this individuality that makes it nearly impossible for an environment to be a “good fit for all users.”  Occupational therapists often work to modify the environment, or help individuals understand the role that the environment plays.

Consider the activity itself. The list of childhood occupations is seemingly never-ending.  From brushing your teeth, getting dressed, and doing chores, to maintaining friendships, navigating the digital world, and learning to take the bus, these skills all require numerous steps and different abilities.  These activities often must be broken down into small steps to determine how to help a child be successful.

My work at NESCA

At NESCA, I am currently working as a community-based skills coach, using occupational therapy to create experiential learning opportunities, and develop functional living skills.  I love having the ability to work with tweens, teens, and young adults in their own environment to collaborate on creating lasting strategies for participation and independence.

Dr. Bellenis works with a small caseload of clients aged 12-26 who have recently participated in neuropsychological evaluation and/or transition assessment at NESCA. If you have questions about working with Dr. Bellenis for Community-Based Skills Coaching, please email Kelley Challen, Director of Transition Services, at kchallen@nesca-newton.com.

 

About the Author:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. Dr. Bellenisjoined NESCA in the fall of 2017 to offer community-based skills coaching services as well as social skills coaching as part of NESCA’s transition 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. In addition to her work at NESCA, Dr. Bellenis works as a school-based occupational therapist for the city of Salem Public Schools and believes that individual sensory needs, and visual motor skills must be taken into account to create comprehensive educational programming.

 

 

 

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

Neurodevelopmental Evaluations – Where and When to Start

By | NESCA Notes 2018

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

Parenthood is a daunting task to say the least. Not only must we worry about keeping our children healthy and safe, but we are constantly bombarded with information about potentially harmful foods, chemicals, toys, etc. Many parents also have concerns about whether their children are meeting developmental milestones on time and/or whether they should worry about certain behaviors their children are displaying.

When concerns arise about older children, parents are often advised to seek a neuropsychological evaluation to rule out possible attention, learning, or developmental challenges. However, parents of children under 5 are often urged to “wait and see” or might be told it is “too early” to seek an evaluation. The truth of the matter is that it is never too early to have your child evaluated when you are worried about his or her development.

Where do I start?

If you have concerns about your child’s development, it is always a good idea to start with your pediatrician. Describe what you are seeing at home and any difficulties you have noticed. Your pediatrician might recommend that you seek a comprehensive neurodevelopmental evaluation to assess for any developmental delays.

What is a neurodevelopmental evaluation?

This is a comprehensive set of tests designed to assess all aspects of your child’s development, including cognition, language, motor, and social skills. This type of evaluation is conducted by a pediatric neuropsychologist. First, you will be asked to provide information about your child’s developmental and medical histories. Your child will then be asked to participate in a series of activities over the course of 2 or 3 hours. For example, he/she will have to solve simple puzzles, label pictures, or play with different types of toys.

Why is a neurodevelopmental evaluation useful?

After completing the evaluation, the neuropsychologist will analyze all of the information and develop a comprehensive picture of your child’s developmental profile. In addition to helping you understand your child’s strengths and weaknesses, the neuropsychologist will also identify any developmental delays that require intervention.

What happens next?

An evaluation will identify developmental delays that need to be treated in order to help your child catch up with peers. Some examples include speech/language therapy, occupational therapy, physical therapy or applied behavior analysis (ABA).

For children under 3, this means they can start receiving Early Intervention services right away. Early Intervention is a system of services for babies and toddlers who have developmental delays or disabilities and is available in every state in the US.

For children over 3, parents can seek services privately, or can work with their local school district to develop an Individualized Education Program (IEP) for their child. Having an independent evaluation completed prior to your child’s transition to public education is extremely useful as it provides the district with the child’s type of disability and informs the process of developing necessary services.

Where can I go?

Neurodevelopmental evaluations are available at many local area hospitals as well as private neuropsychology clinics. Parents can also contact their insurance company for a list of providers or search through the Massachusetts Neuropsychological Society: https://www.massneuropsych.org/i4a/pages/index.cfm?pageID=3309.

At NESCA, we are proud to offer neurodevelopmental evaluations for children ages 1-5 and will provide parents with a comprehensive report, extensive recommendations for services, and ongoing consultation through the years. Our clinicians are able to do observations of children in their natural environments (e.g., day care, preschool) to gain a full picture of the child and provide environmental recommendations that would be most supportive. Moreover, we are available to attend meetings with early intervention specialists and special educators to help a child’s team fully understand their individual learning and service needs.

If you are interested in scheduling a consultation or evaluation at NESCA, please complete our on-line intake form: https://nesca-newton.com/intake-form/.

About the Author:

GibbonsErin 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.

 

0

Pre-Employment Transition Services – What Are They and Who Is Eligible?

By | NESCA Notes 2018
Business professional in a black suit extending a hand for a handshake.
What are MRC Pre-Employment Transition Services (Pre-ETS)?
How Could They Help Your Child on an IEP?

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

On July 22, 2014, the Workforce Innovation and Opportunity Act (WIOA) was signed into national law. The goal of the act is to help job seekers, including vulnerable populations such as individuals with disabilities, to access education, training, and support services enabling them to be successful in finding and sustaining employment.

In response to this act, Massachusetts developed a comprehensive workforce development plan involving a number of programs and partners including The Vocational Rehabilitation Program which spans across Massachusetts Rehabilitation Commission (MRC) and Massachusetts Commission for the Blind (MCB). One important aspect of this plan is that MRC must spend at least 15% of its Title I budget on pre-employment transition services (Pre-ETS) for students ages 16 to 22 with disabilities.
Whereas students historically did not begin involvement with MRC Vocational Rehabilitation (VR) services until the age of 18 or until exiting high school, many students on IEPs are now eligible for support at the age of 16 while enrolled in high school. Given that paid employment in high school is a predictor of both college success and adult employment, the opportunity to engage with MRC VR services in high school is an exciting opportunity!
Each Vocational Rehabilitation (VR) Office has contracted with local providers in order to offer services benefiting students in the following areas: Job Exploration Counseling; Workplace Readiness Training, Work-Based Learning Experiences; Counseling on Enrollment in Transition or Postsecondary Educational Programs; and Self-Advocacy/Mentoring Instruction. Often these services include activities like interest assessment, worksite tours, “soft skills” training, travel training, and paid internships.
Also, every public high school has an MRC liaison who often has office hours within the school. These liaisons are able to offer many direct services within the school setting including providing group education and attending IEP meetings when appropriate.
Transition services as part of an IEP process are designed to support students developing skills and making progress towards their postsecondary employment goals. However, educators may not be as familiar with employment trends and entry-level work skills as vocational rehabilitation specialists. The opportunity for a student to work with MRC VR counselor in conjunction with their IEP team creates a wonderful opportunity to make progress toward high school completion requirements while simultaneously preparing to become an employable adult.
To learn more about MRC and Pre-Employment Transition Services, please visit the following links:
Students with visual impairments may additionally be interested in Pre-ETS services through Mass Commission for the Blind (MCB) VR services:
About the Author:
Kelley Challen, EdM, CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. She 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 also 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. While Ms. Challen has special expertise 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. She is also 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.
0

Transition Planning: The Missing Link Between Special Education and Successful Adulthood

By | NESCA Notes 2018
What is Transition Planning and Why Does it Matter?

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

The Individuals with Disabilities Education Act of 2004 (IDEA 2004) is the law that guarantees students with disabilities an equal opportunity for a free and appropriate public education (FAPE). For professionals and parents supporting youth with special needs, and for the children we love, this is a powerful law. IDEA 2004 guarantees that no matter what a young person’s struggles, they have the right to learn and grow and be provided with the specialized instruction necessary for their individual progress.

While many people are aware that IDEA 2004 guarantees the right to special education for academic learning, the concept of “transition services” is still catching on. In addition to requiring that public schools educate our students, IDEA 2004 mandates that special education services are designed to meet a student’s unique needs and to prepare them for further education, employment and independent living. According to this influential federal law, it is not enough that students be included in learning core academics (reading, writing, math, science, history). Rather, we are mandated to ensure that students with disabilities make progress toward being able to manage learning, working, and daily living activities in their postsecondary adult lives.

In December, I was excited to see the Huffington Post (see link below) publish an article emphasizing the importance of transition services and the challenges for students both during and after public education if this part of special education is ‘forgotten.’ The article was written by Sarah Butrymowicz and Jackie Mader and published in partnership with The Hechinger Report, a nonprofit, independent news organization focusing on inequality and innovation in education. The authors profiled two young people who participated in public special education: Kate and Peter.

Kate’s educational program did not include meaningful transition services (e.g., career planning, homework activities) and was primarily driven by parent goals rather than person-centered activities. The initial outcome for Kate after special education was unemployment; after two years, her parents secured work for her using their own personal networks but not in an area of true interest or strength. Kate’s father summarized, “It was my absolute goal to have her not fall off the map. It’s unfortunate, she kind of has.”

Peter, however, was an active participant in his Individualized Education Program (IEP) process. While career testing indicated possible aptitude in food services, Peter wanted to be a Supreme Court justice and his team supported his enrollment in community college courses utilizing his school’s dual-enrollment program. With this experiential learning activity, Peter realized he was not interested in college and changed his goal, enrolling instead in vocational technical classes related to office administration. When Peter finished high school, he immediately went to work in an office and continued to full time employment as an administrative assistant at a nonprofit organization.

For so many students with disabilities, experiential learning is a critical component of their development of career, classroom, community living, and home living skills. This is best achieved when students have a collaborative IEP team and good transition services. Butrymowicz and Mader interviewed 100 parents, students, advocates and experts across the country and found that the best transition planning requires several things:

  1. An accurate and thoughtful assessment of a student’s abilities and interests
  2. Clear, measurable goals related to his or her postsecondary aspirations
  3. Appropriate support and services to help them achieve their goals

NESCA has provided person-centered transition services since 2009 and this article beautifully captured what we see every day in our work. What I love about being a transition specialist is helping young people to find their voices, to figure out what they love most, and to create small successes that can ultimately build into a meaningful postsecondary adult life. While many parents and educators I work with can find team meetings challenging or stressful, this is often my favorite part of the job — working collaboratively with the student, parents, educators, and community members to think creatively and build a unique strength-based transition plan.


Article:

Butrymowicz, S., and Mader, J. (2017). This ‘Forgotten’ Part of Special Education Could Lead To Better Outcomes For Students: Many former special education students struggle to find good-paying jobs, and high schools are partly to blame. The Huffington Post. Retrieved from https://www.huffingtonpost.com/entry/special-education-transition_us_5a341a65e4b0ff955ad2b810 

About the Author:
 
Kelley Challen, EdM, CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. She 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 also 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. While Ms. Challen has special expertise 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. She is also 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.

 

1

Understanding Motivation in Children and Teenagers, and Where We Went Wrong

By | NESCA Notes 2018

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

As parents and teachers, we hear, and say, these things all the time:

“Why doesn’t he just do it?”

“How many times do I have to ask you?”

“Why don’t you care about your work?”

“She just doesn’t have the drive.”

Be it schoolwork, chores, or social events, some kids seemingly just aren’t motivated to do things. We punish. We nag. We fight. But even with all of this, sometimes things do not change.

It is easy to become frustrated, but in this state of frustration, we often forget to ask ourselves why finding motivation is so difficult for the child.

There are two types of motivation – intrinsic and extrinsic. Intrinsic motivation is an internal desire or drive to do something based strictly on the resulting feeling of satisfaction or enjoyment. Extrinsic motivation relies on external rewards, such as money, good grades, stickers, toys, or other things. Intrinsic motivation has long-lasting effects, while behavior based on extrinsic motivation is fleeting.

Some children seem to develop intrinsic motivation naturally. For other children, we attempt to gain compliance or task completion through extrinsic motivation – behavioral charts, rewards, punishments, etc. Sometimes this works in the short term, but as soon as the rewards or punishments are gone, so is the behavior. Other times, even extrinsic motivation seems absent and behavior still does not change, no matter how big the reward or punishment.

Frustration ensues and we often find ourselves feeling or saying the above things – the child does not have the motivation, therefore the work or task does not get done. But where does this leave us? The adults are defeated, the child feels blamed, and the situation worsens.

So where’d we go wrong?

Our understanding of motivation is often backwards – motivation exists, therefore successful behavior occurs. This is wrong. We are not born inherently knowing how to motivate ourselves. We learn it through successful experiences in the world. So, what really happens is: successful behavior occurs, therefore motivation develops.

Lesson #1: Motivation is the effect, not the cause.

In reversing the relationship, we can now ask ourselves: “What is causing the lack of motivation?” If we are able to identify and address the underlying challenges, the child can begin to experience the successes that are necessary for motivation to develop over time. Further, in accepting that motivation is learned through experience and not inherent, we accept that the term “intrinsic” is somewhat misleading.

Lesson #2: Intrinsic motivation is not naturally intrinsic – it becomes intrinsic after feelings of success are internalized.

By identifying and addressing skills deficits, we can help children to experience more successes and increase their willingness and ability to “try harder.” Academic deficits, attention problems, anxiety, low self-esteem, social challenges, executive function weaknesses, among other things, can all interfere with motivation. Challenges in any one of these areas can, and will, interfere with motivation. As such, motivation is not a single thing. It is a complex skill that can only develop once other, more basic, skills have developed.

Lesson #3: Motivation is not one thing – it is the coordination of many skills.

Now viewing motivation as something that is learned over time as other, more basic, skills develop and a child experiences successes in life, we are better able to develop a plan for how to intervene.

Take home message: All children and teens can be motivated – it is our job to teach them how.

When motivation seems absent or fleeting, we must become detectives, working to figure out what underlying challenges or deficits are present. This may be aided through conversations with the child’s teachers or other support providers. Other times, a comprehensive evaluation may be necessary in order to specifically identify the child’s strengths and challenges, as well as receive individualized recommendations for how to address their needs.

Dr. Currie will be offering a free webinar about motivation and self-regulation this Spring. Stay tuned for sign-up information. 

About the Author:

Dr. Angela Currie conducts neuropsychological and psychological (projective) assessments out of NESCA’s Londonderry, NH and Newton, MA offices, seeing individuals with a wide range of concerns. She enjoys working with stressed-out children and teens, working to tease apart the various factors that may be lending to their stress, including assessment of possible underlying learning challenges (such as dyslexia or nonverbal learning disability), attentional deficit, or executive function weakness. She also often conducts evaluations with children confronting more primary emotional and anxiety-related challenges, such as generalized anxiety, obsessive compulsive disorder, or depression. Dr. Currie 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.

 

4

Increasing Reading Success: Early Identification of Reading Challenges

By | NESCA Notes 2017

 

By:  Alissa Talamo, Ph.D.
Pediatric Neuropsychologist

I recently attended the International Dyslexia Association Conference in Atlanta, GA (dyslexiaida.org). Among the conference attendees were researchers, teachers, speech-language pathologists, psychologists, and parents of children with dyslexia. One recurring key point was the importance of early identification of reading difficulties, as early provision of appropriate interventions and services leads to better outcomes.

It is important to remember that unlike seeing, hearing, and eating, reading is not something humans do naturally. Reading must be learned and it is not easy (Maryanne Wolf, Proust and the Squid).

As a parent, your early observations are important as there are many developmental indicators that may signal a risk for reading difficulties such as:

  • Experiencing repeated early ear infections
  • History of speech delay and/or pronunciation problems
  • Slow vocabulary growth, frequent difficulty finding the right word, use of less specific words such as “the thing,” “the stuff,” or “that place.”
  • Your child struggles to recognize words that start with the same sound (e.g., cat and car) or end with the same sound (rhyming).
  • Difficulty learning letter and number symbols when in preschool
  • Family history of reading problems

During first grade, you can watch for these warning signs as you listen to your child read aloud:

  • Does not know the sounds associated with all of the letters
  • Skips words in a sentence and does not stop to self-correct
  • Cannot remember words; sounds out the same word every time it occurs on the page
  • Frequently guesses at unknown words rather than sounding them out
  • If you ask your first grader to read aloud to you and he/she is reluctant and avoidant

Remember: 

Early identification of reading issues is extremely important for outcome. If children who have dyslexia receive effective phonological awareness and phonics training in Kindergarten and 1st grade, they will have significantly fewer problems learning to read at grade level than children who are not identified or helped until 3rd grade.

What should I do if I suspect my child has challenges with reading?
If you suspect your child is struggling to learn to read, have your child receive an independent comprehensive evaluation so that you understand your child’s areas of cognitive and learning strengths and weaknesses. This evaluation should also include specific, tailored recommendations to address your child’s learning difficulties.

To learn more about evaluations and testing services with Dr. Talamo and other clinicians at NESCA, you may find the following links helpful:

What if I am not sure whether my child needs a neuropsychological evaluation?

When determining whether an initial neuropsychological evaluation or updated neuropsychological evaluation is needed, parents often choose to start with a consultation. A neuropsychological consultation begins with a review of the child’s academic records (e.g., report card, progress reports, prior evaluation reports), followed by a parent meeting, during which concerns and questions are discussed about the child’s profile and potential needs. Based on that consultation, the neuropsychologist can offer diagnostic hypotheses and suggestions for next steps, which might include a comprehensive neuropsychological evaluation, work with a transition specialist, or initiation of therapy or tutoring. While a more comprehensive understanding of the child would be gleaned through a full assessment, a consultation is a good place to start when parents need additional help with decision making about first steps.

Sources used for this blog:

 

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.

 

4

Emerging Psychosis: When to worry about your teen’s thinking

By | NESCA Notes 2017

 

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

Emerging Psychosis: When to Worry about Your Teen’s Thinking

Teenagers are famous for incidents of bad judgment and poorly considered decisions; it is one of the rites of passage for parents and children to have had at least one “What were you thinking?” discussion before the teen leaves the family nest for college or employment. These events are often memorable, however, because they tend to be outliers, occurring simultaneously with instances of relatively accurate appraisals of situations and relatively adequate problem-solving as they navigate the expectations of school, family, friends, and community.

Some parents must confront a separate set of ongoing concerns about their child’s thinking that effect their assessment of the world and themselves. In this article, I will talk about the nature of psychosis, describe the changes leading up to an episode of psychosis and outline emerging models of treatment which aim to prevent the first acute episode or at least delay onset of the episode as much as possible. These findings emphasize the critical importance of early identification and treatment of symptoms to prevent or reduce future impairment.

The Nature of Psychosis
Psychosis refers to a condition in which a person has lost contact with reality and is unable to distinguish what is real and what is not. Psychotic symptoms include what are called “positive” (what is present) and “negative” (what is absent) symptoms.

  • Positive symptoms include: abnormalities of thinking in both content as well as form; the former refers to distortions of reality such as hallucinations or delusions, and the latter refers to disorganization of thinking and bizarre behavior.
  • Negative symptoms refer to the reduction of emotional response (“blunted” or incongruous affect), apathy and loss of motivation, social withdrawal, impaired attention, reduced speech and movement, loss of enjoyment in life (“anhedonia”).

Researchers have also identified subtle cognitive impairments that include:

  • Deficits in processing speed
  • Executive function
  • Sustained attention/vigilance
  • Working memory
  • Verbal learning and memory
  • Reasoning and problem solving
  • Verbal comprehension
  • Social cognition

The impact of these issues can result in severe functional deficits across a range of domains such as work, school, and relationships.

Psychosis is now thought to be a neurodevelopmental disorder, meaning that it is thought to be related to abnormalities in brain development that become apparent as the brain matures in adolescence. Psychosis is thus a condition that emerges gradually as the underlying dysfunction comes to the fore. It is also thought to be a neurodegenerative disorder, meaning that the disease causes physical changes to the brain that results in impaired functioning. These changes include, on average, slightly larger lateral ventricle and slightly less cerebral gray matter for people at the first psychotic break compared to controls. From a behavioral perspective, researchers have found that the longer people live with an untreated psychosis, the more likely they are to experience functional impairments, have a poor response to psychiatric medications, and experience a poor quality of life. These alarming findings have prompted researchers and clinicians to research the period of time before the first psychotic break, referred to as the prodromal period, where symptoms start to emerge, in an effort to discover a way to divert or slow this process.

The Prodromal Period

The prodromal period is a time when “subclinical”, or milder symptoms of psychosis begin to appear. This period can vary in length from a few weeks to a few years. During this period, the adolescent or young adult may experience mild disturbances in perception, cognition, language, motor function, willpower, initiative, level of energy, and stress tolerance. These are differentiated from frank psychosis by lower levels of intensity, frequency or duration. The teen may complain of nonspecific clinical symptoms such as depression, anxiety, social isolation, and/or difficulties with school. They then may start to occasionally experience positive symptoms that are brief in duration and moderate in intensity. These events may become more serious over time, although they don’t happen often, last for only a few minutes to hours, and the person still retains some insight as to the unusual nature of the phenomena. However, this situation changes as the person comes closer to the initial psychotic break, signaled by the emergence of unusual thoughts, perceptual abnormalities, and disordered speech.

Risk and Resource

Who is most likely to move from the prodromal period to frank psychosis? Factors most predictive of this transition include people with a family history of psychosis and a recent deterioration of functioning, a history of substance abuse, and higher levels of unusual thoughts and social impairments. Other mediating factors include poor functioning, lengthy time period of symptoms, elevated levels of depression or other comorbid conditions, and reduced attention.

What factors appear to ameliorate risk of descending into psychosis? Risk/protective factors include higher premorbid cognitive skills and social skills and lack of a history of substance abuse.

How and When to Intervene

The information provided here about emerging psychosis underlines the critical importance of early intervention to address the serious and pervasive impact on functioning. Professionals who treat people at risk of psychosis are now beginning to use a clinical staging of treatment, meaning treatments should be tailored to the client’s needs, starting with safer and simpler interventions for the prodromal stages and increasingly intensive and aggressive treatment for people who are already contending with psychosis. This requires starting with what appears to be most problematic at the time for the person. For some people, this means treating the comorbid psychiatric conditions. For those who are experiencing difficulties with attention/executive function or reporting elevated levels of unusual symptoms, it may mean starting the person on an atypical antipsychotic. The use of targeted psychosocial interventions such as cognitive behavioral therapy, social skills training, and family therapy have all been found to be associated with reduced or delayed transition to first episode psychosis.

Where to Go for Help

Living in the Boston area, we are fortunate to have a wealth of resources in our hospitals and training sites that are engaged in cutting edge research and intervention to address the needs of young people who are contending with emerging psychosis. These include Beth Israel-Deaconess Hospital’s Center for Early Detection and Response to Risk (CEDAR) and the Prevention and Recovery in Early Psychosis (PREP) jointly run by the Beth Israel-Deaconess and Massachusetts Mental Health Center. Also, Cambridge Health Alliance offers the Recovery in Shared Experiences (RISE) program for the treatment of first episodes of psychosis.

Neuropsychological testing, augmented by psychological testing can be a useful tool to learn more about cognitive and emotional functioning. However, this is best undertaken as part of a comprehensive program of intervention.

 

Articles used for this blog:

  • Larson, M, Walker, E, and Compton, M (2010) Early Signs, diagnosis, and therapeutics of the prodromal phase of schizophrenia and related psychotic disorders, Expert Review of Neurotherapy. Aug. 10 (8), 1347-1359. https://www.nimh.nih.gov/health/topics/schizophrenia/raise/what-is-psychosis.shtml
  • NPR Your Health Podcast (2014) Halting Schizophrenia Before It Starts
  • Miller, Brian Negative Symptoms in Schizophrenia; The Importance of Identification and Treatment, Psychiatric Times, March 2017

 

 

About the Author:

Monaghan-BloutFormerly an adolescent and family therapist, Dr. Stephanie Monaghan-Blout is a senior clinician who joined NESCA at its inception in 2007. Dr. Monaghan-Blout specializes in the assessment of clients with complex learning and emotional issues. She is proficient in the administration of psychological (projective) tests, as well as in neuropsychological testing. Her responsibilities at NESCA also include acting as Clinical Coordinator, overseeing psycho-educational and therapeutic services. She has a particular interest in working with adopted children and their families, as well as those impacted by traumatic experiences.

 

 

To book a consultation with Dr. Monaghan-Blout 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.

 

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