Tag

AUTISM

Key Facts about Early Diagnosis of Autism Spectrum Disorder (ASD)

By | NESCA Notes 2020

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

Early diagnosis is a catalyst for propelling children on positive trajectories. If a family and child identify and focus on areas of growth earlier rather than later, there is more time and more possibility of change and improvement. This tenant is particularly critical for diagnosing ASD in toddlerhood and early childhood.

Here are critical facts about the diagnosis of ASD in early childhood and the positive impact of early diagnosis on youngsters as they age into adulthood.

  1. Most children with ASD are not diagnosed until approximately 4 years-old, yet ASD can be reliably identified by the age of 2. There is also expanding research on early identification of infants who may be at risk for ASD. Early detection is possible.
  2. Genes play an important role in ASD. A child’s odds of having an ASD diagnosis increases if he/she has a sibling or parent with ASD, attention deficit hyperactivity disorder (ADHD), intellectual disability, schizophreniadepression, bipolar disorder or anxiety. Family medical history is an important factor for families considering a diagnostic evaluation.
  3. Co-occurring disorders (such as anxiety and depression) are more likely in individuals with ASD than the general population. Identifying emotion regulation issues in early childhood is thus essential.
  4. Neuroplasticity matters. Because ASD is a neurodevelopmental disorder, early treatment improves neuroplastic brain functioning and subsequent behavior. As a child develops, his/her brain becomes less plastic.
  5. Interventions geared at a child’s “first relationships” with their caregivers may exert a strong positive effect on the developmental trajectories of toddlers at high-risk of ASD and also have a positive impact on a child’s social skills with peers as they age.
  6. Research indicates that parent-child interactions in early childhood predict long-term gains in language skills into adulthood for individuals with diagnoses of ASD. Acquiring communicative, pragmatic and useful language by kindergarten has also been identified as a strong predictor of adaptive or functional “real life” skills, which are needed to navigate the environment in adolescence and adulthood.
  7. Social skills instruction in a child’s early years increases competency with peers in school. This social competency is associated with greater adaptive independence in children with ASD.
  8. Working with a “diagnostic navigator” early in your child’s life improves outcomes. Research clearly indicates that social support is vital to relieve stress associated with caregiving for a child with ASD and that a positive parent–professional relationship is helpful in alleviating family stress.

If you suspect your child has or is at higher risk for ASD and you are looking for a “diagnostic navigator” for your child, consider an evaluation with NESCA.  While early diagnosis of ASD can make a positive impact on a child’s trajectory, obtaining the accurate diagnosis and recommendations for interventions at any age is critical.

 

References:

Elder JH, Kreider CM, Brasher SN, Ansell M. Clinical impact of early diagnosis of autism on the prognosis and parent-child relationships. Psychol Res Behav Manag. 2017;10:283-292. Published 2017 Aug 24. doi:10.2147/PRBM.S117499.

Dawson G, Jones EJ, Merkle K, Venema K, Lowy R, Faja S, Kamara D, Murias M, Greenson J, Winter J, Smith M, Rogers SJ, Webb SJ. Early behavioral intervention is associated with normalized brain activity in young children with autism. J Am Acad Child Adolesc Psychiatry. 2012 Nov;51(11):1150-9. doi: 10.1016/j.jaac.2012.08.018. PMID: 23101741; PMCID: PMC3607427.

Jokiranta-Olkoniemi E, Cheslack-Postava K, Sucksdorff D, Suominen A, Gyllenberg D, Chudal R, Leivonen S, Gissler M, Brown AS, Sourander A. Risk of Psychiatric and Neurodevelopmental Disorders Among Siblings of Probands With Autism Spectrum Disorders. JAMA Psychiatry. 2016 Jun 1;73(6):622-9. doi: 10.1001/jamapsychiatry.2016.0495. PMID: 27145529.

Kasari C, Siller M, Huynh LN, Shih W, Swanson M, Hellemann GS, Sugar CA. Randomized controlled trial of parental responsiveness intervention for toddlers at high risk for autism. Infant Behav Dev. 2014 Nov;37(4):711-21. doi: 10.1016/j.infbeh.2014.08.007. Epub 2014 Sep 26. PMID: 25260191; PMCID: PMC4355997.

Mayo, J., Chlebowski, C., Fein, D.A. et al. Age of First Words Predicts Cognitive Ability and Adaptive Skills in Children with ASD. J Autism Dev Disord 43, 253–264 (2013). https://doi.org/10.1007/s10803-012-1558-0.

Siller, M., Swanson, M., Gerber, A., Hutman, T., & Sigman, M. (2014). A parent-mediated intervention that targets responsive parental behaviors increases attachment behaviors in children with ASD: results from a randomized clinical trial. Journal of Autism and Developmental Disorders, 44(7), 1720-1732.

Xie S, Karlsson H, Dalman C, Widman L, Rai D, Gardner RM, Magnusson C, Schendel DE, Newschaffer CJ, Lee BK. Family History of Mental and Neurological Disorders and Risk of Autism. JAMA Netw Open. 2019 Mar 1;2(3):e190154. doi: 10.1001/jamanetworkopen.2019.0154. PMID: 30821823; PMCID: PMC6484646.

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

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

 

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

 

How Do I Prepare My Child for a Neuropsychological Evaluation?

By | NESCA Notes 2020

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

Parents often ask us what they should tell their child about their upcoming neuropsychological evaluation, especially when it is their first experience with testing. I advise parents to refer to the neuropsychologist using his or her first name, as the term “doctor” can be scary and raise fears about medical exams. I might also add that the visit will not involve any shots! In order to describe the evaluation itself; here is some helpful language:

  • They are going to ask you questions, and you just need to do your best to answer.
  • They might ask you to do some drawing or writing.
  • Some activities might feel like you’re in school; for example, reading stories or doing math problems.

It may also be helpful to create a simple social story prior to the evaluation to help preview what to expect for your child.

To explain the reasons for doing the evaluation, some key phrases to use with your child include:

  • We want to understand how you learn, because everybody learns differently.
  • We are going to be “brain detectives” and figure out how your brain works!
  • This will help us identify your strengths and areas that we need to work on. That way, we can help you with things that are harder for you.
  • This will help your teachers understand your learning style so they can help you better at school.
  • Just try your best!

Testing in the age of Covid-19 is different. It can be harder to help children feel at ease when everyone is wearing masks, and we can’t offer a high five for good work. But as we are all learning, children are often more resilient than adults. Prior to coming in for an evaluation, you might want to remind your child to wear their mask, wash their hands and not approach people too closely.

It is also important to understand that a neuropsychological evaluation is a lot of work for your child! Finding a way to reward them for their effort will go a long way in helping them stay motivated and positive. This could be as simple as swinging by the drive-thru for a donut or something more extravagant, like a new video game. Whatever you choose to do, create a plan with your child and let the neuropsychologist know. When I have a child in my office who is starting to fatigue, it’s always a great motivator to remind them of the special prize they’ll get at the end of the visit!

 

About the Author: 

Erin Gibbons, Ph.D. is a pediatric neuropsychologist with expertise in neurodevelopmental and neuropsychological assessment of infants,

children, and adolescents presenting with developmental disabilities including autism spectrum disorders, Down syndrome, intellectual disabilities, learning disabilities, and attention deficit disorders. She has a particular interest in assessing students with complex medical histories and/or neurological impairments, including those who are cognitively delayed, nonverbal, or physically disabled. Dr. Gibbons joined NESCA in 2011 after completing a two-year post-doctoral fellowship in the Developmental Medicine Center at Boston Children’s Hospital. She particularly enjoys working with young children, especially those who are transitioning from Early Intervention into preschool. Having been trained in administration of the Autism Diagnostic Observation Schedule (ADOS), Dr. Gibbons has experience diagnosing autism spectrum disorders in children aged 12 months and above.

 

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

 

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

Preparing our Kids to Reenter the Community

By | NESCA Notes 2020

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

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

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

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

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

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

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

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

Some examples of stories to create during the ongoing pandemic:

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

Some examples of more general stories include:

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

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

 

About the Author: 

Erin Gibbons, Ph.D. is a pediatric neuropsychologist with expertise in neurodevelopmental and neuropsychological assessment of infants,

children, and adolescents presenting with developmental disabilities including autism spectrum disorders, Down syndrome, intellectual disabilities, learning disabilities, and attention deficit disorders. She has a particular interest in assessing students with complex medical histories and/or neurological impairments, including those who are cognitively delayed, nonverbal, or physically disabled. Dr. Gibbons joined NESCA in 2011 after completing a two-year post-doctoral fellowship in the Developmental Medicine Center at Boston Children’s Hospital. She particularly enjoys working with young children, especially those who are transitioning from Early Intervention into preschool. Having been trained in administration of the Autism Diagnostic Observation Schedule (ADOS), Dr. Gibbons has experience diagnosing autism spectrum disorders in children aged 12 months and above.

 

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

 

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

Neurodevelopmental Evaluations – Where and When to Start

By | NESCA Notes 2018

**Creating Roadmaps for the Lifespan: Preschool Neurodevelopmental Evaluations to Life After High School**

NESCA Pediatric Neuropsychologist Dr. Erin Gibbons will be presenting on neurodevelopmental and neuropsychological evaluations in a free educational workshop at NESCA’s Plainville, MA office on Monday, March 9 from 6:30 – 8:00 PM. NESCA Transition Specialist Becki Lauzon will be co-presenting to address the transition process/how to start preparing for life after high school.

For more information, visit the event page. To register to attend the event, email Jane Hauser at jhauser@nesca-newton.com. As a preview to what attendees can expect to learn at the event, read Dr. Gibbon’s blog post.

 

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

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

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

Where do I start?

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

What is a neurodevelopmental evaluation?

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

Why is a neurodevelopmental evaluation useful?

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

What happens next?

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

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

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

Where can I go?

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

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

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

About the Author:

GibbonsErin Gibbons, Ph.D. is a pediatric neuropsychologist with expertise in neurodevelopmental and neuropsychological assessment of infants, children, and adolescents presenting with developmental disabilities including autism spectrum disorders, Down syndrome, intellectual disabilities, learning disabilities, and attention deficit disorders. She has a particular interest in assessing students with complex medical histories and/or neurological impairments, including those who are cognitively delayed, nonverbal, or physically disabled. Dr. Gibbons joined NESCA in 2011 after completing a two-year post-doctoral fellowship in the Developmental Medicine Center at Boston Children’s Hospital. She particularly enjoys working with young children, especially those who are transitioning from Early Intervention into preschool. Having been trained in administration of the Autism Diagnostic Observation Schedule (ADOS), Dr. Gibbons has experience diagnosing autism spectrum disorders in children aged 12 months and above.


 

When Parents and Kids Have BIG Emotions

By | NESCA Notes 2020

By Miriam Dreyer, Ph.D.

Pediatric Neuropsychologist Fellow

Brianna Sharpe’s recent essay for the New York Times – Parenting section titled, “I’d Like to Melt Down When My Kids Do,” captures an essential challenge of parenting – managing one’s own emotions when your child is having big and difficult feelings. Ms. Sharpe writes about her own extensive training as a mental health professional and how even with lots of experience working with children, she was not prepared for the emotional demands of parenting. She writes, “. . . like all preschoolers, my son needs an anchor when the waters get rough. But just when he needed me most, I found myself being pulled under by my own emotions. Although I never called him names or outright accused him of being at fault, I would yell in anger when hurt. My irrational response was often, ‘Why would you do that?!’ Once the red haze faded, I knew he was doing just what preschoolers are designed to do – but I had a hard time reconnecting with him.”

Ms. Sharpe beautifully depicts the intricate link between a child and a parent’s emotions. As parents, one of our essential roles throughout our children’s lives is to help them regulate. From birth, our job is to love, soothe, feed, attend and help our kids make sense of their feelings. This is a hard job, made even more complicated by the nuances and complexities of our own emotional lives.

Emotion regulation is a multifaceted process. As defined by Gross (1998), emotion regulation involves conscious and unconscious processes that operate both before an emotional response is generated and after it occurs. He writes that emotion regulation consists of “processes by which individuals influence which emotions they have, when they have them, and how they experience and express these emotions.” Challenges with emotion regulation are a component of many of the presenting problems we see at our center. Children with ADHD can struggle with emotional impulsivity, shifting and modulating emotional responses. Individuals with depression and anxiety face challenges balancing positive and negative feelings, as well as controlling irrational thoughts and worries. Difficulties with emotion regulation for individuals on the Autism spectrum are also common and intersect with social/emotional and behavioral problems that can arise with symptoms related to rigidity, self-direction and repetitive, self-soothing behaviors.  Symptoms associated with traumatic stress, such as dissociation, mood lability and alexithymia, all interfere with one’s ability to regulate emotionally. Even challenges like communication disorders and other learning disabilities are related to emotion regulation since they generate anxiety and can impede expressing oneself using language, which is a key regulatory process. In fact, theorists are now conceptualizing emotion regulation as a possible unifying, underlying component across psychological disorders (Aldao, Nolen-Hoeksema, & Schweizer, 2010).

What are we, as parents, to do then in the face of our children’s and our own stormy emotions?  How do those of us caring for children who are struggling help them while attending to our own complicated emotional processes? A helpful framework for considering these questions comes from researchers who focus on attachment relationships in parenting, mentalization, as well as the mindfulness and self-compassion literature. 

  • Cultivate self-compassion. Parenting is hard, as is childhood. A stance of self-compassion which acknowledges challenges and encourages kindness to oneself helps move out of cycles of self-blame and anger.
  • Encourage curiosity about your own and your child’s emotions. Developing awareness of our own and our children’s emotional lives helps create a buffer in moments of heightened emotional arousal and can shed light on challenging patterns and interactive cycles.
  • Take a pause. Try breathing and mindfulness exercises to regain calm in difficult moments.
  • Consult with a therapist for parent guidance. There are many different types of parenting programs and support that can help tailor strategies and target complicated dynamics within family systems.

 

References

Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical psychology review30(2), 217-237.

Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of general psychology2(3), 271-299.

Sharpe, B. (2019, June 21). I’d like to melt down when my kids do.  The New York Times.

 

About the Author

Dr. Dreyer enjoys working with children, adolescents and families who come to her office with a wide range of questions about learning, social and emotional functioning. She is passionate about helping children and parents understand the different, often complex, factors that may be contributing to a presenting problem and providing recommendations that will help break impasses – whether they be academic, therapeutic, social or familial.

Dr. Dreyer joins NESCA after completing her Doctorate in Clinical Psychology at the City University of New York.  She most recently provided psychological assessments and comprehensive evaluations at the Cambridge Health Alliance/Harvard Medical School for children and families with a wide range of presenting problems including trauma, anxiety, psychosis, and depression.  During her training in New York, she conducted neuropsychological and psychological testing for children and adolescents presenting with a variety of learning disabilities, as well as attentional and executive functioning challenges.  Her research focused on developmental/complex trauma, as well as the etiology of ADHD.

Dr. Dreyer’s experience providing therapy to children, adolescents and adults in a variety of modalities (individual, group, psychodynamic, CBT) and for a wide range of presenting problems including complex trauma/PTSD, anxiety, depression, ADHD, and eating disorders informs her ability to provide a safe space for individuals to share their concerns, as well as to provide tailored recommendations regarding therapeutic needs.

Before becoming a psychologist, Dr. Dreyer taught elementary and middle school students for nine years in Brooklyn, NY.  She also had an individual tutoring practice and specialized in working with children with executive functioning challenges, as well as providing support in writing, reading and math.  Her experience in education informs both her understanding of learning challenges, as well as her capacity to make specific and well-informed recommendations.

She received her Masters in Early Childhood Education from Bank Street College, and her B.A. in International Studies from the University of Chicago.

 

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

 

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

 

When Grandparents Become Parents Again

By | NESCA Notes 2020

By Yvonne M. Asher, Ph.D. 

Pediatric Neuropsychologist

Grandparents can hold a special place for any child. For some, though, grandparents play a central role in their day-to-day lives. When grandparents raise a child, it is often related to parental challenges, tragic circumstances or government intervention. This brings inherent, understandable stressors for grandparents. Additionally, grandparents face the more typical challenges of child-rearing, such as managing educational experiences, ensuring emotional well-being and navigating health care.

When concerns with educational achievement, behavior, emotional or social functioning arise, there are many obstacles with which grandparents must wrestle. Feelings of guilt may arise, which can stem from a variety of sources. Grandparents may question their own parenting practices, worrying about past “mistakes” in raising their children. They may be especially sensitive to shielding their grandchildren from exposure to risky situations that their children may have faced without their knowledge. Grandparents may struggle when grandchildren are given diagnoses such as ADHD, autism or learning disabilities, wondering if their children faced these same challenges without formal diagnosis or intervention. Many grandparents express understandable fears around their grandchildren’s future, particularly their level of independence. While many caregivers have concerns with the independence of the children in their care, grandparents are often acutely aware of the limited time they will have to support, counsel and assist their grandchildren through their young adult years.

In navigating the special education and mental health care systems, grandparents can face many complex situations. Complexity may be increased if grandparents are in a caregiving role due to parents’ substance use or dependence. Depending on the timing and extent of substance use, there can be long-lasting impacts on grandchildren’s educational, cognitive or emotional health. This can substantially increase the difficulties that grandparents encounter, both in terms of accessing necessary services and supports, as well as coping with the stresses of caregiving.

There are also a number of strengths that grandparents can bring to their time as caregivers. They may be more aware of their rights as caregivers within the educational system, seeking out services and interventions when the “first signs” of difficulty arise. They may have a broader perspective on the school system, potentially having raised children who went through the same schools in the past. With the wisdom that comes in later adulthood, grandparents may be more discerning and skeptical about the opinions of professionals. They may ask more pointed questions, with less reserve or fear. Grandparents may also have built stronger support networks and have deeper connections to community organizations. These strengths can serve grandparents well in managing the complex systems that all caregivers face.

Several states have created advisory councils or legislation specifically designed to support grandparents raising grandchildren. In addition, there are many resources available to grandparents who are caring for and raising grandchildren, including:

https://www.helpguide.org/articles/parenting-family/grandparents-raising-grandchildren.htm

https://www.grandfamilies.org

http://www.massgrg.com/massgrg_2019/index.html

https://sixtyandme.com/resources-for-grandparents-raising-grandchildren/

 

About Pediatric Neuropsychologist Dr. Yvonne Asher:

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

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

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

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

 

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

 

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

 

How to Advocate for Your Child

By | NESCA Notes 2019

By: Reva Tankle, Ph.D.
Pediatric Neuropsychologist

The Federation for Children with Special Needs in Boston offers a Parent Consultant Training course several times every year. I have been privileged to teach this group about Neuropsychological Assessment and the IEP Process for the past 15 years. While many people take this course to become Parent Advocates as a profession, it is just as common that the participants are trying to figure out how to best advocate for their own children.

The process always starts with a concern. Parents request an initial evaluation from either the school or a private clinician because they have a concern about their child’s development. They are looking to understand their child’s challenges, obtain a definitive diagnosis and most importantly develop a treatment plan that will ensure their child’s positive trajectory into the future. What I have learned from the many participants in this course is that they are hungry for information about what they should be doing for their children.

It is encouraging that there are so many resources available for parents to help them with some of these concerns. However, the sheer amount of information can also be overwhelming, as it can be hard to know where to start. And it is important that parents get started right away, as we know there is a great advantage in early diagnosis and intervention; especially when autism is suspected. But where does one start?

  • Assessment/Diagnosis
  • Education
  • Parent Support
  • Advocacy

If you suspect your child may be on the autism spectrum, organizations such as AANE, The Asperger/Autism Network, and Autism Speaks can help you find diagnosticians in your area. Your child’s pediatrician may also be knowledgeable about local referral sources for assessment for suspected learning or developmental issues. Finally, word of mouth referrals from those who have previously navigated the process on behalf of their own child is often another great resource to rely on.

Once there is a diagnosis, parents should educate themselves as much as possible about the needs of their child and the options available. Organizations such as AANE and Autism Speaks can provide a lot of the information parents need at this often stressful time if their child has autism. Of particular benefit, Autism Speaks offers a “100 Day Kit for the Newly Diagnosed Family of Young Children.” This step-by-step guide helps parents feel more in control and confident about how and where to start this journey.

For language-based learning disabilities, parents may find needed resources through organizations such as Decoding Dyslexia or the International Dyslexia Association. Whatever diagnosis a parent is facing on behalf of their child, there are resources to provide the education that is needed.

The internet provides so many resources to parents, which is both a blessing and a curse. How can a parent sort through it all and establish priorities? How do they avoid becoming overwhelmed? Parent Support Groups! It may seem like an overly simple solution, but the benefits of sharing with others who have gone through what you are going through are immeasurable. And not feeling like you are in this alone will give you the confidence to keep going.

Armed with a diagnosis as well as education and support, a parent is ready to advocate as needed. Organizations like the Federation for Children with Special Needs are there to help throughout the advocacy journey. Finally, a strong partnership between the child’s parents and school district is critical to ensure that the district understands the individual child, their unique needs and to know that they will work to provide the appropriate educational opportunities for the child.

It may not be an easy journey to embark on, but know there are wonderful resources out there to help make things smoother.

About the Author

Combining her experience and training in both pediatric neuropsychology and educational advocacy, Dr. Reva Tankle has particular expertise in working with families who are navigating the IEP process. Having participated in numerous team meetings over the years, Dr. Tankle is especially knowledgeable about the many ways that schools can support and accommodate students with special learning needs, information that she clearly communicates in her evaluation reports and in team meetings, if needed. She also has a great deal of experience in articulating the reasons that a student may need a program outside of the public school.

Dr. Tankle evaluates students with ADHD, learning disabilities, high functioning autism spectrum disorders, and neurological conditions, as well as children with complex profiles that are not easily captured by a single diagnostic category.

To schedule an appointment with Dr. Reva Tankle in Plainville, MA, or any of our expert neuropsychologists, please complete our online intake form

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

Acupuncture for the Treatment of Specific Conditions

By | NESCA Notes 2019

By: Meghan Meade, L.Ac, MAOM, MS PREP, CYT

Licensed Acupuncturist, NESCA

A Primer on Acupuncture

While the insertion of needles into the skin to provoke a healing response is a hallmark characteristic of acupuncture, the practice actually involves the potential use of a number of other tools and techniques, including cupping, magnets and other non-insertive tools, and moxibustion, the topical application of a heated herbal substance designed to improve circulation and reduce inflammation.

Chinese medicine approaches healing by seeking to restore balance in the body; in so doing, it evaluates the patient as a complex and ever-changing ecosystem, a composite of multiple interrelated and mutually interdependent systems. Though a patient may be seeking relief from anxiety, for example, acupuncture addresses the issue within the context of a wider landscape, as there are often other symptoms and imbalances accompanying a primary imbalance. To that end, treatments will, of course, take into account a patient’s reported symptoms, but they are rarely the main driver of an acupuncturist’s treatment decisions. Acupuncturists additionally rely on observation of patients’ mannerisms, the sound and qualities of their voices, how they carry themselves and perhaps most importantly – the use of palpation techniques to elicit feedback from the body that guide treatment decisions. What an acupuncturist feels in a patient’s pulse or palpates on a patient’s abdomen or acupuncture channels is immensely influential to the diagnostic and treatment processes.

Implicit in this process is the notion that despite the fact that a patient may be seeking relief from a particular condition, that patient is not the same person he is today as he was yesterday, nor the same as he will be tomorrow. The treatment aims to address the nuances of a patient’s presentation within the present moment, guided by the knowledge of the patient’s health history and health objectives for the future.

Put into a biological context, we humans are continually and necessarily affected by our innate biochemistry as well as by our surroundings – both our mental-emotional and physical environments. Chinese medicine does not reduce a condition down to its primary symptoms, but rather considers all symptoms that are overtly or seemingly less-directly related. If the immune system is affected by a virus, for example, because of its cross-talk with the nervous and endocrine systems, all systems will be influenced in some way, shape or form. Though the rest of this article will discuss the ways in which acupuncture can impact specific conditions that commonly affect the pediatric population, it is predicated on this concept of mutual inter-relatedness and interdependence of the body’s systems.

Acupuncture’s Impact on Mental and Emotional Conditions

The incidence of anxiety, depression and behavior disorders has increased markedly in recent years, with data from the CDC indicating that anxiety and depression incidence among children aged 6-17 has grown from 5.4% in 2003 to 8.4% in 2011-2012. Currently, incidence rates among children aged 3-17 are 7.4% for behavior problems; 7.1% for anxiety; and 3.2% for depression. These afflictions do not occur in isolation and often accompany each other, as 73.8% of children aged 3-17 with diagnosed depression also have anxiety and 47.2% also have behavior problems.

Though we should keep in mind that enhanced awareness of these conditions among children as well as improved assessment and detection in recent years may paint a more dire picture of afflictions that have never in actuality been absent from the pediatric population, the data do represent a critical need to help children in their formative and impressionable years feel more at ease in their bodies as they navigate growth and development.

A dysregulation of the stress response is characteristic of chronic depression, anxiety and behavior disorders. The HPA (hypothalamic-pituitary-adrenal) axis is responsible in part for regulating the body’s response to stress, whether that stress be mental, emotional or physical. When stress becomes chronic, the ability of the HPA axis to allow for functional communication between the brain and body to keep a person feeling safe and calm becomes impaired, resulting in altered activity of stress hormones, such as cortisol, and neurotransmitters such as serotonin and dopamine. Cortisol is of particular interest in this context, as it not only plays a significant role in the stress response but also modulates immune system activity. When cortisol is elevated due to chronic stress, the body ultimately becomes resistant to it, and the immune system is not kept in check, resulting in a proliferation of inflammation. Acupuncture has demonstrated the capacity to modulate HPA axis function to alleviate stress-related symptoms by restoring the body’s responsiveness to cortisol so that its roles in nervous and immune system function can be maintained appropriately. Dysregulated HPA axis function has been implicated in a number of allergic conditions, such as asthma and dermatitis; somatic conditions, such as Fibromyalgia and Chronic Fatigue Syndrome; psychiatric conditions such as PTSD and depression; and numerous immune and autoimmune diseases, underscoring the importance of maintaining proper function of the HPA axis.

Another component of the body’s response to stress involves the autonomic nervous system, comprised of two branches – the sympathetic nervous system and the parasympathetic nervous system. Where the sympathetic branch of the nervous system is responsible for the ‘fight, flight or freeze’ response that alerts us to and helps us remove ourselves from danger, the parasympathetic branch of the nervous system represents the ‘rest and digest’ state, which we’re biologically designed to occupy the majority of the time. Dysfunction of the autonomic nervous system is thought to underlie a number of prevalent mental, developmental and behavioral disorders, such as depression and anxiety, ADHD, and autism. Acupuncture has been shown to activate and modulate the function of brain regions involved with the autonomic nervous system through a number of mechanisms, including increasing concentrations of endogenous opioids, regulating the function of amino acids, such as GABA and glutamate, and enhancing the activity of neurotrophins, such as nerve growth factor (NGF) and brain derived neurotrophic factor (BDNF).

While depression and anxiety are highly heterogeneous in their presentations, and are driven by numerous mechanisms in the central and peripheral nervous systems, increases in inflammation are thought to play a correlational – if not at least partly causative – role in their development. Depression and anxiety have been associated with elevated levels of inflammatory markers, such as C-reactive protein (CRP), Interleukin 6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-alpha), all of which have been shown to be reduced through acupuncture.

Acupuncture and ADHD

ADHD, as defined by the DSM-IV, has a prevalence of 5.9% – 7.1% among children. Characterized by inattention, hyperactivity and impulsivity, ADHD is commonly treated pharmacologically with stimulant medications, such as methylphenidate. While little is known about the long term effects of stimulant medication in this population, and short-to intermediate-term effects include anxiety, depression, weight loss and insomnia, 12% – 64% of parents of children with ADHD have sought out complementary and alternative (CAM) therapies, including acupuncture. In a study of children aged 7-18 diagnosed with ADHD, twice weekly acupuncture treatments for six weeks demonstrated improved attention and memory function among children not taking medication. Another study explored the potential for acupuncture to improve school performance among children aged 7-16; following a series of 10 acupuncture sessions over the course of eight weeks, study subjects showed significant improvements across all three school subjects: math, social studies and Turkish language. Aside from the capacity of acupuncture to improve the stress response through modulation of the HPA axis and autonomic nervous system, acupuncture’s effects on attention and memory and on learning and perception are thought to be mediated in part by its regulation of the neurotransmitters dopamine and serotonin, respectively.

Acupuncture and Autism

With prevalence reports ranging from as low as 1 in 500 to as high as 1 in 50, Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects social communication and interaction, language and behavior. Standard treatment of ASD includes pharmacological therapy and behavioral/educational therapy, though reports from a wide sampling of children with ASD indicate that approximately 88% had utilized CAM therapies to address symptoms such as hyperactivity, inattention, poor sleep and digestive issues. In a study of boys with autism, a treatment regimen of five daily acupuncture sessions over the course of eight weeks demonstrated improvements in speech, self-care and cognition. Significant increases in glucose uptake were shown within the intervention group (vs. control), with improved glucose metabolism in areas of the brain involved in visual, auditory and attentional functioning being thought to underlie the improvements seen in language, attention and cognition. An analysis of 13 studies on acupuncture for autism indicated that the most effective treatment regimen entailed 12 sessions within four weeks, each using a minimum of four acupuncture points, and went on to associate individual acupuncture points with specific effects, from improved language comprehension to enhanced self-care abilities. A meta-analysis of 27 randomized controlled trials found that acupuncture in combination with behavioral and educational interventions (BEI) was more effective than BEI in improving symptoms as determined by a number of evaluation scales (CARS, ABC1, ATEC), suggesting the potential for acupuncture to yield an additive positive effect when utilized with standard of care therapy.

Ultimately, though research supports the use of acupuncture for specific conditions among children and adolescents, it is important to remember that the approach of an acupuncturist is generally not solely protocol-driven as it would be in a research setting. While research findings can and certainly do inform treatment decisions, acupuncturists also rely to a great extent on what is observed and felt during the treatment – they listen to patients’ reported symptoms and experiences, observe how patients speak and carry themselves, palpate acupuncture channels and reflex areas, and feel the pulse to determine imbalances in the body. In this way, Western and Eastern science and medicine are invited to work together to treat imbalances in an informed, patient-centric, holistic way.

References

Almaali, H. M. M. A., Gelewkhan, A., & Mahdi, Z. A. A. (2017, November 11). Analysis of Evidence-Based Autism Symptoms Enhancement by Acupuncture. Retrieved from https://www.sciencedirect.com/science/article/pii/S2005290117301395.

Data and Statistics on Children’s Mental Health. (2019, April 19). Retrieved from https://www.cdc.gov/childrensmentalhealth/data.html.

Duivis, H. E., Vogelzangs, N., Kupper, N., Jonge, P. de, & Penninx, B. W. J. H. (2013, February 8). Differential association of somatic and cognitive symptoms of depression and anxiety with inflammation: Findings from the Netherlands Study of Depression and Anxiety (NESDA). Retrieved from https://www.sciencedirect.com/science/article/pii/S0306453013000073.

Hong, S.-S., & Cho, S.-H. (2015, November 22). Treating attention deficit hyperactivity disorder with acupuncture: A randomized controlled trial. Retrieved from https://www.sciencedirect.com/science/article/pii/S1876382015300585.

Lee, B., Kim, S.-N., Park, H.-J., & Lee, H. (2014, April 1). Research advances in treatment of neurological and psychological diseases by acupuncture at the Acupuncture Meridian Science Research Center. Retrieved from https://www.sciencedirect.com/science/article/pii/S2213422014000237.

Lee, B., Lee, J., Cheon, J.-H., Sung, H.-K., Cho, S.-H., & Chang, G. T. (2018, January 11). The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29552077.

Li, Q.-Q., Shi, G.-X., Xu, Q., Wang, J., Liu, C.-Z., & Wang, L.-P. (2013). Acupuncture effect and central autonomic regulation. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677642/.

Musser, E. D., Backs, R. W., Schmitt, C. F., Ablow, J. C., Measelle, J. R., & Nigg, J. T. (2011, August). Emotion regulation via the autonomic nervous system in children with attention-deficit/hyperactivity disorder (ADHD). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3112468/.

Wong, V. C.-N., Sun, J.-G., & Yeung, D. W.-C. (2014, December 19). Randomized control trial of using tongue acupuncture in autism spectrum disorder. Retrieved from https://www.sciencedirect.com/science/article/pii/S2095754814000064.

 

About the Author

Meghan Meade is a licensed acupuncturist practicing part-time at NESCA.

Having suffered from anxiety, digestive issues, hormonal imbalances and exercise-induced repetitive stress injuries throughout her adolescence and twenties, Meghan first sought out acupuncture as a last ditch effort to salvage some semblance of health and sanity during a particularly stressful period in her life. It worked. Remarkably well. So palpable was the influence of acupuncture on her well being that she was compelled to leave a career in advertising to study Chinese medicine so that she could help others benefit from its effects.

Meghan earned her masters degree in Acupuncture and Oriental Medicine from the New England School of Acupuncture at Massachusetts College of Pharmacy and Health Sciences (MCPHS) and a masters degree in Pain Research, Education and Policy from Tufts University Medical School. She is licensed by the Massachusetts Board of Medicine and is a Diplomate of Oriental Medicine, certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

In her clinical practice, Meghan integrates both Eastern and Western perspectives to provide treatments unique to each patient’s needs and endeavors to empower patients to move forward on their paths to not just feeling good, but feeling like their true selves. In addition to her work as a licensed acupuncturist and herbalist, Meghan serves as adjunct faculty at MCPHS and is a certified yoga teacher.

 

To learn even more about Meghan and acupuncture, visit her alternate web site or read her blog: https://meghanmeadeacu.com/Meghan is practicing at NESCA during the following hours. Appointments at NESCA can be booked by reaching out to me directly at meghan@meghanmeadeacu.com.

Monday: 10am – 6pm

Thursday: 9am – 7pm

 

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.

Why the Autism CARES Act Matters

By | NESCA Notes 2019

 

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

The CDC estimates that 1 in 59 children are diagnosed with an autism spectrum disorder (ASD), and studies by Autism Speaks also found that children with autism have a nearly four times greater chances of having unmet health care needs compared to children without disabilities. With those sobering statistics in mind, it’s important for us to take a closer look at recent legislation to help the growing number of people with an ASD diagnosis.

On September 30, 2019, President Trump signed the Autism CARES Act of 2019, which was due to expire on the same day. Originally called the Combating Autism Act, which was established in 2006. It was reauthorized in 2011, and again in 2014 when the name was changed to the Autism (Collaboration, Accountability, Research, Education and Support) CARES Act. This Act is the primary source of federal funding for autism research, services, training and monitoring

Because of this important Act, the 2014 legislation dedicated over $3.1 billion for autism programming. President Trump renewing this Act in 2019 allowed for an extension of the current primary autism law and authorized $1.8 billion in spending on the developmental disorder over the next five years.

The Autism CARES Act of 2019 renews federal support for existing autism research and programs, but also expands these activities, placing an increased emphasis on reducing health disparities and improving services throughout the lifespan. More specifically, the funding provides:

  • Autism research grants awarded by NIH, focusing on advancing scientific understanding of autism, expanded efforts to develop treatments for medical conditions often associated with autism and address the needs of people affected by it. The NIH also works to foster collaboration among research centers to increase the effect of their efforts.
  • Ongoing support for programs across the country focused on ensuring high-quality services for people with autism. This includes funding 52 Leadership Education in Neurodevelopmental and Other Related Disabilities (LEND) programs and 12 Developmental Behavioral Pediatric Training Programs. These programs allow for the continuation of education, early detection and intervention activities through the training of future leaders and healthcare professionals.
  • The continuation of Collaborative programs like Autism Intervention Research Network on Physical Health (AIR-P), which helps to translate research into improved care and tangible resources for families and clinicians.

The Act also calls for the Department of Health and Human Services to once again produce a report for Congress on the health and well-being of individuals with autism. In 2014, this important report to Congress emphasized the needs of individuals with autism as they transitioned out of school-based services and into adulthood. The 2019 Act has placed an increased emphasis on the needs of individuals with autism “across the lifespan,” highlighting a need to understand challenges faced by individuals of all ages. As noted by Autism Speaks President and CEO Angela Geiger, “this legislation ensures sustained funding to better support people with autism across the spectrum and at every stage of life.”

Indeed, as a neuropsychologist, working side-by-side with NESCA’s team of Transition Specialists, I have the privilege of following many individuals with autism spectrum disorders from early childhood throughout their transition to young adulthood.  I find that families begin to scramble as special education funding runs out and they struggle to understand how these young people will continue to get their needs met. For many years, the focus of funding and research was on children, but as these individuals aged out of school-based services, their needs did not end. Yet,  the funding was and continues to be well below what is necessary. While there have certainly been improvements, there continues to be many more needs than are able to be supported. Research remains essential in understanding the longitudinal needs throughout the lifespan, and I am encouraged that our country continues to support these efforts.

 

Reference:

Autism Speaks

About the Author:

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

 

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

 

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

 

 

A Halloween for Everyone

By | NESCA Notes 2019

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

As Halloween evening approaches, it’s important to take a moment to consider the small steps we can take to be inclusive and promote a successful experience for all children and adolescents. While Halloween is a holiday meant to bring communities closer together, trick or treating can sometimes be overwhelming, wrought with difficulty, or just a bit too spooky.

Over the past few years, significant efforts have been made to ensure that we are being inclusive of all children. Leading the charge is Food Allergy Research & Education, or FARE, a non-profit organization focused on providing education about childhood food allergies. In 2012, FARE started the Teal Pumpkin Project, which encourages families to put a teal pumpkin on their doorstep and offer non-food alternatives, such as small toys or puzzles. A newer movement among families is to carry a blue pumpkin trick-or-treat basket to signify that they are on the autism spectrum. As a nation, we are starting to understand the need to make Halloween enjoyable for everyone.

While these clues may prompt those handing out treats to be a bit more patient or understanding of a child’s actions on their doorstep, I hope this year we can approach Halloween with the goal of being understanding and patient with all the children in our communities. One way is to refrain from saying things, such as:

  • “Oh no! Why aren’t you wearing a costume? You need a costume to get some candy!”
  • “You look pretty old to be dressing up! Are you sure you should still be trick-or-treating?”
  • “Only take one! Put those back!”

The child without a costume may have sensory defensiveness that makes it too difficult to put on a costume without feeling physically uncomfortable. The adolescent who is dressed up may have been looking forward to Halloween for months. The holiday could even be a special interest. Let’s let these adolescents have their day, too. And the five-year-old grabbing four pieces of candy in his little fist may have fine motor delays making it difficult for him to pick up just one small piece at a time.

Simply put, let’s have a fun AND compassionate Halloween by allowing each child or adolescent to be unique and being more sensitive to everyone’s needs.

 

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.