NESCA is currently accepting Therapy and Executive Function Coaching clients from middle school-age through adulthood with Therapist/Executive Function Coach/Parent Coach Carly Loureiro, MSW, LCSW. Carly specializes in the ASD population and also sees individuals who are highly anxious, depressed, or suffer with low self-esteem. She also offers parent coaching and family sessions when needed. For more information or to schedule appointments, please complete our Intake Form.

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adolescents

Image of the words Fading Prompts fading out

Helping Students Become Independent: The Role of Fading Prompts

By | NESCA Notes 2024

Image of the words Fading Prompts fading outBy: Sarah LaFerriere, M.Ed.
Transition Specialist & Special Educator, NESCA

Supporting students with disabilities is an experience filled with opportunities to help them grow and succeed. One key area to focus on is promoting independence, which involves carefully managing the use of prompts. If not handled well, prompt dependence can become a significant barrier, especially as students move toward transition age.

What is Prompt Dependence?
Prompt dependence happens when students become overly reliant on external cues, like verbal or written instructions or physical guidance – from teachers, therapists, or caregivers. While prompts are a helpful tool in teaching, over time, too much reliance on them can make it difficult for students to act independently. This can become a bigger issue as they get older and need to function more independently in real-world situations, such as in jobs or community settings.

Why Fading Prompts Matters and How to Do It
Fading prompts is a technique used to gradually decrease the level of support given to students, helping them gain the skills they need to act independently. The goal is to provide enough support initially so that students can learn, and then slowly reduce that support as they become more capable on their own. This isn’t about suddenly withdrawing help but rather about making a gradual shift that encourages students to rely on their own skills.

  1. Start Early—Addressing prompt dependence early on is crucial. When introducing prompts, consider how you’ll gradually reduce them. For younger students, this could mean starting with more hands-on assistance and gradually moving to less direct forms of support, such as verbal or visual cues.
  2. Reduce Support Gradually—Fading prompts involves a step-by-step reduction of assistance. Begin with more direct prompts and, as the student improves, shift to more subtle forms of support. It’s important to pace this reduction based on the student’s progress, ensuring they have enough opportunity to practice and succeed before making further changes.
  3. Promote Self-awareness—Encouraging students to recognize when they need help and how to seek it can be very effective. By developing self-monitoring skills, students can learn to manage their own needs and understand when they are capable of performing tasks on their own.
  4. Be Consistent and Patient—Consistency among all those involved in a student’s education is key. This means that teachers, therapists, and family members should use the same approach and follow the same plan for reducing prompts. Patience is also important, as progress can be gradual and may require repeated practice.
  5. Customize Approaches—Every student is different, and so their path to independence will be unique. Tailoring the approach to each student’s specific needs can make a big difference. This might involve adjusting how quickly prompts are faded or choosing the types of support that work best for the student. Regularly reviewing and adjusting the plan ensures that students are receiving the right level of support.

Involving Families and Service Providers
Families and service providers are essential in this process. Good communication and teamwork between educators, therapists, and families help create a consistent approach to fading prompts. Families can support the skills being taught in various settings, and service providers can offer valuable insights and guidance.

Preparing for the Future
As students reach transition age, being able to act independently becomes even more important. By addressing prompt dependence early and using effective fading techniques, we can help students develop the skills and confidence they need for adult life. This preparation not only aids students but also benefits their families and communities by fostering a more inclusive environment.

In summary, fading prompts is a crucial practice in helping students with disabilities become more independent. By understanding and applying strategies to reduce prompt dependence, we can better prepare students for a future where they can navigate the world with confidence and self-sufficiency. This not only supports the students but also contributes to a more supportive and inclusive community.

 

About the AuthorHeadshot of Sarah LaFerriere, M.Ed.

Sarah LaFerriere, M.Ed., is a transition specialist and special educator who has nearly a decade of experience working with transition aged students in public schools, college, and home-based settings. She provides transition assessment, consultation, and coaching services to a wide range of clients, and specializes in supporting students with autism, intellectual disabilities, developmental disabilities, mental health conditions, and medical conditions.

To book a consultation with Sarah LaFerriere or one of our many other expert transition specialists, neuropsychologists, or other clinicians, complete NESCA’s online intake form.

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Child in bed suffering from a concussion, holding their head in pain

What School Supports Does My Child Need After A Concussion?

By | NESCA Notes 2024

Child in bed suffering from a concussion, holding their head in painBy: Alison Burns, Ph.D.
Pediatric Neuropsychologist, NESCA

Unfortunately, every year, many children and adolescents experience concussions. A concussion is a mild traumatic brain injury that occurs when an individual sustains a blow to the head or body that results in the brain moving rapidly back and forth. This causes the brain to stretch and strain, resulting in a vast array of possible symptoms. Symptoms of a concussion include:

list of physical, cognitive, emotional, and sleep concussion symptoms

Recent studies have shown that while it is important to rest for the initial few days after an injury, slowly reengaging in cognitive activities at a tolerable level helps to promote recovery. This period of rest followed by a slow increase in cognitive activity means that children are often out of school/slowly transitioning back to school for an unspecified period after injury. As such, many children will benefit from support and accommodation at school during the recovery period. Parents are encouraged to talk to their child’s academic team and school personnel to discuss the need for these supports. As children and adolescents experience differing sets of symptoms after an injury, the accommodations and supports should be tailored to the individual’s unique symptom profile.

Physical Symptoms: Students who experience headaches or fatigue may benefit from rest breaks or even a nap during the school day. Dizziness, balance problems, or nausea may necessitate the need for an elevator pass and it may be helpful for the student to transition to class before the bell rings when there are less people to navigate around in the hallway. Light and noise sensitivity can be particularly hard within the school setting. Students may need to wear sunglasses or a hat, be seated away from the window, and may need teacher notes as looking at a smartboard may be painful. In addition, computer-based work may need to be printed during the recovery period for light sensitive students. Students with noise sensitivity may need to wear ear plugs, avoid crowded and noisy areas, such as the lunchroom, assemblies, or music class, and they may need to transition to the next class before the bell rings and the hallway becomes noisy.

Cognitive Symptoms: A concussion can temporarily impact an individual’s attention, executive functioning skills, and processing speed. Therefore, it may be necessary to reduce a child’s workload (e.g., odd/even problems only, outline a paper instead of writing it fully, reduce homework load) and assign only essential work (i.e., waive non-essential assignments, quizzes, and tests). In addition, it may be helpful to break down tasks into smaller “chunks,” repeat information or instructions, and allow for extended time to complete essential classwork, quizzes, and tests. They may need access to teacher notes if they are unable to keep up with the pace of the instruction to take proper notes, and they may need information presented in a slower manner or repeated to ensure comprehension. Teachers should consider alternative ways to ensure mastery of information (e.g., oral discussion, multiple choice instead of open-ended questions) as students may not be able to demonstrate their true knowledge in standard ways while recovering from a concussion. Tests and quizzes should only be given if symptoms do not interfere, and the student is adequately prepared.

Emotional Symptoms: Emotional symptoms following concussion are often overlooked as they are not a commonly known symptom of concussion. Some children and adolescents may become overwhelmed about missing school and the accumulating workload, and they may feel isolated from their friends. This would also suggest the need to reduce a child’s workload for a short period of time, including waiving non-essential assignments, quizzes, or tests. Students should also be allowed to socialize with their peers as tolerated (e.g., quiet lunch setting with a few close friends).

Sleep Symptoms: A child or adolescent experiencing sleep difficulties as a result of their concussion may not have the energy to complete a full day of school. They may need a later start time or only be able to complete a half day of school. Some students with disrupted sleep may be able to complete a full school day, but they may require a nap in the nurse’s office.

In sum, a concussion presents in many ways and often has a significant impact on the day-to-day functioning of a child or adolescent. In particular, school is often disrupted after a concussion, even for children and adolescents who have a short recovery. School supports and accommodations should be tailored to the child’s individual profile of symptoms to best support them throughout their recovery.

 

About the Author

Dr. Burns conducts comprehensive evaluations of school-aged children, adolescents, and young adults with a variety of developmental, learning, and emotional difficulties. She has expertise in the evaluation of individuals following a concussion/mild traumatic brain injury and particularly enjoys working with individuals with attention (ADHD) and executive functioning (EF) difficulties. Dr. Burns is passionate about helping individuals and their families better understand their areas of strength and weakness and provides tailored treatment recommendations based upon that unique profile to make the evaluation most helpful for each client.

 

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

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Supporting Teens: Helping Them Engage in Treatment

By | NESCA Notes 2024

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

I was fortunate to join my colleague, Kelley Challen, Ed.M., CAS, in a recent presentation about fostering self-advocacy and self-determination for young adults. The focus of our conversation was around encouraging teens to participate in the special education process as active members of their IEP team. It got me thinking: what are other ways that teens should be included in decision making? How do we ensure that teens are included in vital treatment decisions? And what do we do about those teens who are reluctant to engage?

There is a robust body of empirical evidence to suggest that the combination of medications and therapy is most effective at reducing symptom severity for emotional health disorders including anxiety and mood disorders. While adults on a treatment team may be well aware of this evidence, teens may look elsewhere to gather information – turning to the less than reliable sources of anecdotal conversations and social media. If we want teens to participate in the treatment planning process armed with greater information, there are a few steps we can follow to support their treatment engagement.

First, when the question relates to medications, I always encourage teens to have very open discussions with their parents and providers about the risks and side effects of medications. It’s incredibly helpful to open conversations by asking teens what they already know or what they have already heard or read about different types of medications. This helps to eliminate any confusion or misperceptions, either about negative side effects or about their unrealistic expectations that things will be “magically cured” in a very short period of time. It is important for teens to understand how long medications may work in their system, how long they need to take the medication to reach the therapeutic dosing, and the risks of not taking it or experimenting with other substances which may interfere with the mechanisms of action. For anxious kids who may not feel comfortable speaking up within an appointment, I encourage families to make a list of their teen’s questions and a plan for who will read the list of questions in the appointment. There are valuable supports that can help with the executive functioning demands needed to remember medications (e.g., daily pill boxes, setting alarms, or reminders on their phone, etc.).

When it comes to therapy, it is relatively common for me to hear a parent state that a child is reluctant or unwilling to attend therapy. There may be many very valid reasons why a teen may feel this way, and it is a sign that they are engaging in the developmental task of individuation when they push back on this recommendation. We don’t need to fear this struggle, and we can use it as an opportunity to invite a conversation. For teens who struggle to explain why they are reluctant about treatment, I might share a few common explanations to see if they resonate with the teen: “Some teens think it’s boring, or it’s too hard, or it’s a waste of time. Some worry their parents will know each thing they say, or feel like they are not in control of the treatment goals.” It may also be as simple as finding virtual sessions to be frustrating and impersonal, or finding the commute to an office for an in-person session to be time consuming. Many of these logistic concerns can be addressed with scheduling. It is also important for teens to know that therapy is not “one size fits all.” There are different forms of therapeutic treatment, and it is important to find a provider with experience delivering evidence-based treatments for the specific diagnosis that your teen carries.

One of the most important factors in treatment adherence is a trusting therapeutic relationship. Those relationships take time to build. If a teen is not feeling well connected to their therapeutic provider, I encourage them to have a discussion either directly with their provider about this or to explore other treatment providers. The same way someone may not wish to be friends with every person they meet, there are certain connections that just “feel right.” Skilled providers also use techniques, such as Motivational Interviewing, to encourage teens to develop their own goals for treatment. This can help to diffuse the argument that a teen is only engaging in a treatment to appease their parent or caregiver. These powerful tactics include important elements of empathy, highlighting discrepancies in thinking (or in conflicting actions and behaviors), accepting (and even expecting) resistance, and promoting self-efficacy.

In helping teens to find their own voice in the treatment process, a power struggle or a demand for engagement from a parent is unlikely to get us very far. Bringing in the support of other trusted people in a teen’s life (e.g., teacher, school counselor, coach, uncle or aunt, older cousin) may also be a useful way to open the discussion about why therapy feels stressful. While teens may wish for things to get better on their own, ignored or avoided struggles do not just go away magically. Treatment can be hard as it does involve facing anxiety-provoking material. However, teens will be facing this content with a trusted adult and armed with new tools to master these triggers. It is important to acknowledge that therapy can be hard work, and they will not be doing it alone. Engaging in special self-care routines after a therapy session, particularly if parents can acknowledge and create space for these, can be a powerful way to encourage commitment to treatment. When teens feel more control in engaging with their treatment, they are far more likely to persist.

For more information on enhancing motivation for treatment engagement, consider the following resources:

 

About the Author

Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.

 

If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, please fill out and submit our online intake form

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

The Importance of Building Grit

By | NESCA Notes 2024

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

“I’ve missed more than 9,000 shots in my career. I’ve lost almost 300 games. Twenty-six times I’ve been trusted to take the game-winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed.”

Michael Jordan

 “Our potential is one thing. What we do with it is quite another.”

– Angela Duckworth, “Grit: The Power of Passion and Perseverance

What is it that separates those who succeed and those who give up? Is it talent? Is it luck? In the book, “Grit: The Power of Passion and Perseverance,” psychologist Angela Duckworth examined why some people are more successful than others, and she concluded that the common denominator is ‘grit.’ She defines grit as “passion and perseverance for long-term goals” and notes that “bouncing back from failure turns out to be one of the best lessons a kid can learn.” While we, as parents, sometimes focus on academic success to help our children succeed, Angela Duckworth believes that grit “matters more to a child’s ability to reach his full potential than intelligence, skill, or even grades.” Research into grit also finds that, unlike IQ, which is relatively fixed, grit is something everyone can develop.

While some children seem to be naturally grittier than others, we can help our children develop the habits of persistence and perseverance that will allow them opportunities to be successful in whatever it is they feel passionate about. So, how do we help our children develop the ability to push through when things get hard, recognize that making a mistake is an opportunity to learn rather than a ‘failure,’ and stay focused on goals even during times of disappointment?

One important thing parents and teachers can do is to model and encourage goal setting. It is important to encourage children to set realistic and achievable short-term goals, so that they can experience small successes that will keep them motivated to reach their long-term goals. For example, a short-term goal could be to practice the piano for 20 minutes per day with the long-term goal of participating in the school talent show.

As parents or caregivers, we tend to want to ‘fix’ things for our children, or make the path easier for them, but to truly develop grit, a child must be provided opportunities to attempt difficult things. According to Duckworth, “It has to be something that requires discipline to practice,” and she reminds parents to remember that the actual activity doesn’t matter as much as the effort, and that it is effort that should be rewarded over achievement.

It is also important to model to children that success does not occur right away, that practice and perseverance are needed, and that learning something new is hard but that does not mean they will not be good at it. Additionally, when a child does come across a problem, rather than solve the problem for them, encourage them to figure out a way to solve it themselves. According to Paul Tough, author of “How Children Succeed,” “It’s so much more powerful for a child to be able to deal with adversity and overcome it. What the child takes from that experience is, ‘Hey, I can solve things.’”

Most importantly, children learn what they see, so demonstrate to your child that you are able to take on tasks that are sometimes scary. And while sometimes you may have difficulty with those tasks or even fail to complete them, your ability to persevere, problem solve, and bounce back from these experiences will go far in allowing children to believe that they also can try hard things, that failing is not a lack of success but a stepping stone to gaining a skill, and that perseverance and grit are traits that will serve them well as they continue to grow and develop.

Sources:

https://www.scholastic.com/parents/family-life/social-emotional-learning/social-skills-for-kids/power-defeat-how-to-raise-kid-grit.

https://psycnet.apa.org/record/2021,Grit and academic achievement: A comparative cross-cultural meta-analysis

“Grit: The Power of Passion and Perseverance,” Angela Duckworth, Scribner, 2016

“How Children Succeed: Grit, Curiosity, and the Hidden Power of Character,” Paul Tough, Houghton Mifflin Harcourt, 2012

 

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.

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Sibling Stress: How to Support the Siblings of a Child with Emotional Needs

By | NESCA Notes 2024

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

A child with significant mental health or developmental needs impacts the whole family system. The impact is multifaceted – from the way that a child interacts in the home environment to the challenging logistics of coordinating outpatient care and appointments. Families have to make sacrifices with their time, attention, and financial resources to address the mental health needs of one (and sometimes more than one) child. Families may also arrange schedules, including planning vacations or social events, for the family in order to accommodate treatment. It can add more stress when parents stop to consider: how is this impacting the other kids in the family?

To buffer siblings against negative impacts from being in the home with someone struggling with mental health:

  • Create an environment of safety and predictability. Talk in a family meeting about basic safety needs for the household – things like being safe with your body, being safe with property, and maintaining basic travel safety (e.g., staying buckled in the car). It is important that all siblings hear the rules and the consequences for violating the rules. If there is an episode of dysregulation, it can be very helpful to return to this conversation again.
  • Create a plan for when there is dysregulation. Remind your child/children without mental health concerns that the job of the parent is to re-establish safety, and where your other child/children should go while you address a problem. This can be their bedroom, basement playroom, or other identified place in the home. Take a moment to identify Plan B for where the safe place is if the dysregulation is happening in a common space. Talk to your child about what activities may distract and distance them from the commotion.
  • Remind your child what adults are available for them. If you are in a two-parent household, one parent can address dysregulation, and the other can stay with the sibling(s). If you are in a one-parent household (or a partner is not home), remind your child that they can call the other parent, aunt, uncle, grandparent, or identified friend or neighbor if they need some reassurance.
  • Put on your “oxygen mask” first. After an incident of dysregulation, check in with yourself as a parent to regulate emotionally before approaching your other child/children. Take a few moments for deep breaths or progressive muscle relaxation to calm your own nervous system. Once you are re-regulated, your message that safety has been re-established will be more soothing and believable.
  • Set aside time in each day to connect with each child. The focus can often be on positive connection with the child struggling. But, all children need the positive connection, praise, and child-driven interactions. This can help ensure that all children receive the attention they need to thrive.
  • Hold the frame. It can be easy to relax the rules with a sibling whose struggles and behavior may seem mild by comparison. It’s important to establish standards that work for each child’s unique skills and needs. It’s worth a candid conversation with each child about what the expectations are and why.
  • Use the village. Establishing a support system is critical to buffer the entire family from the overwhelming stress that can accompany emotional health issues. Enlist the support of other family members, neighbors, teammates’ families, or school personnel. If you feel that your support system is small, start with your child’s pediatrician or school to connect to community resources.
  • Reach out for help. It’s important to closely monitor siblings for signs of increased anxiety, stress response, low mood, or atypical behaviors. If you see classic signs of anxiety (fight/flight/freeze), reach out to your child’s school or pediatrician to evaluate symptoms and initiate treatment.

Additional resources to support siblings:

 

About the Author

Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.

 

If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, please fill out and submit our online intake form

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Falling through the Cracks

By | Nesca Notes 2023

By: Yvonne Asher, Ph.D.
NESCA Pediatric Neuropsychologist

“You’re going to have a tough conversation on your hands,” I said. The parent sighed and nodded in response. “That’s what her ABA provider said, too,” she responded.

This conversation would not be difficult because her child was acting out, engaging in challenging behaviors, or taking up a great deal of adult time. In fact, she was exactly the opposite. Quiet, calm, gentle, and well-regulated were some of the words I used during our feedback session. And this, we discussed, is a huge part of the problem.

Despite their best efforts, teachers simply cannot be with every child that needs help, each time they need help. School providers do not have infinite caseloads, time, or capacity. There are real-world limitations to providing support and services for children at school. And yet, the children who suffer from these very real constraints are so often the quietest and least disruptive. This is extremely unfortunate when the child has real, diagnosed, observable deficits that absolutely require special attention and intervention at school.

Our brains often develop schema in order to reduce the brain’s workload (these occur entirely outside of our conscious awareness). Many social psychology studies have characterized the harm that schema can do. One such harm often comes to children for whom teachers have either strong positive or strong negative schema about. The effects of negative schema are likely obvious, but the positive schema can be just as challenging to manage. When teachers view a child very positively, they may be more likely to “write off” concerns (e.g., “she was just tired today,” “he really does know, he’s just having a bad day”), over-emphasize the child’s effort and diligence (rather than their actual skill level or mastery), and focus on positive attributes of the child in place of focusing on their weaknesses.

It can be challenging for parents to hear such positive feedback, particularly when it does not correlate with their perception of the child’s difficulties. Although neuropsychology attempts to be a strength-based field as much as possible, fully exploring and adequately characterizing deficits is often an invaluable part of what we do. This can help us to bring objective, data-driven recommendations to school teams for all students, hopefully preventing those quiet, hard-working youngsters from “falling through the cracks.”

 

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.

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham (coming soon), Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy 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 or another NESCA clinician, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

Going South: NESCA Announces New Hingham, MA Location

By | Nesca Notes 2023

By: Jane Hauser
Director of Marketing & Outreach, NESCA

NESCA is excited to announce that it is opening a Hingham location to serve clients on the South Shore of Massachusetts. NESCA is currently booking appointments now for Neuropsychological and Psychological Evaluation Services commencing on November 1, 2023. Learn more about what is being offered by our Hingham-based staff from my interview with Hingham Director; Pediatric Neuropsychologist Moira Creedon, Ph.D.

What prompted NESCA’s expansion to the South Shore or Massachusetts, and how can clients benefit from our Hingham location’s services?
NESCA is expanding our in-person services to Hingham on the South Shore to widen the breadth of neuropsychological and educational evaluation and consulting services offered within the state. We know that families have options as they partner with neuropsychologists, and we want to be in close proximity to communities we hope to serve. This is an exciting opportunity to support students in elementary, middle, and high school as well as young adults, as they navigate the complexities of their daily lives. It is our priority to continue providing detailed, client-centered, thorough evaluations that highlight a client’s areas of strength and vulnerability. I am also excited to strengthen relationships with local care providers and schools, and to build new relationships as a new clinician within the South Shore community.

What services do you offer?
At this time, NESCA’s South Shore-based practice will offer Neuropsychological Evaluations and Projective Assessments. The goal of these services is to build a complete picture of a client’s functioning, including their intellectual, academic, and social-emotional profile. Team members are also available to participate in team meetings at school (IEP meetings), conduct school observations, and offer consultation to parents and team members. Sometimes, a child has already participated in evaluations in other settings (schools, hospitals), and a family needs help to review these documents and make meaning of the findings.

What types of clients will NESCA serve in its South Shore location?
NESCA’s South Shore-based practice is similar to our other locations and will serve children, teens, and young adults with a range of presenting issues. The focus is in working with students in elementary, middle, and high school as well as young adults. I can see clients with diagnostic questions, including Autism Spectrum Disorder (ASD), Learning Disorders (e.g., dyslexia, dysgraphia), Attention-Deficit/Hyperactivity Disorder (ADHD), anxiety, depression, and complex psychiatric diagnoses.

A specialty we have at NESCA – including in Hingham – is working with clients who have multiple diagnoses or who don’t fit neatly into a singular diagnostic box. I also see clients who are high functioning and curious about their learning style, how to improve their study skills, and how to plan for their academic future based on their unique profile.

Where are you on the South Shore? Are services in-person or remote?
We are practicing in person in an office at 99 Derby Street, Suite 200, in Hingham, MA. Hingham is uniquely positioned to serve the South Shore/Southcoast, and the Cape and Islands. For those traveling for appointments, most clients schedule testing in two longer (2.5 hour) blocks of time so the commute is reduced for families. I am also available to participate in IEP team meetings and conduct student observations in person on the South Shore, which is an exciting way to collaborate and build strong relationships with families, schools, and organizations.

What is different about what NESCA offers on the South Shore compared to other organizations or services available locally?
NESCA is highly respected in the community for providing detailed, comprehensive evaluations of students that speak to their strengths as well as their needs. Compared to some practices, your child or teen will be assessed directly by a neuropsychologist rather than a technician. You can depend on your neuropsychologist to bring their own expertise as well as the “village” of NESCA, as I am always collaborating with NESCA’s team of innovative neuropsychologists, transition specialists, educational consultants, speech and language pathologists, occupational therapists, and therapists. We work routinely with special education attorneys, advocates, therapists, and school personnel in collaborative relationships to support children and teens. At NESCA, we live our core values everyday: being creative problem solvers, being collaborative and building lasting relationships, and caring deeply for students, their families, and the community.

Does insurance cover your services in Hingham?
Several NESCA providers take both Blue Cross Blue Shield and private pay for services. I am paneled with BCBS. Some families are able to obtain some coverage or reimbursement through other insurance agencies, and we can provide those families with brief billing information to submit to their insurance company. We can never guarantee insurance reimbursement, so it is important that families check with their insurance plan regarding covered services.

What if I am unsure if I should refer my child or client for an evaluation?
Give us a call! Our administrative team is happy to support you in navigating this process. We are also planning some community events to provide information to our community about a variety of topics, including who we are and how to recognize signs that a child or teen may need additional support. There is also a ton of information on our website.

How do people get more information about NESCA’s South Shore services?
You can fill out our online intake form, call 617-658-9800 to speak with an intake coordinator, or reach Hingham-based Pediatric Neuropsychologist Dr. Moira Creedon directly at mcreedon@nesca-newton.com.

 

About the Author

Hingham Director; Pediatric Neuropsychologist Dr. Moira Creedon has expertise in evaluating children and teens with a variety of presenting issues. She is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.

 

If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, please fill out and submit our online intake form

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham (coming soon), Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

NESCA Welcomes Back Carly Edelstein, MSW, LCSW, Licensed Clinical Social Worker and Executive Function Coach

By | Nesca Notes 2023

By: Jane Hauser
Director of Marketing & Outreach, NESCA

NESCA welcomes Ms. Carly Edelstein, MSW, LCSW, back to its coaching and psychotherapy services teams. She previously interned with NESCA, and we are thrilled to have her back on board as both a Psychotherapist and Executive Function Coach. Read more about Ms. Edelstein’s career journey and her return to NESCA in the following Q&A interview.

 

This is your second time working with NESCA. Tell us what you did with NESCA previously.
Yes, and I am elated to be back! During my graduate studies at Simmons University, I interned at NESCA as a psychotherapist. In addition to providing individual psychotherapy to children, adolescents, and young adults, I worked with a few high school and college students as an executive function (EF) coach. I also provided psychotherapy to clients from India and the Philippines, which was an incredible and unique experience. I have yet to find a practice as dynamic and integrative as NESCA and look forward to rejoining as a seasoned clinician!

You will be splitting your time and talents in two roles here at NESCA. Fill us in on your dual role and what your previous experiences bring to both.
At NESCA, I’ll be providing psychotherapy and executive function coaching. Both of these roles have been a consistent focus of mine simultaneously throughout my professional life. After obtaining a B.S. in education at the University of Vermont, I worked in special education as a paraprofessional, supporting students with special needs in the classroom. In this role, I helped students learn new strategies to maintain their focus, self-regulate, and improve their organization. Additionally, throughout graduate school, I worked part-time as an EF coach at Engaging Minds, helping elementary, middle, and high schoolers with their homework and school assignments by finding ways to improve their task initiation, organization, time management, and planning skills.

My interest in social work/mental health counseling was sparked by my experience as a student teacher at UVM. During the entirety of my practicum, I found myself  gravitating towards students who struggled academically, mentally, socially, and emotionally. I was determined to help these students navigate their challenges by building meaningful connections, providing additional academic support, and increasing their self-confidence by focusing on their strengths.

My counseling experience officially started in graduate school with two full-year-long internships. My first internship took place in the counseling department at Boston Green Academy, a public charter school for grades 6-12, and my second was at NESCA. After graduate school, I worked as a school adjustment counselor at Newton South High School and also took on clients part-time at a private practice. In these roles, I supported the social and emotional wellbeing of students with special needs, as well as their families. After working in corporate wellness for the last year and a half, I am excited to return to the clinical setting, working for a practice that was a major part of my social work journey.

Having worked as a high school adjustment counselor, you must have seen many of the challenges students have with executive function. What are your biggest takeaways from that experience? How do you think that prepared you to be an EF coach?
The majority of my students struggled with executive function, therefore providing support in this area was part of my day-to-day routine. My biggest takeaways are:

  1. Identifying a “why” helps individuals become more motivated to be proactive in their EF journey. For example, I tend to ask people how improving these skills will affect their academic goals, mental health, social relationships, etc., so that there is significant meaning to the work being done.
  2. There is a system that works for everyone! Whether it’s electronic or physical, once someone identifies an organization system that increases their independence, it’s important that they stick to it and are consistent with it. Having a set system will allow them to easily locate their assignments, know when they are due, and how they’ll go about completing them. It’s always helpful for parents and teachers to be made aware of this system as well so that everyone is on the same page.
  3. Creating a regular homework routine is key to increasing productivity and limiting distractions. This includes having an identified start time, location, and plan. I always recommend structured breaks being part of this plan as well.
  4. I always advise folks to not compare themselves to others when it comes to their EF skills! We all have natural strengths. A skill that comes easy to you may be the most challenging task for someone else.

There have been countless reports and studies related to the negative impact COVID had on kids. As a psychotherapist to teens and young adults, what challenges are you seeing most in youth post-pandemic?
There’s no doubt that the impact of COVID on our youth has presented serious and complex challenges. The loss of structure, social opportunities, and extracurriculars (to name a few) is a shock to the system and very traumatic. The biggest challenges I’ve seen post-pandemic have been an increase in digital dependence, cyberbullying, school-based anxiety/refusal, and regression in social skills. That being said, as important as it is to identify post-pandemic challenges, there is value in pointing out gained strengths as well. A lot of students who I worked with learned new coping skills, acquired a deeper understanding of their needs, and discovered exciting new hobbies that they now get to share with others.

 

About Carly Edelstein, MSW, LCSW
Carly Edelstein is a Licensed Clinical Social Worker practicing in Massachusetts and Rhode Island. Having worked both in private practice and schools, she has extensive experience supporting students, families and educational teams to make positive changes. Ms. Edelstein provides executive function coaching and psychotherapy to clients ranging from middle school through adulthood. She also offers consultation to schools and families in order to support her clients across home and community environments.

 

To schedule an appointment with Ms. Edelstein for psychotherapy or EF coaching, please complete our online intake form

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, Londonderry, New Hampshire, and the greater Burlington, Vermont area, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Don’t Let Summertime Chores Deflate Your Vibe

By | NESCA Notes 2021

By: Jessica Hanna MS, OTR/L
Occupational Therapist, NESCA

It’s summertime, and let’s face it, nobody wants to do chores. However, through learning about the benefits of chores in a previous NESCA blog post, we realized all that it can bring to the table to improve child development skills.

Nevertheless, let’s step back. No one ever said chores must be painful or that it is all business and no play. Even when it comes to chores, you can keep it fun! The beauty about chores is that in addition to learning personal responsibility, improved self-care skills, and teamwork, chores help children to incorporate and work on an array of skill sets, such as:

  • Visual perceptional skills
  • Executive functioning skills
  • Bilateral coordination skills
  • Fine motor skills
  • Upper body strength
  • Sensory regulation

Let’s take a closer look at exactly what that can look like:

 Water play chores

Stop what you’re thinking…yes, it can seem messy, but remember the goal: participation, have fun, work on important skills (bilateral coordination, sequencing, crossing midline, integrating sensory input).

  • Cleaning off sandy beach items Works on a 2-step or 3-step sequence and bilateral coordination skills.
    • 2-step sequence (rinse and dry using a water bucket or water hose)
    • 3-step sequence (rinse/dry/store back in beach bag)
  • Watering plants/flowers outside – Provides heavy work and promotes bilateral coordination to hold a water-hose and use upper body strength to maintain arms lifted above gravity.
  • Rinse dishes in the sink – Works on sequencing steps, crossing midline, upper body strength, and bilateral coordination.
  • Wipe down indoor/outdoor tables – Incorporates motor planning, crossing midline, and promotes upper body strength.
  • Clean reachable outdoor/indoor windows – Remember it is not about the streaks left behind. The task promotes and builds on upper body strength, hand strength, motor planning skills, and bilateral coordination skills.

Chores that work on visual perceptual skills

  • Sorting clean laundry – Play assembly line with clean clothes or turn it into a mini obstacle course. Sorting and putting away laundry can be a group effort for everyone in the family!   
    • Matching socks
    • Color coding clothing
    • Sorting by category (pants/shirts/undergarments)
  • Putting away groceries…what is more fun than playing store? – Have your child follow a pre-made visual or written checklist to make sure and check off all items purchased (e.g., create your shopping list on Prime Now or Peapod where visuals are supplied, and you print a copy for your child to follow and mark up).
  • Loading the dishwasher – When it comes to loading the dishwasher, we all know it can be a game of Tetris, even for adults! When helping your child load the dishwasher safely, make sure you place one item first in a designated area and see if they can sort items accordingly.
  • Cleaning up toys on a floor – When asking your child to pick up toys, reduce visual clutter, and be specific.
    • Place a perimeter (e.g., use a hoola hoop/painter’s tape) around toys that need to be picked up.
    • Use a visual checklist to identify toys to be picked up (e.g., books, Legos, crayons).
    • You can turn it into a scavenger hunt game (e.g., find 10 crayons on the floor).

Chores that promote regulation

Heavy work chores/activities help with sensory regulation through the act of pushing, pulling, and lifting heavy items.

  • Laundry – If you have a front-loading reachable washer and dryer, have your child pull wet clothes out of the washer, or dry clothes from the dryer. Or have your child (depending on size and strength) help carry a basket of clean or dirty clothes to and from the washer and dryer. (To add a fun twist, have them walk over items, around items, spin, bend, etc., with a basket of clothes).
  • Vacuuming/Swiffering – Make sure the size is appropriate. Little ones love handheld vacuum cleaners and dust pans if they cannot manipulate larger sized appliances. Handheld vacuums are fun for kids to use in helping to clean out the car! Turn it into a game to vacuum the treasures your car “ate” during those summer outings can be an adventure for them and a bonus for you!
  • Bed making – Have your child sit in the bed and help pull up those sheets and blankets from the sitting position. It’s fun when it fluffs up and gets tricky when you must sneak or crawl out without pulling the sheets down!

Always keep in mind what you want the goal of a chore to be and remember that they do not have to be done perfectly. When chores are broken down into steps, are provided and paired with a verbal and visual demonstration, and are concrete, your child will be successful in participating in your chore of choice. You must remember to create the just-right challenge regarding your child’s age and pair it with fun!

 

About the Author

Jessica Hanna has over 10 years of pediatric OT experience in conducting assessments and providing treatment of children and adolescents with a broad range of challenges and disabilities, including autism spectrum disorders, sensory processing disorders, visual impairments, cerebral palsy, executive function deficits and developmental disorders of motor function. Prior to joining NESCA, Jessica trained and worked in a variety of settings, including inpatient and outpatient hospital settings, private practice, schools and homes. She has served on interdisciplinary treatment teams and worked closely with schools, medical staff and other service providers in coordinating care. In addition, Jessica provided occupational therapy services at Perkins School for the Blind and Spaulding Rehabilitation Hospital pediatric inpatient unit, where she conducted comprehensive evaluations and interventions for children with a broad range of presentations.

 

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.

 

Shouldn’t We All Get Neuropsychological Evaluations, Then?

By | Nesca Notes 2023

By: Yvonne Asher, Ph.D.
NESCA Pediatric Neuropsychologist

One frequent question I have been asked by parents following a neuropsychological evaluation is, “Wouldn’t this process be helpful for everyone?” This tends to come up around the issue of disclosing results of an evaluation to children and teenagers and helping them better understand “how their brain works.” Many families with whom I have had the privilege of working come back months or years later with siblings of an initial client, noting that the process was so valuable the first time, they are hoping for a similar experience for their other child or children.

So, should we all get neuropsychological evaluations? Largely, I think this question is motivated by parents who are eager to help their children understand their own strengths and weaknesses. This is a wonderful goal, as self-understanding is one of the most valuable and lifelong gifts we can give our children.

In my experience, many people come to this kind of self-understanding naturally, over time, through experiences in adolescence and young adulthood. In particular, experiences that involve more independence in living and learning promote this kind of understanding. During childhood, we may learn our relative skill among family members (“I’m good at soccer, and my sibling is good at piano”), but these relative differences may not hold once we leave our family of origin. Many people venture out into the world and find that, compared to their peers, they are actually quite skilled at getting groups of friends together, doing everyday math, putting their thoughts down in writing, or staying organized. These real-world strengths often reflect the strengths that could be found through formal evaluation. As we gain self-understanding, we may be prompted to enter certain professions, take on particular hobbies, or pursue friends and partners with specific traits.

A neuropsychological evaluation can “speed up” the process of self-understanding, giving some young people a head start on the identity formation process that naturally occurs during adolescence. For some, this head start is vital – their brains are structured in ways that present clear, observable differences between them and their peers. This may be the case with diagnoses like autism spectrum disorder, a learning disability, or ADHD. For these individuals, the feedback from a neuropsychological evaluation can (under the best of circumstances) stave off feelings of inadequacy, negative self-esteem, and shame, helping a young person to recognize the deeply important strengths that are present alongside their more observable challenges. In these cases, a neuropsychological evaluation is not only for self-understanding, but also for self-compassion. Our goal as neuropsychologists in these cases is not just to help the child or teen understand themselves, but also to be gentle and kind with how they view their difficulties. Our hope is that, when these individuals venture out of their families and into the broader world, they are able to show resiliency in the face of the obstacles that will almost certainly be present.

 

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.

 

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.

 

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