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back to school

Simple Executive Functioning Strategies When The World Is Anything But Simple

By | NESCA Notes 2020

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

Whether your children have returned to school full-time, on a hybrid model or fully virtual learning, we are all juggling. Juggling work demands, family demands, household demands and educational demands in a time of remarkable uncertainty. The start of the school year typically brings the smell of fresh school supplies and our best organizational efforts, but many of us may feel hesitant to use organizing strategies to manage our lives. Why? Because our lives are unpredictable and anything but typical these days. If you’re hesitating to use pen on a calendar, I hear you!

The ability to plan and employ organizational strategies is a key task of our executive functioning system. It’s what allows us to coordinate multiple schedules, dance and sports practices, projects at work, PTO bake sale reminders, and get out the door each day on time. I have been hesitant to adopt routines because I recall vividly how all those plans imploded in March when the world stood still. I hear the buzz about how school will end up fully remote so “put it all down in pencil before it all changes.”  Maybe that will prove true, but in the meantime, let’s consider the ways that we can rally our executive systems to do what they do best: plan, organize and regulate. Some suggestions for how to do this now while the world is unpredictable:

  1. Adopt the Sunday Game Plan. Put information in a family or personal calendar once a week. Spend a few moments on Sunday night catching up on plans for the coming week. Even if we end up transitioning from “hybrid” to “remote” (or all remote), this planning routine can still be adopted. Conclude your Sunday Game Plan by previewing what may be coming the week after in the event of long-term projects. While the content of your game plan may change, the structure can remain consistent.
  2. Keep a consistent schedule for sleep for the family. When we were all in school and work, we had set times to wake up in the morning. We should adopt more consistent bed times at least from Sunday through Thursday nights. Engage kids and teens in a conversation about the plan for sleep. If there are days when children are not waking up to physically attend school, try to keep wake up times no more than an hour off to allow for more consistency in our overall sleep regulation.
  3. As part of your weekly plan, set aside time for exercise. This is particularly important for children who will have reduced physical education activities. Research about the positive impact of exercise on mood, anxiety and attention underscores how important movement is in the day.
  4. Work together with your child to identify a consistent work space. Needing a work space at home is not suddenly and dramatically forced on all of us like it was in the spring. Take the time to arrange a space that is as distraction-free as you can make it. It’s not necessary to run out and buy things as minimal distractions can allow your child to focus on their school work. Keep the supplies nearby in their own bin, basket or box top.
  5. Help your child to create visual schedules or checklists for the day. Include times for virtual school, times for completing assignments and steps to submit the work either electronically or packed for the next day in school. Keep checklists consistent throughout the week when possible.
  6. Plan and schedule breaks. For young kids, try to plan breaks from tasks for every 15-20 minutes. Incorporate movement or stretching when possible to improve focus. For older students, try to plan breaks every 30 minutes of sustained effort. Try to take a full break from screens rather than replacing a tablet/computer screen with a phone or video game.

Children and teens develop their executive functioning skills over time. Keep this in mind as you set up routines and expectations for your whole family as what is expected for a second grader should and will differ from a seventh grader. Again, the content can differ but the structure of using a checklist, planning a break, or working at a desk or table is the same.

Please remember: the pandemic has depleted our executive functioning systems, so it’s important that we are gentle and kind to ourselves. Think about simple and reasonable systems to organize yourself and your family.  And be flexible when we have to go back to the drawing board.

 

Resources:

Positive impact of exercise:

https://www.sciencedirect.com/science/article/abs/pii/S0022347612009948

Executive Functioning tips and sample schedules:

https://www.smartbutscatteredkids.com/

 

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

 

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

What In-person School Looks Like During COVID-19

By | NESCA Notes 2020

By: Tabitha Monahan, M.A., CRC
Transition Specialist/Counselor

Fall is approaching, and school is starting. As a student, I always knew summer was close to ending when Staples started their “Most Wonderful Time of the Year” commercial. The joy that parents and the community feel as fall approaches and another year of learning begins is understandably absent this year. Many parents, teachers and students are still unsure if they will be remote, in-person or both. All are too aware that even if students and teachers return to the school building, school will not look as it did in the fall of 2019. The comradery that our children experience through recess and interactive group work will be limited. Lunch will not be the boisterous room of students comparing who is in each class and what teachers are giving homework the first week.

What can we expect then–especially our students who need the small in-person support they have received from their special education teachers, teaching assistants and related service providers? I was able to get a glimpse of what our new in-person normal would look like providing vocational counseling and support during an extended-school year (ESY) program this summer. When returning to school, the first thing I learned—remembered, is how resilient children are. Most students in the programs had very few issues with masks. For those who did, more frequent mask breaks and workarounds, such as face shields, greater distance between them and other students or neck scarves let them still participate in much needed in-person support. Hand-washing and sanitizer have become the norm, and staff and students had frequent opportunities to use both. Social Skills groups still occurred but were modified to continue to be possible. Community-based opportunities were limited, but again, teachers and service providers have long been accustomed to finding out of the box solutions for their students.

Yes, the first day was nerveracking. How were the students going to tolerate wearing a mask for hours on end? How were my co-workers and I going to wear a mask all day long? How was I going to get a drink safely while wearing a mask? But we did. Staff and students alike remained diligent with hand-washing, and the students were ready to learn. Teachers and teaching assistants (TAs) were available and came together for short periods to help students understand challenging tasks. Some of our children and students have behaviors or need activities of daily living (ADL) support that may have us more uneasy with their health and safety returning to in-person learning. Teachers and TAs were prepared for that, too. Whether it was a face shield with a mask, an extra set of clothes to change into or an additional layer of PPE, the student’s needs were met, and we all returned the next day.

Every district seems to have its own approach and plan. Still, in the end, each plan’s goal is the same: have every student continue to learn and prepare for life after high school and have each person return home safe and healthy.

 

About the Author

Tabitha Monahan, M.A., CRC, is an experienced transition evaluator and vocational counselor. While she is well-versed in supporting a wide range of transition-aged youth, she is especially passionate and knowledgeable in helping clients and their families navigate the complex systems of adult services and benefits as well as medical and mental health systems. She is further adept in working individually with students of all abilities to empower self-advocacy and goal achievement.

 

To schedule an appointment with one of NESCA’s expert transition specialists or 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.

 

There Is No Wrong Decision

By | NESCA Notes 2020

By:  Alissa Talamo, Ph.D.
Pediatric Neuropsychologist

We are living in an unprecedented time. As such, parents are faced with decisions that they have never faced before. For example, families are facing the challenging decision about whether or not to send their children back to school for in-person classes in the middle of the COVID-19 pandemic. Parents have to wrestle with the idea that, on the one hand, sending children to school could increase the risk of COVID-19 among children and family members; while on the other hand, children who don’t return to in-person school may experience disruptions in their education and may miss out on the social interaction and community feeling within the school building. In addition, some families simply don’t have a choice because they need to go to work or a family member at home is immunocompromised.

What is most important is to recognize is that whether or not to send a child to school in the fall means something different to everybody. It is imperative that, as parents, you give yourself permission to feel whatever it is that you are feeling, and that you do what feels right for you and your family. It may be difficult to accept, but we have little control over much of what is happening around us right now. While it is important to acknowledge how you are feeling, it is equally important to remember that, in fact, any reactions are normal under the current circumstances.

How you respond to stress during the COVID-19 pandemic can depend on your background, your financial situation, your health and emotional background, your social support system, the community you live in and many other factors. When it comes to parenting, every day can be a challenge, and the coronavirus has made an already scary world feel even more menacing.  Remember to “ignore the noise” and give yourself credit for taking care of yourself and your family.

 

 

About the Author:

With NESCA since its inception in 2007, Dr. Talamo had previously practiced for many years as a child and adolescent clinical psychologist before completing postdoctoral re-training in pediatric neuropsychology at the Children’s Evaluation Center.

After receiving her undergraduate degree from Columbia University, Dr. Talamo earned her doctorate in clinical health psychology from Ferkauf Graduate School of Psychology and the Albert Einstein College of Medicine at Yeshiva University.

She has given a number of presentations, most recently on “How to Recognize a Struggling Reader,” “Supporting Students with Working Memory Limitations,” (with Bonnie Singer, Ph.D., CCC-SLP of Architects for Learning), and “Executive Function in Elementary and Middle School Students.”

Dr. Talamo specializes in working with children and adolescents with language-based learning disabilities including dyslexia, attentional disorders, and emotional issues. She is also interested in working with highly gifted children.

Her professional memberships include MAGE (Massachusetts Association for Gifted Education), IDA (International Dyslexia Association), MABIDA (the Massachusetts division of IDA) and MNS (the Massachusetts Neuropsychological Society).

She is the mother of one teenage girl.

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

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

Back to School 101: How to Support your Child

By | NESCA Notes 2019

By: Reva Tankle, Ph.D.
Pediatric Neuropsychologist

 

When should I start transitioning back to the “school routine?”

The summer break should be a time for kids to have fun playing with their friends and family and enjoying new adventures and experiences. As the new school year looms, however, parents start to think about how to transition from the flexible downtime of summer to the more structured and rigid schedule of the school year. As such, they often wonder when to start the process of getting back to the school routine. Of course, it will be different for each child but, for most children, a slow transition is the best plan. Things to consider are:

  • Probably the most important routine to get back into is the bedtime and morning schedule. Parents should consider a slow transition starting 1–2 weeks before the first day of school. Move the bedtime by 10–15 minutes earlier every few days; inching closer to the school night bedtime. By the time it is the night before the 1st day of school, your child should be back to their regular bedtime. After allowing for an adequate number of hours of sleep, parents might consider waking their child up earlier in the morning, again, inching closer to the wake-up time on school days.
  • During the summer months, some children’s access to screen time might increase. Parents should consider reducing screen time during the day and especially in the evening; closer to their family’s rules for access to screens during the school year. Since many children have summertime reading to do, this might be a good time to get your kids off the screens and focused on completing their summer reading.
  • Regardless of your best intentions to transition smoothly to the school year routine, the beginning of school can be challenging for many children. Giving children, especially younger children, adequate time after school for play and ensuring the right amount of sleep will help children make the transition from summer to school.

What can I do to help this year’s teachers, specialists and therapists get to know my child as well as what’s in their IEP or 504 Plan?

If you child is in elementary school, your child will likely have one or at most two new teachers. It is a good idea to make sure the teachers are prepared to meet your child’s educational needs from the first day of school. But it is also important to recognize that it will take time for the teacher to get to know your child, and you want to make sure that you don’t overload the teachers with more information than they can handle. They will read the IEP, but that can be very overwhelming. To help them get started, you can send an email on the teachers’ first day back at school. Keep it short. Write a few sentences describing your child’s strengths and weaknesses. And then write the 2 or 3 things in the classroom that you think will be most important for your child to be successful in the upcoming year. I can’t stress enough how important it is to be short and to the point in this note. If you keep it focused on the most important information, it is more likely that the teachers will remember what you have shared.

If your child is in middle or high school, you could use a similar approach and write a short note about your child. You may choose to send it to all their content teachers or specifically to their Special Education teacher/liaison.

Finally, if your child is on a 504 Plan, it is definitely worthwhile to send a note to all your child’s teachers that informs them of the 504 Plan, listing the accommodations that are in your child’s 504 Plan. If, however, it is a very long list, you might consider writing the most important accommodations and request that they refer to the official 504 Plan for the comprehensive list. If you have a scanned copy, you could attach it to the email and make it easier for them to have access to it.

My child is anxious – how can I help my child feel more at ease?

Many children feel anxious at the start of a school year. They worry about having a new teacher and being with new classmates. To ease your child’s worries about the first day of school, here are some suggestions:

  • Often teachers start working in the school a few days before the students arrive. Call the teacher and arrange for your child to visit the classroom and have a brief 1:1 meet and greet with the child. If the classroom is set up, the teacher might be able to show your child where their desk will be. Consider taking pictures of the room, desk, locker/cubby and other locations in the school where your child may frequent throughout the school day. As the first day approaches, you can remind your child about how nice the teacher was and possibly, where their desk is, reviewing the photos, if taken. Taking away some of the “unknowns” should reduce your child’s anxiety.
  • Find out from other parents which children from last years’ class are in your child’s new class. Arrange playdates toward the end of summer so you child has some familiar faces to look for.
  • Make sure your child has a “go-to” person in the school with whom they feel comfortable. If they had a counselor the prior year, make sure that person is available to them and remind your child they can go see them if needed.
  • Most importantly, be positive and optimistic about the upcoming year. If you are calm and expect the best, your child will pick up on that and approach the new year with a positive attitude.

New School?

If your child is moving to a new school, many of the suggestions listed above will be helpful in your child’s transition to that school. Most importantly, the opportunity to tour the school and meet teachers should ease their concerns. If they are a middle or high school student, it might be helpful for them to know where their locker is and to “practice” going to their different classrooms. Again, revisit pictures, if  taken during the school visit/meet and greet. The more familiar they are with the environment, the better!

My child doesn’t have an IEP or 504, but I have concerns. What do I do?

If, as the school year begins, you have concerns from the previous year, you should be prepared to act quickly to ensure that your child doesn’t fall further behind. Within the first few days of school, you should send your child’s primary teacher a brief note that outlines your concerns. For example, you might write: “My son didn’t meet the end of the year benchmark in reading last year. I am concerned about his reading development. I would like more information from you about his reading level after you do your beginning of the year benchmark assessment.” It will be important for you to follow up with the teacher within 3–4 weeks and get the information you requested. If you remain concerned because of academic, behavioral or emotional issues you are seeing at home, you should not hesitate to request a Special Education evaluation for your child. Make your request in writing to either the Special Education coordinator at your school or the main Special Education office (find out from your school where to send it or, to be sure, send it to both).

It is critical that you don’t let too much time go by at the beginning of the year to make your request for an evaluation. The school is obligated to evaluate at your request so, don’t be dissuaded from the evaluation if you have concerns about your child’s development and their ability to make progress in school.

I wish you and your family a positive and happy return to school this year!

 

 

Reva Tankle, Ph.D.
Pediatric Neuropsychologist

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.

 

The Great Masquerader: Anxiety and School Refusal

By | NESCA Notes 2017

 

By:  Ryan Conway, Psy.D.
NESCA Clinical Psychologist

Everyone experiences anxiety at some point in life. It is a normal, adaptive human emotion that helps us prepare for important events and optimizes performance – think upcoming tests, ballet recitals, sports playoff games – and alerts us to danger in situations that threaten our safety. However, some individuals experience anxiety so intensely and so frequently that it becomes impairing, hindering their daily functioning. In fact, according to the National Institute of Mental Health (NIMH), it is the most common mental health disorder in the United States among adults and children. In my work with children and teens, I have seen anxiety become such a powerful force that it gets in the way of having sleepovers at friend’s houses, limits social engagement, results in marked physical discomfort, impairs concentration in class, and even contributes to flat-out refusal of school.

Anxiety is an inward-focused feeling, meaning that we experience it internally. As a result, it is often unrecognizable to parents and teachers and can go easily undetected for a long time until it becomes a problem. Children might be ashamed to talk about it, try to push it away to avoid distress or be limited in their ability to fully articulate what is happening. Behaviorally, anxiety causes a fight-flight-freeze reaction. It leads to acting out and aggressive behaviors (i.e., “fight”) as well as running away and escaping (i.e., “flight”). Anxiety can also be an underlying source of noncompliance, disguised as an unwillingness to engage and shutting down in overwhelming situations (i.e., “freeze”).

In a recent New York Times Magazine article (see link below), writer Benoit Denizet-Lewis takes a closer look at the increasing prevalence of adolescent anxiety as well as a residential program, Mountain Valley Treatment Center, that provides services for more severe cases. In an information age, many teens, parents, educators and mental health professionals are citing social media as partly to blame for the uptick in anxiety. The constant comparing to peers through social media is problematic in that it makes teens feel like they aren’t good enough, which can greatly impact their self-esteem. In my clinical work I see an overreliance on smartphones due to the reinforcing function they serve – whether it be a text back to hang out or a “like” on an Instagram post – and I will often work with youth on self-reinforcement and finding alternatives that are intrinsically rewarding to them.

Many of the students interviewed for the New York Times Magazine article who attended Mountain Valley had histories of significant difficulty attending their regular school due to severe anxiety and/or depression, a presentation known as school refusal. School refusing behaviors exist on a spectrum, from the mild (e.g., missing gym class every now and then due to fears of changing in front of classmates) to the more severe (e.g., missing entire weeks of school due to persistent worries about having panic attacks). Early intervention is key. The longer the child or adolescent is out of school, the more pressure they feel about “catching up” academically. The more they feel like they are falling behind, the more depressed and anxious they become. The more upset and stressed they are, the more difficult it is to get back to school. And the cycle continues.

Understanding this cycle, NESCA offers a special program for youth who refuse school because of emotional distress, called Back to School (BTS). In this program, clinicians use a comprehensive evidence-based treatment approach and work closely with parents and school faculty to figure out the most effective plan that will help the student reenter school.

Given the importance of catching school refusal early, here are some warning signs to look out for:

  • Test-taking anxiety
  • Peer bullying
  • Ongoing visits to the nurse despite no apparent signs of illness
  • Frequent requests to phone or go home during the school day
  • Somatic complaints without a medical explanation (e.g., stomachaches, headaches, etc.)
  • Absences on significant days (e.g., tests, speeches)
  • Sleep problems or resistance to leaving the bed in the morning
  • Changes in mood – anxiety, irritability, sadness

If you have any questions about the BTS Program or NESCA’s therapy program in general, please contact Dr. Ryan Ruth Conway at rconway@nesca-newton.com or 617-658-9831. Dr. Conway will additionally be speaking at several workshops this fall on the subject of School Anxiety, School Phobia, and School Refusal. Information regarding upcoming NESCA events can be found on our website at http://www.nesca-newton.com/events.html.

Article: 

Denizet-Lewis, B. (2017). Why Are More American Teenagers Than Ever Suffering From Severe Anxiety? The New York Times Magazine. Retrieved from https://www.nytimes.com/2017/10/11/magazine/why-are-more-american-teenagers-than-ever-suffering-from-severe-anxiety.html.

 

About the Author:

Conway

Ryan Ruth Conway, Psy.D., is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.

 

If you are interested in working with Dr. Conway or have any additional questions about NESCA’s therapy services, please complete NESCA’s online intake form.

 

 

 

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