Tag

academics

Teens Online: Participation vs. Observation

By | NESCA Notes 2021

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

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

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

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

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

 

About the Author

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

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

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

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

 

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

 

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

 

Digital Literacy, Executive Function and Remote Learning

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L

Occupational Therapist; Real-life Skills Program Manager and Coach, NESCA

The experience of watching a small child who is only two or three years old pick up a smartphone, quickly type in a passcode (as they have memorized the pattern) and open up their favorite game can be jarring for adults who remember the days of dial-up internet and who learned to use technology as it staggeringly evolved. For many of today’s children, handheld electronics have always been a fundamental part of their world. Flipping between apps, using their pointer finger to manipulate games and opening a screen using facial recognition all feel like second nature to many in the current generation of school age children. We assume that children have higher digital literacy than we do and intrinsically understand technology in a way that many of us never will. But what do our children actually know? And, are they missing out on vastly important direct instruction when adults make an assumption that they are already tiny experts in the digital field?

Over the past six months, a time fraught with a monumental shift in education, I have worked one-on-one with a widely diverse group of learners. If I had to pinpoint one theme that comes up over and over, across ages, levels of ability and school systems, it is frustration, confusion and lack of problem-solving strategies as they relate to technology. Statements I have heard during this period of remote learning include:

  • “I don’t turn off my Chromebook. I lose everything, and I’m actually not quite sure that I know how to turn it back on.” – High school honors student
  • “I didn’t know that Google Slide and PowerPoint were different things. I lost so much trying to switch between them.” – High school senior
  • “Hardware or software? I didn’t realize there was a difference.” – Middle school student
  • “I just save my document with whatever my computer suggests as a title. I guess it does make it tricky to find things later.” – High school junior

As an occupational therapist focused on making sure our students can access their curriculum, comments like these teach me a few incredibly important lessons.

  1. Students are lacking information on the basics. The same student who is not sure how to turn off his Chromebook can quickly navigate Google Classroom without any support, both uploading files and opening modules with ease. We need to focus on teaching the fundamentals of technology. What are hardware and software and how to they interact? What options exist within the system preferences of a particular device? How is an iPad different from a Chromebook, a Windows laptop or a MacBook? Why do we need to power down devices sometimes? What are the downsides to never restarting a computer or updating an operating system?
  2. Successful digital organization does not come naturally. Students are typically taught specific systems for organizing physical space and materials, such as color-coded folders, binders and labels. Teaching students to organize their digital space and their digital materials is equally, if not even more, important. Learning to create folders for each class and systematic ways of labeling documents saves students time and energy, and this often decreases frustration in the moment.
  3. Academic and professional tools are not particularly intuitive (a stark contrast to entertainment tools). There are incredible programs designed to help students create presentations, synthesize data and put documents together. These include, but are not limited to, the Microsoft Suite and Google Workspace. These tools can be tricky to manipulate and many middle and high school students would benefit from taking an introductory course, watching online tutorials or working directly with teachers to explore their functionality before layering on assignments requiring competent use of the tools.
  4. Students are often completely unaware of their gaps in knowledge. This is potentially due to the fact that today’s students are so impressive when it comes to using technology for leisure purposes. They seamlessly transition from an iPad, to a Chromebook, to a Samsung phone and can access games or social media without difficulty on each device. Unfortunately, very few schools have programs focused on teaching computing skills or digital literacy in the academic context. Our students piece together enough information to get by for a short while, but often come up against challenges later. Students also may believe they have built competency because they have some exposure to a tool. For instance, I have worked with students who are building resumes and including claims such as, “Proficient in Excel, PowerPoint and Word” but score poorly when tested on these computer abilities.

So, what do can we do?

The first step towards ensuring that a child or adolescent has adequate digital literacy skills is to actually assess how much they already know. Some students do have these skills mastered and others will have unexpected deficits or gaps. This assessment can be done formally or informally. A starting point I often use is to sit down with a student at a computer and ask how they organize, how they navigate, how they save files, etc. I also like using online assessment resources, such as TypingClub.com and Northstar Digital Literacy.

Once the skills that a student needs to grow are identified, there are many opportunities available to teach them. A few options include:

  • Online courses in specific software programs. Sites, such as Coursera, LinkedIn and Udemy, have comprehensive courses focused on specific programs for all different levels of learners.
  • Free online videos. A quick search on YouTube often leads to short, accurate videos and tutorials filmed by teachers or professionals. If your student learns well through video format, these can be a great tool.
  • Ask your school for support. Often, students learn better with direct instruction. If a student’s team is aware of their lack of knowledge regarding technology, there are many professionals at school who may be able to teach these skills during a free period, study hall or meeting.

 

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.

 

Multi-sensory Learning: Bringing it into the Home

By | NESCA Notes 2020

Sophie Bellenis, OTD, OTR/L

By: Occupational Therapist; Real-life Skills Program Manager and Coach

In our last OT Tuesday blog, we delved into the topic of multi-sensory learning: what it is, what it looks like in the classroom and what it intends to do. We reviewed the fact that this technique consists of targeting children’s auditory, visual, tactile and kinesthetic systems with hands-on learning activities. This week we will further discuss multi-sensory learning and brainstorm ways that this approach can be incorporated by parents into home-based learning. Multi-sensory learning is hugely variable and can be applied in a plethora of creative ways. Here are some tips to help tailor this approach to your child at home.

  1. Consider Your Child’s Learning Profile. It is common knowledge that both children and adults tend to have a unique style of learning, as well as preferences for how information is presented. Think about how your child has learned from you in the past. Did she learn to wash her hands thoroughly by singing a song? Watching a timer? Observing you demonstrate the best way first? Information from teaching simple tasks like these can help you suss out how your child may best learn and take in academic information. If you are unsure, consider reaching out to teachers and professionals who have worked with your student in the past. Teachers are excellent at determining the ideal way to present information to each child. They may be able to help you better understand your child’s unique learning profile and give suggestions for activities.
  2. Create Manipulatives. Manipulatives, or things that children can hold, feel and manipulate with their hands, are tools that help solidify concepts for many of our tactile learners. While school buildings are often full of creative manipulatives, many of these are easy to make using household objects. Have your child cut up cereal boxes to make letter cards. Write numbers on bottle caps or rocks and have your children count them out or create math equations. Cut up paper plates into slices to help visually represent fractions. Use an egg carton with ten cups to build a homemade ten frame. Write out words using pipe cleaners or clay. If you are not feeling particularly “DIY,” many manipulatives can be purchased online. Here are few options for manipulatives, by subject:
  1. Consider Learning Opportunities in Your Community. There are, of course, universal lessons and aspects of curricula that are consistent across the Unites States. Children all work to learn their letters, the basics of addition and subtraction, and eventually how to write a paragraph. In contrast, the unique fabric of the varied communities across our country, allows for specific education through hands-on experiences in our environments. In New England, we have access to the coast, historic sites relating to the Revolutionary War, and many state and national parks. Teach environmental science by exploring tidepools and looking at sea creatures. Involve kinesthetic learning by having your children walk along part of the Freedom Trail. Get your children outside and show them physical representations of the things that they read about and see in pictures.
  2. Tap into Online Resources. Some of the most effective multi-sensory learning tools are quite simple. Having a child follow along in a book as they listen to someone read out loud targets both the visual and auditory systems. Kids both review their spelling and focus on reading comprehension while they listen. Videos and audio recordings of educators and parents reading children’s books aloud can be found on YouTube, Audible and many other internet sites. Look at your personal library and search the titles to see whether this option is readily available. Additionally, with this teaching method becoming increasingly evidenced-based and popular, sites such as Pinterest, TeachersPayTeachers and Understood.org have excellent ideas and examples of activities to incorporate into your day.
  3. Use What You Have. Many of the multi-sensory learning activities, especially for younger children, invite kids to get their hands dirty and feel. We prompt children to practice writing their letters in bins of beans or rice. We practice patterns with popsicle sticks or blocks. We use playdough or clay to both make art projects and forms letters. Look around your house and see what you already have available. If you do not have rice or beans, but you do have some sand outside, write letters in sand! If your supply of popsicle sticks ran out back in March, have your children step outside and collect 20 small sticks each. Use those sticks to spell out words. Color them with markers and then line them up to create patterns. Have your child dip them in water mixed with food coloring and practice writing letters on a piece of paper. Multi-sensory learning is all about having children learn from the complex and rich environments around them, while using multiple sensory pathways within their bodies. Teaching materials are all around us!

 

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.

 

Multi-sensory Learning: More than Just a Buzz Word!

By | NESCA Notes 2020

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

As teaching methods continue to become more and more creative, and learning is being facilitated through interventions that target all types of students, the term “multi-sensory learning” has started to cement its place in the educational lexicon. You may have seen a line in an evaluation, such as, “This student would benefit from a multi-sensory learning approach,” or “The use of multi-sensory teaching methods will help this student to solidify their learning.” In some ways this phrase is easy to interpret. Multi means many. Sensory refers to the body’s different senses, the tools we use to interpret and experience the environment around us. Reason would tell us that this phrase means using all of these senses to acquire knowledge, information, and skills, and….it does! But what does this look like in practice? How are professionals actually using this method to help our children learn?

If you picture a typical classroom from a few decades ago, there is a teacher standing up at the front of the room providing students with information to copy down into their notebooks. These students are receiving information through the auditory system only. They are being expected to listen, comprehend and retain the lesson using one sense, their hearing.

Now let’s picture the classroom of a teacher using multi-sensory learning techniques. Often, students are clustered in different areas with a teacher checking in at every table to provide each small group with support. Students are looking at images or pictures of the object they are studying, both reading information and hearing it clarified by their teacher, and are likely using manipulatives, or things they can feel to help understand the content. These students are learning through their visual, auditory and tactile systems.

Humans grow, evolve and learn in complex, multi-sensory environments that are constantly targeting all of our senses. Our brains are built to learn through a combination of visual, auditory, tactile and kinesthetic data (Shams & Seitz, 2008). Using visual methods helps children learn through the sense of sight; auditory through the sense of hearing; tactile through the sense of touch; and kinesthetic through body movement. Children display greater performance when learning activities target all of these systems, as opposed to when they are taught using one modality (Broadbent, White, Mareschal, & Kirkham, 2018).

As an example, let’s look at teaching Kindergarten students their letters. A robust multi-sensory approach to teaching the alphabet includes looking at pictures of the letters, saying the sounds out loud as a class, tracing the letters in the air with one finger, making each letter out of playdough, writing the letters in bins of rice, making the student’s bodies into the shape of individual letters, and finally picking up a pencil to attempt to form the letters on the page independently. Students gain a comprehensive understanding of the letters as their brains have been targeted across multiple sensory systems.

There is substantial research for using this multi-sensory approach for another foundational academic skill: reading (Walet, 2011). Many of the most well-known phonics and reading programs, such as Orton-Gillingham and the Wilson Reading System, use these strategies to help students who learn differently to master this skill (AOGPE, 2012 & Wilson, 2017). When using some programs students learn to tap out syllables and letters on their fingers as they read, incorporating tactile feedback. Others focus on including books on tape so that students both see and hear each word as it is read aloud.

Other excellent examples of multi-sensory learning in the classroom include:

  • Songs and rhythm to solidify content
  • Base ten cubes as math manipulatives
  • Fieldtrips!
  • Games involving movement, such as flashcard races, Around the World and clapping games
  • Paper with raised or highlighted lines for tactile or visual feedback
  • Video clips to review concepts
  • Real coins and dollars when learning about money
  • Science experiments in a high school lab

While students are currently all at home receiving their lessons and assignments through a digital medium, many are missing out on the creative ways that their fabulous teachers use these strategies in their classrooms. In my next blog, we will discuss some ways to incorporate these strategies in the home!

 

References

Academy of Orton-Gillingham Practitioners and Educators (AOGPE). (2012). The Orton-Gillingham

Broadbent HJ, White H, Mareschal D, Kirkham NZ. Incidental learning in a multisensory environment across childhood. Dev Sci. 2018;21(2):e12554. doi:10.1111/desc.12554

Shams, L., and Seitz, A.R. Benefits of multisensory learning. Trends in Cognitive Sciences, 60, November 2008, pp. 411-17.

Walet, J. (2011). Differentiating for Struggling Readers and Writers: Improving Motivation and Metacognition through Multisensory Methods & Explicit Strategy Instruction. Journal of the American Academy of Special Education Professionals,83-91.

Wilson, B. (2017). Teaching total word structure. Wilson Language Training Corporation.

 

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.

 

Visual Motor Integration Deep Dive – Part 2

By | NESCA Notes 2020

 

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

Last week’s blog taught us the nuts and bolts of Visual Motor Integration. Let’s jump into the what VMI really means for students who struggle with VMI.

Research has shown a statistically significant correlation between performance on visual motor integration assessments and teachers’ assessments of early elementary school students’ reading, mathematics, writing and spelling ability (Optometry and Vision Science, 1999; Pereira, D., Araujo, R., & Braccialli, L., 2011). Now that we understand what visual motor integration is as a concept and that it is a foundational skill for academics, let’s look at some areas of education that may be difficult for children with visual motor dysfunction.

  • Written Output – Beginning in preschool, children start to learn how to draw vertical, horizontal and diagonal lines. They practice circles, squares, crosses and drawing an X. All of these are considered pre-handwriting practice. As a child moves along in their academic career, they start incorporating these movements into letters and eventually words. Children who struggle with VMI have particular difficulty recreating the images that they see. This often manifests itself in letter reversals, illegible written output and inability to judge whether their copy looks like the model or not. As children get into later grades, visual motor dysfunction may include difficulty copying information from a whiteboard, trouble staying on the line or within the space provided, and a simple lack of fluidity when writing. Tasks, such as filling out graphic organizers and brainstorming, feel tedious and tiring, as opposed to helpful.
  • Math – While math is not typically thought of as a motor-based task, substantial portions of current math curriculums rely on visual motor integration. For younger students, drawing shapes, writing equations and recognizing patterns may be particularly tough. As students get older, geometry requires them to write out proofs and draw shapes, while calculus requires graphing and drawing lines based on complex equations. Building on VMI helps students to access more than simple written output.
  • Using Classroom Tools – While this may not seem as academically focused as the other areas that are affected by VMI, classroom tools are frequently used throughout the school day. Scissors, a stapler, a hole puncher and a mouse/keyboard all require some level of visual motor function.

It’s difficult to briefly sum up all of the ways that students are incorporating their visual motor integration skills into a typical school day, or realistically a day in general. They use these skills without even realizing it, which means they unintentionally practice them all day. VMI is something that can continue to develop all through the lifespan. Artists pick up new tools and build mastery, adult calligraphy classes have become a new fad as people learn to modify and improve their handwriting, and even Tom Brady continues to work on perfecting that spiral. Targeted intervention can help children build on their foundation and find confidence in their abilities. If you feel that VMI might be affecting your child’s education, reach out to an occupational therapist and see if they can help you better understand your child’s individual profile.

 

References

Optometry and Vision Science: March 1999 – p 159-163. Retrieved from https://journals.lww.com/optvissci/Abstract/1999/03000/Relationship_between_Visual_Motor_Integration.15.aspx

Pereira, D., Araujo, R., & Braccialli, L. (2011) Relationship between visual-motor integration ability and academic performance. Journal of Human Growth and Development, 21(3), 808-817. Retrieved_from https://www.researchgate.net/publication/317462934_Relationship_analysis_between_visual-motor_integration_ability_and_academic_performance

 

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.

 

Visual Motor Integration Deep Dive – Part 1

By | NESCA Notes 2020

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

If your child is currently receiving occupational therapy services in either a sensory clinic or a school-based setting, it is likely that you have heard the phrase “visual motor integration (VMI).” It has possibly been described as the ability to “see something and then recreate it with a pencil,” or “coordination between the eyes and the hands to create an intended outcome.” While these phrases or simple definitions do give some insight into the skill, there are layers to understanding the intricacies of VMI and how it may affect someone in a classroom setting. Why is visual motor integration important? Why does this skill affect a child’s ability to successfully access their curriculum? And really, why do occupational therapists seem to be so focused on this foundational skill?

Let’s start by dissecting the phrase visual motor integration, as each word truly highlights an important aspect.

Visual.

In this sense, “visual” refers to the functional visual skills and visual perception. Functional visual skills include being able to follow along a horizontal, vertical or diagonal line with one’s eyes, as well as being able to account for depth by focusing on objects that are both close to the face (a book) and far away (the whiteboard). Clinically, these skills are referred to as visual tracking and convergence respectively. Visual perception is the brain’s ability to interpret the data that the eyes are seeing and turn it into meaningful information. This is not simply the ability to clearly see something, a skill that is often assessed by school nurses or optometrist. It is the ability to understand it. Visual perception is complex in its own right, but the specific details are for another time, or potentially another blog.

Motor.

Similar to visual skills, “motor” refers to one’s overall motor skills. This includes:

  • Fine motor control – the ability to use the small muscles in the hands to make coordinated movements;
  • Gross motor – the ability to use the large muscles in the body; and
  • Postural stability – the ability to create a supported foundation when sitting or standing; a child’s postural stability is hugely affected by their core muscles and their position when sitting.

Integration.

Some students have visual motor dysfunction because of a deficit in either their visual skills or their motor skills. They find using these two skills together difficult simply because one foundational piece is already affected. Conversely, some students have trouble with VMI simply because of this integration piece. Being able to use these two skills in conjunction with intention and coordination is a skill within itself. Through standardized assessment and clinical observation, occupational therapists should be able to determine the root cause of a child’s VMI dysfunction. This helps to guide appropriate intervention and accommodation. In some ways, visual motor integration is similar to hand-eye coordination.  Being able to recreate something that a child sees, such as a square, the letter “A” or a horizontal line is truly using VMI skills.

Next week, we’ll dive further into VMI and how it serves as a foundational skill for academics, its impact on learning and the output students produce.

 

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.

 

The Enemy of the Good

By | NESCA Notes 2020

By Jason McCormick, Psy.D.
Pediatric Neuropsychologist

As a neuropsychologist who has primarily focused on assessment of middle school, high school and college students, I have worked with many children, adolescents and young adults plagued with perfectionism. On the surface level, perfectionism is defined as a refusal to accept any standard short of perfection. Digging deeper, at the roots of perfection are fears of making mistakes, fears of being judged, and, ultimately, fears of being inadequate.

By definition, students with perfectionism hold impossibly high standards, which can severely undermine productivity and can lead to high levels of emotional distress. The adage, perfection is the enemy of the good, “perfectly” describes these students’ challenges. Students with perfectionism often run into “blank-screen syndrome,” presenting with such a harsh self-censor that they shoot down their own good ideas before they have a chance to develop them. Further, with the additional time needed to “gild the lily,” students often end up blowing past paper deadlines, thus undermining their grades.

Complicating treatment, many students – even those with recognition of their impossibly high standards – view a call to work on ameliorating their perfectionism as an intolerable directive to lower their standards or even as an affront to their intelligence and ability levels. Thus, despite the emotional distress and work production challenges perfectionism causes, many students with perfectionism present with insufficient motivation to change.

In response, treatment needs to begin with helping these students appreciate the negative impact perfectionism can have on their mental health, and, from a more mercenary standpoint, on their grades. Further, it will be important for these students to be able to broaden their definition of success beyond mere quality to include a balance of quality and efficiency. An A paper turned in two weeks late might earn a B, C or even (depending on the philosophy of the teacher or professor) a failing grade, due to its tardiness.

After securing some buy-in, work with a therapist or therapeutic tutor, with background in cognitive-behavioral therapy, is often needed to move the needle on perfectionism. More specifically, the use of exposure and response prevention (ERP) can be effective. Typically used to treat obsessive-compulsive disorder (OCD) and phobias, ERP involves exposing an individual to their feared stimulus (e.g., heights, snakes and in this case sub-perfect work) and not allowing for the avoidant response (in this case, over-reviewing/over-thinking behaviors that are used to avoid the possibility of mistakes). For instance, an ERP assignment might involve a student setting a reasonable time limit to complete a given task and having the student pass in that work, no matter what final state it is in. Over time, such work can help a student progress toward their ultimate goal of producing “the good enough paper.”

To be clear, this progress does not happen overnight, and it can feel difficult and mentally painful. However, it is important work, as learning to strike a reasonable balance between quality and efficiency is a critical element of the “hidden curriculum,” needed for success in college and the workforce.

 

About the Author:

Dr. Jason McCormick is a senior clinician at NESCA, sees children, adolescents and young adults with a variety of presenting issues, including Attention Deficit Hyperactivity Disorder (AD/HD), dyslexia and non-verbal learning disability. He has expertise in Asperger’s Disorder and has volunteered at the Asperger’s Association of New England (AANE). Dr. McCormick mainly sees individuals ranging from age 10 through the college years, and he has a particular interest in the often difficult transition between high school and college. As part of his work with older students, Dr. McCormick is very familiar with the documentation requirements of standardized testing boards. He also holds an advisory and consultative role with a prestigious local university, assisting in the provision of appropriate academic accommodations to their students with learning disabilities and other issues complicating their education.

 

To book a consultation with Dr. McCormick 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.

 

Identifying and Supporting Twice-exceptional (2e) Children

By | NESCA Notes 2019

By: Alissa Talamo, PhD
Clinical Neuropsychologist, NESCA

  • Rodney gets decent grades and achieves close to or at grade level in all of his district assessments. When concerns about his reading achievement were raised and an evaluation was conducted, it was found that his IQ is well above average, superior in some areas, but his reading decoding scores are below the average range for students his age. He has a combination of some gifted abilities and other areas that require intensive intervention. Rodney is twice-exceptional. (National Education Association, The Twice Exceptional Dilemma).
  •  Because of his behavioral difficulties, James attends a special program within his school for students with emotional and behavioral disorders. His teachers have difficulty seeing him as “gifted” as he is often uncooperative and reluctant to perform academic tasks in class. However, indicators are there. He participates in a weekly community program with students who are not disabled, to design a functioning robot and does so with a tremendous amount of ingenuity. He is also an avid reader outside of school and can offer a very keen oral analysis of the works he has read.  James is twice-exceptional.  (National Education Association, The Twice Exceptional Dilemma).

Twice exceptional—or “2e”—students are those who possess outstanding gifts or talents and are capable of high performance, but who also have a disability that affects some aspect of learning (Brody & Mills, 1997).  The largest group of twice exceptional children are those students who are academically gifted but who also have a disability (e.g., learning, physical, social/emotional or behavioral).

Some common characteristics of gifted students who also have a disability include:

  • Demonstrates a high verbal ability, but displays extreme difficulties in written language (reading, written expression)
  • Has strong observation skills but difficulty with memory skills
  • Shows attention deficit problems, even though they demonstrate special talents that consume their attention
  • Understands concepts at a high level, but struggles with basic skills (e.g., reading decoding, math fact fluency).

As a result, these students are at risk of facing challenges, such as:

  • Asynchronous development (the child is far ahead intellectually, but far behind socially and emotionally)
  • Underperforming academically
  • Frustration
  • Argumentative personality
  • Sensitivity to criticism
  • Poor study habits and organizational skills
  • Difficulty in social situations
  • Because they are clearly bright but performing poorly, they may be perceived as “lazy,” which, in turn, puts them at risk for criticism that can negatively impact self-esteem, which can also put them  at risk for depression.

Unfortunately, in the states of Massachusetts and New Hampshire, there is currently no gifted education legislation. As a result, schools are not required to identify gifted students.  Even if a specific school system does choose to identify these students, there is no mandate to create a program for those identified, and there is no gifted funding.  Massachusetts and New Hampshire are two of only eight U.S. states that do not have a gifted and talented mandate. And while Rhode Island has mandated identification of gifted students and requires programs to serve those students, it does not provide the schools with any government funding.

Since Massachusetts and New Hampshire are not yet mandating screenings for giftedness, nor mandating programs for these students (although some schools do so independent of the lack of mandate), it is important for parents to be informed of their child’s learning profile to advocate for needed services as well as to encourage their child’s areas of strengths and interests. The best way to determine if a child meets criteria for twice exceptionality is through a neuropsychological evaluation. A thorough neuropsychological evaluation will help a parent and school understand a child’s cognitive, academic and social/emotional strengths and weaknesses, helping to identify what supports or programming that specific child truly needs.

In addition, there are supports out there, as many giftedness programs and extra-curricular opportunities exist. Some helpful websites include:

  • davidsongifted.org – along with a strong (and easily searchable) database, the Davidson Institute and Davidson Academy are dedicated to supporting profoundly gifted students in the United States, including summer programs, scholarships and an accredited online school.
  • massgifted.org – The Massachusetts Association for Gifted Education’s (MAGE) mission is to support and advance the understanding of high potential/gifted children and their special needs, to promote the establishment of programs, services and opportunities for high ability/gifted students, and to encourage the exchange of information pertaining to gifted individuals among educators, parents, policy-makers and students on the national, state and local levels.

Additional sources used for this article:

childmind.org/article/twice-exceptional kids both gifted and challenged

www.nea.org/assets/docs/twiceexceptional.pdf

www.understood.org/myths about twice exceptional 2e students

https://www.givingcompass.org/article/schools-struggle-to-serve-gifted-students-with-disabilities

 

 

About the Author:
Talamo

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 StudentsDr. 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.

 

To book a neuropsychological evaluation or consultation  with Dr. Talamo or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate that you would like to see “Dr. Talamo” in the referral line.

 

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.