NESCA has unexpected availability for Neuropsychological Evaluations and ASD Diagnostic Clinic assessments in the Plainville, MA office in the next several weeks! Our expert pediatric neuropsychologists in Plainville specialize in children ages 18 months to 26 years, with attentional, communication, learning, or developmental differences, including those with a history or signs of ADHD, ASD, Intellectual Disability, and complex medical histories. To book an evaluation or inquire about our services in Plainville (approx.45 minutes from NESCA Newton), complete our Intake Form.

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Accommodations

Pediatric-onset Multiple Sclerosis

By | Nesca Notes 2023

By: Ferne Pinard, Ph.D.
NESCA Pediatric Neuropsychologist

Although typically thought of as an “adult illness,” children and adolescents can get diagnosed with multiple sclerosis (MS). Pediatric-onset multiple sclerosis (POMS) occurs when MS is diagnosed before age 18.

Approximately 30% of POMS patients show evidence of cognitive impairment. Problems with attention, working memory, processing speed, and language (including word retrieval) are commonly reported. Poorer verbal expression/vocabulary acquisition have also been reported among patients who were diagnosed at younger ages. Overall IQ, memory, complex attention (i.e., shifting attention between competing stimuli) and visual-motor integration skills may also be impacted. These cognitive deficits as well as absences due to illness and fatigue can undermine the student’s academic performance (i.e., grades), leading to feelings of inadequacy and a sense of not being able to “keep up with” their peers academically.

However, POMS can also affect the child’s/adolescent’s social and emotional functioning. Fatigue, depression, bowel/bladder problems and physical limitations can decrease a child’s/adolescent’s interest in socializing. Heat sensitivity can limit participation in physical activities while in a warm environment, which can make them feel even more isolated. They may also feel embarrassed and have lowered self-esteem because they feel different from peers. Children/adolescents with chronic illnesses are also at an increased risk for teasing and bullying from peers. It is no surprise then that children/adolescents with MS are vulnerable to psychiatric disorders. Depression, anxiety, and bipolar disorder occur more often in the MS population than the general population.

Multiple sclerosis is an unpredictable disease. Symptoms can come and go without apparent reason or warning, and no two people experience MS symptoms in exactly the same way. Some symptoms are clearly visible (like weakness, causing walking problems) or less visible (like fatigue or cognitive concerns). It is not possible to predict when symptoms will occur or what parts of the body will be affected. MS symptoms can change from week to week.

It is important that school officials understand that because symptoms come and go without warning, accommodations need to be in place, even when symptoms seem to diminish for a time. Accommodations can include:

    • Home tutoring when students are not able to attend school
    • Excused absences and a reasonable plan to make up missed work
    • Extended time for tests/exams/projects
    • Second set of books at home
    • Preferential seating for visual, attention, or bladder/bowel issues
    • Bathroom pass/extended bathroom time
    • Portable air conditioner/fan
    • Elevator access
    • Psychotherapeutic support
    • Plan to manage fatigue:
      • Frequent/scheduled breaks
      • Modification of class schedule
      • Workload modifications

A detailed neuropsychological evaluation is essential for objectively measuring any neurocognitive deficits, tracking them over time, and informing treatment recommendations. Speech/language, audiology, occupational therapy, and physical therapy evaluations may also be warranted depending on the severity of symptoms to determine whether these services are needed. Psychologists, psychiatrists, school guidance counselors, teachers, and school administrators as well as support groups with other patients and families facing this disease should also be part of the child’s/adolescent’s care team.

 

About Pediatric Neuropsychologist Ferne Pinard, Ph.D.

Dr. Pinard provides comprehensive evaluation services for children, adolescents, and young adults with learning disabilities, attention deficit/hyperactivity disorders (ADHD), and psychiatric disorders as well as complex medical histories and neurological conditions. She has expertise in assessing children and adolescents with childhood cancer as well as neuro-immunological disorders, including opsoclonus-myoclonus-ataxia syndrome (“dancing eyes syndrome”), central nervous system vasculitis, Hashimoto’s encephalopathy, lupus, auto-immune encephalitis, multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), and acute transverse myelitis (ATM), and optic neuritis.

 

To book a neuropsychological evaluation with Dr. Pinard or another expert neuropsychologist at NESCA, complete NESCA’s online intake form

 

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

Individualized Education Program or 504 Plan? How do I Know which is Right for My Child?

By | Nesca Notes 2023

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

Both an Individualized Education Program (IEP) and a 504 Plan can provide supports for students in grades K-12 who are struggling in school, to ensure the student is able to receive “free and appropriate public education (FAPE).” However, not all students who are struggling will qualify for these supports.

An IEP provides a plan for students who require special education supports and direct related services to meet their unique needs, and these supports need to be provided at no cost to the family.

There are two requirements a child must meet to qualify for an IEP. The student must have one or more of the 13 disabilities noted in The Individuals With Disability Education Act (IDEA), which is the federal special education law for children with disabilities. Some of the disabilities listed include a Specific Learning Disability, autism (ASD), other health impairment (e.g., AD/HD), speech or language impairment, or an intellectual disability (for a full list of the 13 disabilities, see https://www.doe.mass.edu › sped › definitions). The second requirement is that the disability must affect the child’s educational performance and/or ability to learn and benefit from the general education curriculum, meaning the child must need specialized instruction to make progress in school. The IEP sets learning goals and describes the services the school will provide. Some components the IEP must include are: how the child is currently performing in school (e.g., academic and functional performance) along with annual education goals and services the child will receive. Additionally, the school will track progress toward those goals and the IEP team must review the IEP at least once a year.

A 504 Plan stems from Section 504 of the Rehabilitation Act of 1973. This is a federal civil rights law to stop discrimination against people with disabilities and requires the school to provide support and remove barriers for a student with a disability. A 504 Plan provides services and changes to the learning environment to enable students to learn alongside their peers. As with an IEP, a 504 plan is provided at no cost to families. There are two requirements to be eligible for a 504 Plan. A child has any disability, and the disability must interfere with the child’s ability to learn in a general education classroom. According to Section 504, the disability must substantially limit one or more basic life activities. Because the definition of disability is broader on a 504 Plan, a child who does not qualify for an IEP might still be eligible for a 504 Plan. In general, a 504 Plan is a good option for students with disabilities who do not require specialized instruction but do need specific accommodations to receive FAPE (e.g., extended time on tests, larger print text, priority seating close to the front of the classroom).

To determine if your child would qualify for an IEP or 504, it is important that they receive a thorough evaluation (cognitive, educational, functional, social/emotional, etc.) to determine their level of need. This evaluation can be completed through the public school system or an independent evaluator.

Sources:

www.understood.org

https://www.mpgfirm.com/back-to-basic-rights-iep-vs-504/

 

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 college-aged daughter.

 

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 and Plainville, Massachusetts, Londonderry, New Hampshire, and Burlington, Vermont, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

College Freshman and Executive Function: The Often Unexpected Demands

By | NESCA Notes 2022

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

It is no surprise that the experience of a high school student is vastly different than that of a college student. This transition is seen as a pivotal step towards independence as we send students off to learn, grow, and explore in an often substantially less supported and less controlled environment. The hope is that after 13 years of K-12 education, our students have developed the academic, communication, and organization skills needed for success in school. They know the tricks of the trade. They have systems to employ and even more systems to fall back on if needed. They have become experts at learning, and they know the drill. But what happens when students get to college and everything, from the style of instruction, to the flow of coursework, all the way to the demands outside of learning are just…a little bit different? For some students, this is a welcome opportunity to rise to the challenge, but for others, this is a daunting, overwhelming, and seemingly impossible ask. As an occupational therapist specializing in executive function, I have spent the last few years directly supporting those college freshman – the ones who look at the new demands and think, “I was never prepared for this, I don’t know if I can do this.” And I don’t blame them for feeling that way! The demands and expectations truly change. Here are a few that stand out:

  • Time management – High school schedules are rigid. Students are expected to arrive at a specific time, follow a block schedule, and make it to each of their classes (generally all in one building). If they forget what period it is, they can ask a friend, teacher, or almost anyone in the hallway. Conversely, every student in college has their own schedule that they are expected to track and manage. On Monday, they may be in class from 10am-2pm, while on Tuesday they are in class from 3pm-5pm on the other side of campus. There is no one to quickly ask or check in with regarding when and where they are supposed to be and consistency is rare. This trouble is further compounded by the fact that college coursework requires a substantial amount of work to be done outside of the classroom that must be planned for and built into the weekly schedule.
  • Reading a syllabus – While “reading a syllabus” may sound simple, these documents are often over 20 pages long, providing information about course content, course expectations, professor’s preferred method of communication, grading systems, and a full schedule of what is due and when. Additionally, each of these documents uses a different format and is frequently amended during the semester. High school students are used to an online portal that is consistently used by their teachers and provides built-in reminders and updates. Syllabi are tricky, and many students skim them without absorbing.
  • Assignment tracking – As mentioned above, college portals are nowhere near as comprehensive, up-to-date, or accurate as most ex-high school students expect. Professors may change a due date in class without updating a syllabus or expect students to keep track of a paper that is due more than a month away. Many college students need support putting a system in place to quickly consolidate due dates, set internal deadlines, and track what they need to hand in. This is especially important when breaking down large assignments into manageable chunks or learning to prepare in advance to for busy times in the semester, such as midterms or finals week.
  • Communicating with instructors – Many college students need support in pushing themselves to attend office hours, reach out early and often via email if they have questions about classwork or assignments, and even introduce themselves to their professors.
  • Developing healthy habits and routines – On top of academic executive function demands, college students are dealing with an increase in life-based executive function demands. They are managing their own eating habits, morning routines, evening routines, and organizing all of their personal belongings in their own space. Completing all of this while maintaining life balance can be tricky, and may require some support.
  • Accessing accommodations – The accommodation process at a college level is vastly different from the IEP or 504 process in high school. While this topic could be a blog on its own, the biggest takeaway for me is the level of responsibility that falls on the students. They are in charge of letting each professor, at the beginning of every semester, know about their accommodations for sitting in classes, taking exams, or turning in assignments. This requires a level of self-advocacy and functional communication that they may not have had to demonstrate in high school. This demand does not disappear throughout the semester, as they often need to remind professors a week before an exam about their needs or independently book a room to take their test.

While this may seem like a lot, the good news is that our students have learned how to learn. Their systems may need updating, and their strategies may need fine tuning, but with guidance I have found college success to be a truly achievable goal. I often find that once provided with a foundation and tips for how to be successful, my college freshmen do rise to the challenge and eventually build the ability to do all of this independently. If you feel that your student could benefit from some executive function support as they embark on their college journey, please reach out about NESCA’s EF Coaching Program!

 

About the Author
Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. 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. 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, 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 Executive Function Coaching 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.

 

Handwriting vs. Typing: Where do we draw the line?

By | NESCA Notes 2021

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

For many of our students with dysgraphia, or those who struggle with the fine motor precision and the skills necessary for written output, digital tools and accommodations that promote the use of tech and keyboarding in the academic setting are immensely helpful. These tools allow our students to show their knowledge, demonstrate their written abilities, and fully access their curriculum.  When implemented correctly, these accommodations can have a huge impact on a student’s academic career. While all of this is true, it is worth discussing whether fully taking away the need to produce and practice handwritten work is leaving some of our students at a disadvantage.

When working with adolescents and young adults to help figure out future career or education plans, I am consistently reminded of the fact that despite our continuing transition toward a more and more digitally-based world, the need for handwriting has not disappeared. While we absolutely do not need to be handwriting essays, papers, or long letters sent via snail mail, there are aspects of almost every profession and daily life that require the skill. Here are a few common issues that I am seeing pop up that speak to the need for some continued practice –

  1. Job or rental applications. While some of this has moved over to an online format, many of these still need to be filled out appropriately and legibly by an applicant.
  2. Jotting down notes. The importance of this skill should not be diminished. Whether taking a phone message, making a grocery list, or writing down a phone number, most young adults are expected to be able to read their own handwriting at a later date, or leave a message for someone else who will need to be able to read it.
  3. Vocational responsibilities. Many of our students with disabilities choose to forgo the traditional college path and find a more suitable career field to pursue. Many of my clients have become successful carpenters, mechanics, or other tradespeople. These fields all require vast skill and talent, and often require employees to mark down measurements or make quick notations.
  4. Signing documents. Many banks, institutions, and legal documents require a handwritten signature and initials on any paperwork.

While I am not advocating that we take away accommodations from our students who do not have the foundational skills to write long paragraphs or essays, I am advocating that we stop fully eliminating the demand. By expecting some quick, consistent practice of handwriting, we are building a skill that will be needed multiple times throughout life. I would suggest that students who are being given a keyboarding fine motor/visual motor accommodation, also continue to receive instruction or opportunities to practice writing activities that are less fatiguing in order to continue to build the motor planning and skill necessary. It is unfair to equate the inability to use handwriting as a tool for academic output, with an inability to learn handwriting as a useful functional tool for life.

 

About the Author
Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. 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. 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, 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.

 

Accommodations for Computer-based Testing

By | NESCA Notes 2019

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

As a school-based occupational therapist, I found myself beginning each academic year by focusing on what my students needed to learn, the skills they needed to develop, and how I could best use my time to help them be successful in the classroom. Despite it being September, every year this inevitably led me to consider standardized testing – one of the many academic themes of springtime.

My third graders not only needed to know the foundational mathematics skills being assessed, but how to navigate the computer screen in front of them. They needed to practice the fine motor precision to move a mouse and click on small boxes or multiple-choice bubbles. My sixth graders not only needed to understand how to plot points on the x and y axes, but they needed to have the visual perceptual skills to plot these points on a computer screen that scrolls up and down.

This demand for computer literacy skills within testing was noted as early as 2003, when Thompson et. al noted the inherent disadvantage for students who lack access to computers. However, as we continue to move further and further into the digital age, it is clear that computer-based testing has become our nation’s go-to method for assessing its students’ grasp of academic content and subject mastery. Computer-based testing allows for more efficient administration, quicker result times, built-in accommodations, and other positive benefits that make commitment to this practice worthwhile. For many students, computer-based testing is hugely preferred, and the option to type an essay is far less daunting than writing pages and pages by hand.

However, the National Center on Educational Outcomes claims that, “Despite the fairly dramatic increase in attention to CBT (computer-based testing), accessibility challenges continue to have the potential to reduce the validity of the assessment results and to exclude some groups of students from assessment participation” (Thurlow, Lazarus, Albus, & Hodgson, 2010).

So, what happens when this manner of assessment is more difficult for our students with disabilities? How can we help? What can we do?

As is often noted by test creators and administrators, most computer-based tests have relatively comprehensive built-in accommodations. Options such as enlarged font, speech-to-text, and line masking are often built into the platform. Despite this, computer-based accommodations may not be enough. When it comes to being truly accessible, the assessment of skill areas, individualized accommodation, and significant practice of testing systems are all necessary to arrive at an accurate assessment of academic skills.

Consider Charles, a fourth-grade student who has been receiving occupational therapy for decreased fine motor precision, visual perception, and low visual and fine motor endurance. He has difficulty with visual memory and gets easily overwhelmed by visual clutter. As a student in the general education setting, it is initially assumed that Charles will take his standardized tests in the computer format. At his team meeting, Charles’ mother raises her concern that he will fatigue quickly due to the visual demands of staring at a computer screen for the testing period. The team offers to provide Charles with a paper-based version of the test so he can avoid having to look at a computer screen. But Charles has decreased fine motor precision and endurance! How do we accommodate his needs?

This one case displays the importance of considering the whole child, trialing different options, and working collaboratively. Charles could potentially be allowed to take the assessment on the computer with access to a paper copy. He could use a scribe to help him type or write while he takes a computer or paper version. Maybe Charles feels confident using the computer-based test and his mother’s concerns about visual fatigue were unwarranted. Realistically, the team does not know what is best for Charles until they try a few distinct options and get his input.

Computer-based testing tools are here to stay, and fortunately our children are becoming more and more comfortable with digital methods. As we continue to make this transition, it is important to maintain the commitment to be individualized. Each student has different needs, and I urge teams, related service providers, educators, and parents to consider these needs early in the school year and early in the student’s academic career.

References:

Thompson, S., Thurlow, M., & Moore, M. (2003). Using computer-based tests with students with disabilities (Policy Directions No. 15). Minneapolis, MN: University of Minnesota, National Center on Educational Outcomes. Retrieved [9/09/2019], from the World Wide Web: https://nceo.info/Resources/publications/OnlinePubs/Policy15.htm

Thurlow, M., Lazarus, S. S., Albus, D., & Hodgson, J. (2010). Computer-based testing: Practices and considerations (Synthesis Report 78). Minneapolis, MN: University of Minnesota, National Center on Educational Outcomes.

 

About the Author:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. Dr. Bellenis joined 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 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.

 

How High School and College Differ for Students with Disabilities

By | NESCA Notes 2019

By: Dina DiGregorio Karlon, M.A.
Transition Specialist, NESCA

Today, more students with disabilities are opting to attend college. As students plan to pursue college, it’s important for them to understand the increased expectations in college in the areas of academics, independence and social environments. For example, while in high school, the responsibility to get the students the services needed to be successful fell on parents and teachers; however, college students must advocate for themselves in post-secondary education. Below are some important ways in which the college and high school settings differ for students with disabilities, as well as some suggested strategies to prepare them.

Applicable Laws – In high school, students with disabilities are covered under the Individuals with Disabilities Act (IDEA), which mandates a free, appropriate public education for students with a disability (3-22 years of age). Some students in high school are covered under Section 504. In college, schools must comply with the Americans with Disabilities Act (ADA) and Section 504 – both laws are based on civil rights and prevent discrimination for people with disabilities. In short, IDEA is about success; ADA is about access.

Required Documentation – In high school, the school district is responsible for providing an evaluation at no cost to the student; this documentation focuses on whether a student is eligible for services under specific disability categories. Colleges are not responsible for the documentation. Students must get an evaluation at their own expense (if documentation is not current). Most colleges will accept current testing (within three years). This documentation must provide information about how the disability impacts the student and demonstrate the need for accommodations. Colleges will list on their website the type of documentation needed.

Modifications vs. Accommodations – In high school, if necessary, classes and materials may be modified, and the school is responsible for those accommodations and modifications. Some modifications may include reduced assignments or readings, adjusted grading to weigh a student’s daily work equal to semester tests. However, in college, there are no modifications to assignments or the curriculum; there are only accommodations. School is no longer responsible for arranging accommodations; rather students must advocate and arrange accommodations  for themselves.

Self-disclosure and Self-advocacy – In high school, teachers and parents support the student’s needs, with teachers approaching students if they believe assistance is needed. In college, the student is primarily responsible for arranging accommodations and advocating for their own needs. This is a significant shift—not just for the student, but for the parents, too. Parents no longer have access to the student’s records. The high school cannot disclose to a college a student’s disability—only the student can choose to disclose.

Disclose or Not to Disclose…That is the Question – Choosing to disclose that a student has a disability to a college is a deeply personal decision. As discussed, it is up to the student to disclose. If the student decides to disclose a disability, they need to understand not only the name of the disability, but also be able to communicate and describe how the disability impacts them and their learning. This is critical in determining what types of accommodations will be written into their 504 plan. While in high school, the student should be honest and realistic about the types of accommodations actually used and which of those were helpful. Helping your child practice discussing their disability and how it impacts them is very useful in preparing them to meet with the Office of Disability to share their needs. If a student decides not to disclose, they will not receive accommodations. However, all colleges have some type of tutoring and/or writing center to help students improve their academic skills. If a student chooses not to disclose and does not do well, they can still meet with the Office of Disability at any time to look into a 504 plan. However, their 504 plan will not be retroactive for the semester. Instead, accommodations will start from the date of the plan.

What Can Parents Do?

Preparing your child with a disability is critical to helping them be successful. Specifically, they will need self-determination skills. Self-determination is the understanding of one’s strengths and limitations together with a belief in oneself as capable and effective. These skills enable a person to participate in goal-directed, self-regulated, independent behavior. A person with self-determination skills is more likely to be independent and successful in work and training. Some suggested activities to help build self-determination skills include: Teaching your child how to make phone calls to make appointments, write emails with a professional tone and speak directly to people in stores or restaurants. Parents may need to start with a script to help a child practice, then fade support so the child is speaking as independently as possible in various settings. Other activities include having your child plan and prepare a weekly family meal (including making the grocery list, shopping for items, etc.), playing financial literacy games and activities (http://www.practicalmoneyskills.com/play/the_payoff), or talking with your child about how to begin to interact more independently with healthcare providers.

As parents, it is important to know that as your children become more independent, such as going to college, while they are now holding onto the reins, they are likely to need your help with the steering.

While these differences may seem daunting, self-advocacy, executive functioning and independent living skills taught throughout an individual’s transition to adulthood (starting as early as possible) can help to ease the jump to post-secondary education and its accompanying expectations. If you would like to discuss this topic in greater detail as it relates to you/your student, please complete our online intake form and note that your inquiry is for Transition Services.

 

Resources:

Center on Community Living and Careers, Indiana Institute on Disability and Community, Indiana University

National Council on Disability 

Santa Clara University

Think College

Life After IEPs

Financial Education for Everyone: Practical Money Skills

 

 

About the Author: 

Dina DiGregorio Karlon, M.A., is a seasoned counselor who has worked as both a school counselor and vocational rehabilitation counselor, guiding and coaching students and adults through transitions toward independence in both college and the working world. With NESCA, she offers transition assessment services in Londonderry, New Hampshire as well as transition planning consultation and coaching to students and families throughout New England.

 

To book Transition Services at NESCA or an evaluation with one of our expert neuropsychologists, complete NESCA’s online intake form. To book Transition Services in N.H., ask for Dina Karlon. 

 

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.

Visual Skill and Academic Success – Looking Past 20/20 Vision

By | NESCA Notes 2019

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

When a school nurse pulls a child into his or her office to complete a basic eye screening, he or she may write, “20/20 vision in both eyes. No visual concerns.” This child has successfully looked at an eye chart and read the letters; demonstrated the ability to look straight ahead, from an appropriate distance without things becoming blurry or illegible; and demonstrated visual acuity, or the ability to see with acceptable clarity.

But does this necessarily mean there are no concerns?

Visual acuity measures whether a stimulus is being seen – not necessarily if the information is truly being understood. The visual system is a complex part of the central nervous systems that incorporates the eyes, ocular pathways and brain to produce and interpret sight. It requires consistent communication between all of these individual anatomical pieces, the vestibular system and the skeletomuscular system. Essentially, vision is complicated and messy and requires many many different skills.

Breaking It Down

In terms of visual skills needed for academic success, we often break things down into three main areas: ocular motor control, visual perception and visual motor integration.

  • Ocular motor control describes the ability to physically move the eyes using the 9 ocular muscles. It encompasses the ability to track an object across a screen or a line of text across a book, or the ability to look up at the board and then quickly refocus on a sheet on paper on the desk. Imagine trying to watch a basketball game without the ability to track the ball across the screen smoothly. It quickly becomes tiring and frustrating. Occupational therapists often refer to these specific eye movements with technical terms, such as visual saccades, pursuits, convergence/divergence and accommodation. But in essence they describe eye movement.
  • Visual perception or visual processing is in many ways more nuanced. It focuses on the brain’s ability to organize, interpret and fully understand the information it receives from the eyes. Two main skills needed at school are visual figure ground and visual closure.
    • Visual figure ground is the ability to discern relevant information from a busy or cluttered background. A student with visual figure ground difficulty may not be able to search a busy white board and find a homework assignment. These students may also be visually overwhelmed by a worksheet with 20 math problems, but successful with the same problems presented individually.
    • Visual closure is a skill that specifically helps with reading efficiency and fluency. It is the ability to identify or visualize a complete form or picture when given incomplete visual information or when only a small piece of the image is shown. Visual closure allows us to read a sentence quickly without stopping to decode each individual letter. It is aslo oen raeosn taht mnay pelope can raed setneces wtih julmbled up ltetres. We recognize the form, not simply the sequential letters.  :  )
    • Visual closure plays a role in sight words and reading partially-covered papers or street signs in the community. While there are many more important visual perception skills, these two examples have functional, measurable effects in the classroom setting and are commonly identified through occupational therapy testing.
  • Visual motor integration (VMI) describes the ability to use all of these foundational visual skills in conjunction with foundational motor skills. It is the ability to interpret visual information and produce a precise motor response. In the classroom, this affects a student’s ability to copy shapes, produce legible handwriting and use scissors to cut along a line. Not only can these things be difficult, they can be exhausting as a child tries to use all of these skills at once.

While all of these visual components have multiple layers and intricacies, it is important to simply acknowledge that there’s more than the eye can see when it comes to vision. A child who “can’t see the board,” but has 20/20 vision, may just be visually overwhelmed. A child who looks at a page full of small block text and immediately gives up may not have the visual skill to read across a line. And a child who is learning to read beautifully, but still has difficult forming the letters in his name may have poor visual motor integration. Fortunately, there are many interventions and accommodations that can help build on and develop these skills further to foster confidence and success in the class and community.

About the Author:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. Dr. Bellenis joined 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 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.

 

8 Tips You Need to Know about SAT and ACT

By | NESCA Notes 2019

 

By: Dina Karlon, M.A.
Transition Specialist, NESCA

Starting to think about the college admissions/testing process? It can be costly and confusing, so we’ve compiled some tips to help you navigate the testing landscape.

Tip 1 – SAT or ACT – Which test should a student take? Most colleges will take either, but there are differences to the tests. SATs, which were revamped a few years ago, has Reading, Math and Writing, while the ACT adds a Science section. SAT questions assess problem-solving abilities, while ACT questions are more fact-based, similar to school testing. Typically, SATs use much higher-level vocabulary than the ACT. The ACT tests math concepts through trigonometry, while SATs stop at geometry. SAT divides its scores into two areas – Reading/Writing and Math, with a perfect score of 1600 (800 for each). ACT scoring is based on 4 sections that are averaged into a composite, with a perfect score of 36. While SAT is more well-known by many New Englanders, the ACT is taken slightly more often, having gained popularity in the past 5 to 10 years. A student may prefer one test over the other if the individual:

Still not sure which one to take? Visit the tests’ websites to take/score a practice test. See which one may be better through this conversion chart: https://www.studypoint.com/ed/sat-act-concordance/.

Tip 2 – SAT Subject Tests – In addition to the general SAT, students can register for tests in specific subject areas. There are 20 specialized tests, and an individual would usually only take 2, if any. Most colleges do not require them, although a student may take them to demonstrate a strong interest or aptitude in a subject or area of passion. For example, a bilingual student could demonstrate proficiency in a language. Subject tests could be a way for students to strengthen their application among similar candidates. If a student wants to major in a science, a strong score on a science subject test could set that person apart from others.

Tip 3 – Apply Early – Standardized testing is pricey, and hidden costs can creep up. Register early to avoid late or waiting list fees. Doing so also allows students to reserve a slot at their own school (if offered there). Whether students are neuro-typical or not, there is comfort in taking tests in one’s own school. For students with anxiety, it is very important, as familiarity with their environment can reduce anxiety.

Tip 4 – Vouchers – Visit SAT and/or ACT sites to determine eligibility for test fees being waived through a voucher. Work with high school counselors to obtain a waiver.

Tip 5 – Costs – There are registration fees for standardized tests. The current fees for the exams are:

There’s good news for New Hampshire residents. A few years ago, the SAT replaced the New England Common Assessment Program (NECAP) as the state test for high school juniors. Therefore, all juniors have the opportunity to take one free SAT. Factor this in for next year, as the deadline to take the test is in March.

Tip 6 – Free Test Scores Sent to Colleges – To lower costs, take advantage of having 4 free test scores sent to colleges. When you register to take both the SAT and ACT, students have the option to send up to 4 tests to 4 colleges at no charge, saving $52 ($13 per test) for the ACT and $48 ($12 per test) for the SAT. Individuals have up to nine days after taking the SAT test to register for score reports. It’s best to sign up for them when you register as it’s easy to forget to do so after. Some students may not opt to do this because they want to see their scores before they are sent to colleges. The benefit of sending them with the SAT is – regardless of your scores – if taken again, a person’s entire history will be sent to colleges where they take the highest score from each section. For example, if a student scores a 400 on English and a 500 on Math in April, then chooses to retake the test in October and scores a 500 on English and a 400 on Math, the school will take the two 500 scores for a total of 1000. If a student is very unhappy with a score on a particular day and they don’t want a college to see that score, students can research whether the schools they are applying to will accept score choice. While this may be an option, it will incur an additional fee. In general, I recommend sending all of the scores and letting the admissions team select the highest. With ACT, score histories are not sent to colleges. Instead students pick a specific test date’s scores to send. Unlike the SAT, if a student gets a higher score in separate sections on various test dates and wants the colleges to see the scores from each test date, they will have to pay for each test date’s score to be sent.

Tip 7 – Accommodations – The process for requesting accommodations and when to apply for them is different for each test. Check the SAT and ACT websites for exact processes for each. Here are some tips:

– Apply early as it can take up to 7 weeks to hear which accommodations are approved. Accommodation request applications may be due at the time one registers for the test – or even before.

– Students should talk with their SAT/ACT school representative about accommodations. While ACT only accepts requests through students’ schools, SAT allows students to apply for accommodations independently. I recommend working with the Accommodations Coordinator at the high school (school counselors will know who this is).

– It is up to SAT and/or ACT if they will allow students accommodations, not the high school.

– Once accommodations are determined for a school year, students can take the test several times (though it’s not recommended to take it several times each year) and not have to reapply for accommodations. SAT accommodations last for one year after high school graduation.

– Lists of accommodations and procedures for requesting them are at: https://www.understood.org/en/school-learning/partnering-with-childs-school/tests-standards/how-to-apply-for-sat-and-act-accommodations.

Tip 8 – Test-optional Schools – Some of us just don’t test well and are terrified of taking such tests. If a student doesn’t feel standardized tests reflect their academic ability and don’t want them considered in their admissions application, consider applying to test-optional schools. These schools review admission materials (transcript, recommendations, etc.) to determine if a student is a good fit for their institution. Here is a list of test-optional schools: https://www.fairtest.org/university/optional.

References

SAT website: Collegeboard.org

ACT website: ACT.org

https://www.understood.org/en/school-learning/partnering-with-childs-school/tests-standards/how-to-apply-for-sat-and-act-accommodations

https://www.understood.org/en/school-learning/choosing-starting-school/leaving-high-school/sat-or-act-how-to-know-which-is-best-for-your-child

https://www.huffpost.com/entry/differences-between-the-s_b_3451049

 

About the Author: 

Dina DiGregorio Karlon, M.A., is a seasoned counselor who has worked as both a school counselor and vocational rehabilitation counselor, guiding and coaching students and adults through transitions toward independence in both college and the working world. With NESCA, she offers transition assessment services in Londonderry, New Hampshire as well as transition planning consultation and coaching to students and families throughout New England.

 

To book an evaluation with one of our expert neuropsychologists, complete NESCA’s online intake form. To book Transition Services in N.H., ask for Dina Karlon. 

 

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.

What is Working Memory and How Can We Address It?

By | NESCA Notes 2019

By: Nancy Roosa, Psy.D.
Pediatric Neuropsychologist, NESCA

Melanie is a sweet, hard-working 11-year-old girl whose parents brought her to NESCA for an evaluation to try to understand why she was struggling in school. Melanie was a cheerful, vivacious girl who seemed intelligent, curious and articulate. But she was barely getting by in fifth grade, putting in hours on homework every night on assignments her teachers thought should take 30 minutes. Her parents were concerned about how she was going to manage middle school next year.

During the evaluation, Melanie did quite well on most tests. Her intelligence measured in the “Above Average” range, and her academic skills were solid. She worked hard and even did well on a test of sustained attention. So, it was clear she did not have a classic case of attentional dysregulation.

Upon further analysis, a few striking results emerged. Melanie had a good ability to remember information or work on structured tasks, but got confused on multistep tasks. One important result: she was able to remember and repeat back long strings of digits when repeating them verbatim, but she really struggled when she had to repeat them in reverse. The mental manipulations involved flummoxed her.

This is working memory: the ability to hold multiple bits of information in memory banks while there is another, distracting bit of information processing going on. Working memory is the “working” part of memory, as it holds information long enough for us to use it or store it away in longer-term memory banks. Analogies can be made to computer storage, where current information is held while processing occurs; or a mental chalkboard, where we jot down our ideas while working out a problem. For some children, like Melanie, that computer storage or chalkboard space is quite limited, causing difficulty with many aspects of learning. As a first grader, Melanie easily learned the sounds of letters, but it was harder for her to remember and apply that knowledge while reading words. Similarly, she easily learned math facts, but got stymied on multistep math problems. Finally, she had trouble with multistep directions. When her parents or teachers told her three things to do, her response was typically, “Wait, what?”.

Melanie’s parents were right to be concerned about middle school, since this is when students are presented with more complex assignments, such as lengthy reading and writing assignments, PowerPoint presentations and many other multistep projects, which were going to be hard for her.

Working memory deficits are related to other cognitive processes. Children with attentional regulation deficits or learning disabilities often – but not always – have working memory deficits. However, every child is unique, with an individual set of strengths and weaknesses. Therefore, a comprehensive and well-done evaluation is essential to clarify a child’s specific profile – a vital first step in crafting an appropriate plan for support and treatment.

Now that we identified Melanie’s difficulties as primarily due to working memory deficits, how do we help her?

My recommendations centered first on the types of accommodations Melanie would need in school to manage an uptick in demands.

  • Any complex or multistep assignment needed to be presented in writing so Melanie can refer back to the directions. She should be shown completed models and provided with scoring rubrics.
  • Melanie might need support from a learning specialist to manage complex tasks, by dividing them into component parts, then completing each part and integrating the whole.
  • Melanie should not be expected to take notes while simultaneously listening to a teacher’s instruction. She should be provided with notes or given an outline of the teacher’s talk that she could fill in.
  • Melanie’s pace of work was slow, given the need to frequently check back and remind herself what she was doing. Therefore, teachers should consider giving her shorter homework assignments that focus on quality not quantity, and extra time to complete tests and assignments.

We also discussed the strategies that Melanie would need to learn to compensate for working memory deficits. She was already using some important strategies, likely based on coaching from some talented teachers in her past. She knew she needed to write things down to remember them, so she had become good at creating outlines before she started writing and drawing pictures of math problems. However, as assignments got longer, Melanie was going to need additional strategies. For example, for lengthy reading assignments, Melanie might need to jot down sticky notes on pages or develop an ongoing “story board” to keep track of main character descriptions or plot points.

Once the family brought this information to Melanie’s educational team, they were able to meet and establish important accommodations, including time to work with a learning specialist several times weekly. The team also agreed to continue to monitor her ability to manage future challenges.

Beyond accommodating working memory deficits, there is ongoing research into programs that could actually improve an individual’s working memory. The hope is that by targeted practice, one could strengthen one’s working memory the way we strengthen muscles by working out at the gym. Despite a great deal of research, the preponderance of evidence does not indicate that these kinds of training programs are effective in improving working memory, except on the specific tasks used in the training program itself. At NESCA, we remain optimistic that further research and refinements will eventually yield more promising treatments.

Finally, one of the most important outcomes of the evaluation was a feedback session with Melanie herself, where I explained her learning profile to her in age-appropriate terms. My goal was to help her appreciate her many strengths and understand that her learning challenge was relatively small and specific. She might have to work harder in certain ways, but would be able to be successful in school and life.

At NESCA, we find that when a child is old enough to process this information about their profile, it is vital to provide it. We find that many children, even teenagers and young adults, tend to be black-and-white thinkers. When they struggle in school in any way, they conclude they are “stupid.” It is obviously vital to prevent this kind of global, negative self-concept from developing. Rather, we hope to give the child the self-awareness and confidence to develop and use compensatory strategies, no matter the area of weakness. We need Melanie and children like her to be confident enough to ask a teacher, college professor or even a job supervisor to provide written instructions to a task or go over directions more than once. Our goal is to arm her with enough self-awareness and confidence that she can go into any new situation, as a student or adult, and be successful while not letting her challenges define or limit her.

 

About the Author: 
Roosa

Dr. Roosa has been engaged in providing neuropsychological evaluations for children since 1997. She enjoys working with a range of children, particularly those with autism spectrum disorders, as well as children with attentional issues, executive function deficits, anxiety disorders, learning disabilities, or other social, emotional or behavioral problems. Her evaluations are particularly appropriate for children with complex profiles and those whose presentations do not fit neatly into any one diagnostic box. As part of this process, Dr. Roosa is frequently engaged in school visits, IEP Team Meetings, home observations and phone consultations with collateral providers. Dr. Roosa has also consulted with several area schools, either about individual children or about programmatic concerns. She speaks to parent or school groups, upon request.

 

 

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.

Addressing Anxiety through the IEP Process

By | NESCA Notes 2019

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

Anxiety disorders are becoming more and more common among children and adolescents. Recent data from the National Institute of Mental Health (NIMH) reported that 31.9% of adolescents between 13-19 have an identified anxiety disorder. Although fewer statistics are available, it is clear that students who have a developmental, learning, or attention disorder are at high risk for developing clinically significant anxiety in light of their struggles with academics, learning, and/or social development. Given the rising numbers of affected children and adolescents, it has become increasingly important that a student’s emotional health is addressed both at home through private counseling, as well as through the provision of school-based services. When students experience a high level of unmitigated anxiety throughout the day, they are less able to learn and meet their potential.

When parents are seeking services for anxiety through their school system, there are different levels of support. First, teachers can provide classroom supports and address emotional health with all students, whether or not they have an identified anxiety disorder. Some examples of useful classroom strategies include:

  • Create predictable routines and clear expectations.
  • Provide warnings about upcoming transitions.
  • Have a “cool down space” available in the classroom or another room in the school.
  • Incorporate movement into lessons throughout the day.

There are also programs designed to address emotional regulation that can be used throughout the school or district. For example:

If these supports are not sufficient to meet a student’s needs, then it is necessary to develop goals through the IEP process. In order to make needed progress, it is important that the goals and benchmarks in the IEP are specific. For example, a benchmark might state: “Johnny will show better emotional regulation in stressful situations.” A more specific benchmark might state: “When Johnny starts to shut down or refuse to participate during a math class, he will identify his current emotion(s) in 4 out of 5 opportunities.”

When parents seek supports for their child’s anxiety through the IEP, they should consider whether their child needs accommodations, specialized instruction or both.

Examples of accommodations for anxiety include:

  • Extra time in testing situations.
  • Opportunities to take tests in a quiet setting.
  • Access to breaks as needed.
  • Access to the school counselor as needed.
  • Student does not need to sign out of class to use the bathroom.
  • Student is prompted to take breaks when showing signs of distress.
  • Student has modified homework.
  • Teacher will check in with student before independent work blocks.
  • Specialized instruction can be provided in the classroom (push-in) or in a different setting (pull-out).

Push-in services might include:

  • Provision of an instructional aide to support emotion identification and regulation.
  • The school counselor/psychologist works with the entire class once or twice a month to discuss emotional health.

Pull-out services might include:

  • Regular sessions with the school counselor/psychologist.
  • Social skills groups.

Consultation services are also important, especially if a student participates in private therapy outside of school. Parents should consider giving permission for the private therapist to speak with the school counselor to discuss common treatment goals and ways in which the student’s coping skills can be supported and reinforced in school.

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.

Dr. Gibbons recently began serving clients in NESCA’s newest location in Plainville/Foxborough, MA. She is thrilled to bring her expertise in evaluating and supporting children with a wide range of abilities to this area of the state.

 

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

 

 

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