Tag

behavior

A Halloween for Those with Sensory Challenges

By | NESCA Notes 2021

By: Julie Robinson, OT
Director of Clinical Services; Occupational Therapist, NESCA

Halloween – a holiday full of tricks and treats. For some children, getting in the Halloween spirit by getting dressed up, carving pumpkins, and going trick-or-treating with friends is what they look forward to all year. For others, dressing up in an itchy costume, not being able to see someone’s face because they are wearing a spooky mask, being out in the dark with crowds of noisy trick-or-treaters, carving pumpkins and having to touch the oooey goooey insides of a pumpkin, and seeing decorations that make sudden noises or movements may make this holiday overwhelming for these children. Halloween can be tricky for families with children living with sensory processing difficulties, but with some creativity and planning ahead, families can build their toolboxes with their own tricks to combat the challenges that come with Halloween so their child can enjoy the treats that Halloween has to offer.

Here are some tricks for some common challenges that Halloween brings up:

Prepare for the day

Have an open discussion with your child about the traditions and activities associated with Halloween. You can read Halloween-themed books or watch Halloween movies (perhaps not the really scary ones!) to prepare your child for what to expect, because the anticipation of a new routine or anticipation of participating in unfamiliar activities can cause stress on a child. Discuss the plan for Halloween regarding decorations, attending parties, going trick-or-treating, etc., ahead of time so the child knows what to expect when celebrating the holiday. Consider the use of a visual picture schedule with activities that may be added into your typical routine. Provide ample warnings for transitions, when possible, to give your child time to move from one activity to another.

Be creative and imaginative with your child’s costume

The most important aspect of a costume for a child with sensory processing difficulties is ensuring that the costume is comfortable. Certain costume material may be itchy or scratchy, costumes with masks may occlude a child’s vision or be too tight on their head, or make-up may smell off-putting to a child. Children should have the opportunity to try on their costume when walking, sitting, and reaching for things before wearing it for real to make sure they are comfortable moving around in it. It is important to remember the idea of “less is more” and to use your imagination when coming up with costume ideas. For example, if a child wants to be a superhero, consider attaching a superhero logo to the front of a shirt they wear regularly rather than having your child wear a full superhero one-piece costume that may be itchy, tight, and hot.

Choose activities that best fit your child’s sensory needs

Meaningful participation in Halloween festivities doesn’t just include carving pumpkins and going trick-or-treating. Halloween activities can include roasting pumpkin seeds, setting out the candy bowl for trick-or-treaters, doing Halloween-themed crafts, etc. It is important for you to pick activities that best fit your child’s sensory needs. For example, if your child dislikes carving pumpkins because they have to touch the messy pumpkin insides, consider having your child paint their pumpkin or decorate it with stickers instead or make a pumpkin out of paper to decorate. If you and your child really want to go trick-or-treating but your child becomes overwhelmed with noisy crowds, consider trick-or-treating on only quiet side streets, or limit your time, allowing for breaks in between. If your child becomes overwhelmed with flashing lights, loud noises, or scary decorations, consider doing a drive-by of the neighborhood before taking your child out for trick-or-treating so you know which houses to avoid. For some children who crave a great deal of movement, it may be useful to engage in some heavy work activity before participating in a Halloween activity: wall push-ups, yoga poses, carrying weighty objects, for example. It may also be useful to engage in calming sensory activity to ease the transition from a busy setting back into the house: tactile materials like playdough or putty, water play, or a sensory table may be worth trying, or consider making a play tent or fort with quiet books or puzzles, or drawing to smooth the transition.

Monitor for overstimulation

Knowing when your child has had enough of Halloween festivities is just as important as knowing how to get your child engaged in them. A child may not be overstimulated at first, but may become overwhelmed minutes later. It is important to give your child choices of activities and next steps they can take as well as alerting your child about the sequence of events and the timeframe of events so that they know what to expect. If possible, help your child learn to advocate for themselves by saying things like, “please don’t touch me,” or “no thank you, I don’t want wear that,” in order to give them some autonomy over the activities that they participate in. However, in situations where this isn’t possible, it is important as the parent to know when to stop or disengage from festivities when sensory overload occurs and return home or to a quieter, more familiar space to give the child time to decompress.

Resources:

Enjoying Halloween With Sensory Challenges. (2021). Aota.org. https://www.aota.org/About-Occupational-Therapy/Patients-Clients/ChildrenAndYouth/halloween-sensory.aspx?fbclid=IwAR23ux4OKqJmXEZdnCIzb2_Uh0of55YKuCf8ek97UEAc1jZflndR_ZEBRwM

Morin, A. (2019, August 5). Halloween Challenges for Kids With Sensory Processing Issues and How to Help. Understood.org; Understood. https://www.understood.org/articles/en/halloween-challenges-for-kids-with-sensory-processing-issues-and-how-to-help

5 Ways to Help Children with Sensory Challenges Participate in Halloween Festivities. (2021). Aota.org. https://www.aota.org/Publications-News/ForTheMedia/PressReleases/2019/102419-Halloween-Tips-Sensory-Challenges.aspx

 

About the Author

Julie Robinson is an occupational therapist with over 25 years of experience as a clinician. The work Julie does is integral to human development, wellness and a solid family unit. She particularly enjoys supporting families through the process of adoption and in working with children who are victims of trauma. Julie has extensive experience working with children diagnosed with an Autism Spectrum Disorder (ASD), or who have learning or emotional disabilities. She provides services that address Sensory Processing Disorder (SPD) and self-regulation challenges, as well as development of motor and executive functioning skills.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services or other clinical therapies, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

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

 

The Safe and Sound Protocol: Increase Self-regulation and Decrease Sound Sensitivity

By | NESCA Notes 2021

By: Julie Robinson, OT
Director of Clinical Services; Occupational Therapist, NESCA

NESCA is excited to announce that we now offer our clients the Safe and Sound Protocol (SSP)—a therapeutic listening program, designed to increase self-regulation and decrease sensitivity to sound. This new service is provided through our occupational therapy (OT) department and is facilitated by either Julie Robinson or Maddie Girardi, both of whom have been trained and certified in its administration. The process begins with an initial phone intake with Julie, who will help you determine if the program is a good fit for you as an adult, or your child. For new patients, we always initiate the program in the office for two to three visits. After this point, (if it seems feasible), you can transition to a home program. If not, we can continue through direct office visits until the program has been completed. In addition, we can offer the program as part of an existing OT treatment protocol.

Who is SSP appropriate for?

SSP is appropriate for anyone over two years of age through adulthood, who has the capacity to listen to music with over-the-ear headphones. It is ideal for patients on the autism spectrum, or individuals with sound sensitivity, sensory processing disorders, or difficulty with self-regulation. It can be used to facilitate more frequent calm and settled states of arousal for those under stress, or who have experienced trauma. It has been also observed to improve sleep and even feeding patterns in some of our clients who have difficulty in those areas. We have seen this carry over into improved behavioral control, independence, and focus in completing daily routines and academic work, as well as more availability for social interactions.

What if my child cannot tolerate wearing headphones?

Your OT will work with you to find an appropriate pair. In our experience, most children can learn to wear headphones with a bit of gentle coaxing and positive reinforcement. Sometimes we need to start with music, outside of the listening program, that a child is already interested in. Other times, we can start right in with the program and, bit by bit, build up increased tolerance.

What type of music is played in the program?

All programs are offered with both children’s music (common tunes from TV or movies, such as Disney programming) as well as adult-oriented songs (pop music or classical music).

NESCA offers two programs, each described below:

  • SSP CORE—This is the basic listening program, appropriate for most patients who are program, and what most individuals are ready to start with. This program has been used since 2017 as a mechanism to reduce stress and auditory sensitivity. It consists of a five-hour long listening protocol, that can be done ideally across five one-hour or 10 half-hour sessions, depending on tolerance levels. For some of our clients who cannot tolerate it as easily, listening sessions can be even shorter in duration. For clients who tolerate it well, and would be compliant, it can also be delivered as a home program after initial set-up through a clinician. It presents music that has been acoustically modified based on a specific algorithm that triggers physiological states of safety and trust. Calming the physiological state helps to promote social engagement and self-regulation, and further therapy can be enhanced or even accelerated. It has music with high frequency sounds gradually filtered in, allowing for slow and steady desensitization to auditory stimuli. It is suited for those who are accustomed to listening to music with headphones, those with subtle sound sensitivities, or those with general difficulties with self-regulation.
  • SSP CONNECT—SSP CONNECT is intended to be used as a less demanding introduction and foundation to the SSP CORE program, specifically for those who are not yet used to headphones, or who do not tolerate filtered sounds well. There is a classical music playlist—one for adults and another for children. It can be used for individuals who are highly sound sensitive, or very young listeners without high frequency filtering to get them ready for the CORE program. It also has five hours of listening time and is intended for use before the SSP CORE program, therefore resulting in a total of 10 hours of active listening time. The SSP CONNECT program should yield a sense of safety with the listening process and expectancy of what is to come next. It is important for the therapist and client to establish a strong rapport, with since there is a good deal of support from the clinician.

If you are interested in talking with a clinician who can determine if this would be a good fit for you or your child, please contact Julie Robinson, OT, Director of Clinical Services, at: jrobinson@nesca-newton.com.

 

About the Author

Julie Robinson is an occupational therapist with over 25 years of experience as a clinician. The work Julie does is integral to human development, wellness and a solid family unit. She particularly enjoys supporting families through the process of adoption and in working with children who are victims of trauma. Julie has extensive experience working with children diagnosed with an Autism Spectrum Disorder (ASD), or who have learning or emotional disabilities. She provides services that address Sensory Processing Disorder (SPD) and self-regulation challenges, as well as development of motor and executive functioning skills.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services or other clinical therapies, 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.

 

Going with the Flow

By | NESCA Notes 2021

By Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Services, NESCA

It’s September, and a new school year has already begun for most children. We had hoped that Covid would be behind us and the start of this school year would begin with a greater semblance of the old normal. Sigh…it has not. We are still wearing masks, keeping our distance and washing hands amongst other health considerations. Many students are eager to get back to school and in-person learning even though they have to wear masks. Many are accustomed to it, and it is no big deal. However, there are those students who preferred virtual learning and have grown more and more anxious at the thought of going back to in-person learning.

Back at the start of the pandemic, I wrote a blog about going with the flow, and it seemed appropriate to reintroduce the topic again as we start another school year still with so much uncertainty. Will there be outbreaks of the new variants at school? Will there be quarantines happening again? Will someone in my family, class, school get sick and how serious will it be?  We don’t know the answers to these questions, and worrying about them doesn’t help us be in the moment. In Bostonia’s current cover piece, “The kids are stressed, anxious, lonely, struggling, learning, grateful, adapting, alright,” Eric Moskowitz summed it up accurately. What researchers found is that children who were at a disadvantage before the pandemic suffered the most – which is not surprising – yet overall kids are resilient.

In  Angela Currie’s recent blog, “Helping Students Transition Back to School,” she covers the essentials of establishing bed time/morning routines, connecting with teachers, mask wearing routines and many more. I would like to add to her list with the psychological, social and emotional routines and ways of being that will also make the transition smoother.

Education Week offers a few social-emotional checklists that are good to review to help you set your student off on the right foot as they start this school year.

  • First check in with yourself and your own emotions/feelings. If you are feeling anxious, do something to help calm your emotions and gain some centeredness. Take care of yourself so you can take care of others.
  • Establish those all so important sleep, eating and exercise routines.
  • Establish a calming routine that the family can do together for a few minutes (i.e., yoga, mindful minute, deep breathing, etc.).
  • Acknowledge the breadth of feelings your child may have and how rapidly they may change. Point this out to him/her when they are calm. Introduce the realization that thoughts are connected to feelings, and they can change their thoughts to help their feelings change. Be understanding, supportive and empathetic yet also encourage your student to use their “past data” to support their progress forward through their feelings.
  • As Angela said, establish routines and predictability at home but also model and help your child know that things don’t always go as planned. Have routines yet be flexible, adaptable and a “go with the flow” mindset will be essential as s/he enters this school year. There are always Plans B, C, and D when Plan A doesn’t work. For instance, you may insist your child wear a mask and another child in his class, or afterschool activity/sport, may not. Preview this possible scenario so your child can adept and accept. Or, a student starts the year in-person, but then hybrid (hopefully not) happens…again. You get the idea about teaching flexibility.
  • Stay positive even in the midst of uncertainty, as this helps create the right biochemical mix that allows you to think more clearly.
  • Be aware of your thoughts and help your child be aware of their thoughts. Thoughts influence our mood, feelings and behavior, and we can exert control over them.
  • Be grateful (end the night with a gratitude moment).
  • Be supportive. Acknowledge the efforts, tasks, feelings, etc. that your kids are taking on and experiencing. It helps them develop self-confidence, self-esteem, self-efficacy, pride and a sense of competence.
  • Be hopeful. Yesterday is history (don’t dwell there), tomorrow is a mystery (don’t worry about it) and today is a gift (even if you don’t feel like it is). Be present and allow whatever feelings come up (positive or negative) to flow through you so you can make way for new feelings.

Wishing everyone a smooth start to the 2021-2022 school year, and may the force be with us as we continue to combat Covid.

Resources

https://www.bu.edu/bostonia/

https://www.edweek.org/leadership/preparing-for-in-person-learning-a-covid-19-checklist-for-parents/2021/08?utm_source=nl&utm_medium=eml&utm_campaign=eu&M=63136722&U=1970318&UUID=f2e19d19dbb5bd4e92068a32311b141c

 

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

 

To book a consultation with Ms. Lucci or one of our many expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician/consultant in the referral line.

 

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

 

The Value of Mulligans

By | NESCA Notes 2021

By:  Stephanie Monaghan-Blout, Psy.D.
Pediatric Neuropsychologist

Let’s face it – a lot of parenting involves socializing children whose brains are in the process of being built. This means:

  1. They do not yet have the cognitive capacity to understand the moral principles behind such behaviors as “sharing, “being nice” and “using our words.”
  2. They are in the process of learning how to inhibit the impulse to grab, say whatever one thinks and using physical force to get what one wants.

Behavioral reinforcement strategies (rewarding desirable behavior) can be quite effective as a socialization technique – but only if the strategy is keyed to both an understanding of the level of the child’s cognitive/moral development and their capacity for impulse control. All too often, the parent’s efforts to shape their child’s behavior run aground because of problems in assessing either (or both) of these areas. The concept of a “mulligan” can be a very useful in compensating for either child or parent error.

The term “mulligan” comes from the game of golf where it means getting an extra stroke after a poor shot. There are several stories about the origin of the term, but most involve a player named Mulligan who had been so rattled by a variety of events that he made a very poor shot on his first effort and claimed a “correction” – basically a do-over. This fits well with the dilemma presented to parents when a child has not been able to stick to an agreement, like “if you boys can work out your differences without verbal or physical fighting this morning, we will get some ice cream this afternoon.”

The first step in taking a mulligan, or correction do-over, always involves giving everybody involved some time to calm down, thus restoring the capacity for flexible thinking and problem solving. Once this is achieved, it is time to figure out where things broke down: was it overestimating the child’s capacity for controlling their impulses over time, in certain situations, or with certain people? Or was it because the child did not know how or why to take certain actions? If the problem involves impulse control, it will be up to the parent to restructure the situation in order to make it more realistically doable for the child or children – in other words, the parent takes a mulligan. For instance, s/he might say, “Look, this is not working out. I’m going to take a mulligan. Every 15 minutes that you guys can get along and work out your differences, I will give you a point. If you can get 3 points this morning, we will go for ice cream this afternoon.” Notice that this directive leaves some room for inevitable error, but still imposes reasonable expectations.

When the problem falls in the “how” or “why” category, parents also need to consider the child’s developmental status before engaging in problem solving. It is really important to appreciate that a child’s understanding of common conventions, like “sharing” and “fair.” In the egocentric and preconventional thinking of young children, “sharing” is too abstract of a concept and “fair” means “I get my way.” To speak about “taking turns,” make more sense to them. In the more conventional thinking of elementary school children, the key element in sharing is “fairness,” or, is the exchange equal? (In high school or college, some students will begin to struggle with the concept of equity, or how to allocate resources and opportunities in order to ensure an equal outcome, but this is a foreign thought to most children when it applies to their own resources, like candy or access to video games). Once the parent is clear about how the child is viewing the problem and where their strategies broke down, they can offer a chance for a mulligan while teaching more effective strategies than brute force or crying. Concrete aids, such as wind-up timers that show minutes, can help children understand the passing of time. Whimsical strategies, such as “shooting fingers” or “Rock, Paper, Scissors” are fun ways of determining who goes first or who gets to choose the video that also teach tenets of compromise and collaboration.

 

Resources:

https://www.golfdigest.com/story/did-you-know-where-did-the-term-mulligan-originate

 

About the Author:

Formerly an adolescent and family therapist, Dr. Stephanie Monaghan-Blout is a senior clinician who joined NESCA at its inception in 2007. Dr. Monaghan-Blout specializes in the assessment of clients with complex learning and emotional issues. She is proficient in the administration of psychological (projective) tests, as well as in neuropsychological testing. Her responsibilities at NESCA also include acting as Clinical Coordinator, overseeing psycho-educational and therapeutic services. She has a particular interest in working with adopted children and their families, as well as those impacted by traumatic experiences. She is a member of the Trauma and Learning Policy Initiative (TLPI) associated with Massachusetts Advocates for Children and the Harvard Law Clinic, and is working with that group on an interdisciplinary guide to trauma sensitive evaluations.

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

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

Is It Sensory? Or Is It Behavior?

By | NESCA Notes 2021

By: Julie Robinson, OT
Director of Clinical Services; Occupational Therapist, NESCA

As parents or other caregivers of children with special needs, we can often find ourselves confused between what is a sensory response and what is behavior. Although this is often a complex question, and one without a straightforward answer, there are some tools of the trade that OTs use to help us determine just what is going on with these children. What makes this so complex is that each child is an individual, with their own unique ways of responding to sensory stimuli, to social interactions, and when out in varied settings in their community or with family. Children may also present differently from minute to minute or day to day, depending on sleep, hunger, and fluctuations in mood. But we can often look closely for patterns that may help to guide us in finding the answers.

When working with a child who seems to be in a meltdown, one of the best things you can do is take a quick scan of the environment. Is there a loud or distracting sound in the background? Did someone touch the child unexpectedly? Is the overall environment too busy and overstimulating, such as at party or a restaurant? Sometimes just naming or removing the stimuli, if possible, is enough to help get things back under control. If you know a triggering situation might arise that provokes a meltdown, see if you can give the child a warning and a plan of where to go for comfort. “We will be having a fire drill in 10 minutes, so when it happens you can hold _____’s hand, or we can get you some headphones to cover your ears to make you more comfortable” is one example. Find something soothing from a sensory perspective to help the child settle: a quiet corner with books, some tactile play or fidgets, calming music, a tight squeeze ( but only if tolerated and given permission to do so ). If you know you are entering a highly stimulating environment, it may be best to go in for short periods, with frequent breaks built in for your child every 10 minutes or so to take a walk, use the bathroom, or get a drink.

If you do not see something sensory in your environment creating the discomfort or the meltdown, then behavior and emotions are more likely at play. You child may feel confused about a social interaction, about expectations, or what may be coming next in a transition. Your child may feel a lack of confidence or anxiety in a situation, that although may be seemingly simple and straight forward to you, may not to him or to her. An academic task may feel misunderstood, and not knowing how to start can result in a meltdown for many of our children.

When you see that the child you are caring for is beginning to ramp up, that is the best time to intervene. Once a meltdown has begun, language processing will be limited, and the child may not be reachable for a period of time in order to settle down. The best thing you can do in those moments, is to help the child to stop. I often use a stop sign to hold up in my therapy sessions, that cues the child to take a quick break from interacting with me when I see things starting to spin out of control. I limit my language, provide a calming sensory activity, then we can talk about the upset once I have the child back in my court.

Here are some things to think about and questions you might ask yourself to help guide your interactions and expectations when you, as the adult, are confused about whether this is sensory or behavior:

  1. What are the undesirable behaviors that my child observes when he or she is upset or uncomfortable? Are they different when there is sensory discomfort, in comparison to when he or she is upset with a person or a demand? Notice quality of voice, bodily tension, inability to stay still or focused, aggression, flight or an attempt to get away, shutdown or inability to interact. You may start to see patterns in behavior when you look at them in relation to a sensory event or something that is more emotionally-laden.
  2. What occurred just before this behavior appeared? Was there a sensory distraction or discomfort or was he or she upset with a person or a demand?
  3. How did the child behave during this episode?
  4. How did adults or peers interact with my child during the episode? Did it calm the child, or make him or her more agitated?
  5. List sensations that may have triggered a meltdown: tactile, auditory, visual, smell, taste, movement. Were they loud, distracting, uncomfortable? Was the child in a space that may have been too small or too large? Was the child able to get away from the uncomfortable stimuli, or did he or she feel stuck in the moment?

It will be beneficial for team members to share information and write these things down, perhaps in a format of a journal, so that the team can work together to uncover the patterns, find strategies that are successful, and provide consistency across the board. We all know consistency for these children is one of the most effective tools for learning, and although it may take some extra work up front for caregivers, the pay off on the other side is often so rewarding that it is worth the effort.

If you would like to explore this topic further with NESCA OT Julie Robinson, join us for a free webinar on this topic on September 13, 2021 at 10:30 am ET. Register in advance for this webinar at:

https://nesca-newton.zoom.us/webinar/register/WN_-edHNIwkRBKnjk0gq6-bUw

 

About the Author

Julie Robinson is an occupational therapist with over 25 years of experience as a clinician. The work Julie does is integral to human development, wellness and a solid family unit. She particularly enjoys supporting families through the process of adoption and in working with children who are victims of trauma. Julie has extensive experience working with children diagnosed with an Autism Spectrum Disorder (ASD), or who have learning or emotional disabilities. She provides services that address Sensory Processing Disorder (SPD) and self-regulation challenges, as well as development of motor and executive functioning skills.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services or other clinical therapies, 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.

 

When the Worry Bug Makes You Mad: Understanding the Importance of Positive Behavior Plans for Anxious Kids

By | NESCA Notes 2021

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

“Don’t Feed the Worry Bug,” by Andi Green is a wonderful book for children who are anxious or experience a lot of worrisome thoughts. The story is about a monster who constantly feeds his WorryBug, only to find that as he worries more and more, the WorryBug continues to grow until the monster is totally overwhelmed by the emotion. Eventually, he learns to control it. In my practice, I evaluate a number of children with lots of worries…but they don’t actually look worried. Instead, children may appear defiant, hyperactive and aggressive. Why do children overwhelmed with anxiety sometimes become frustrated and angry or have poor behavioral control at home and in the classroom?

Children with anxiety “on the surface” may appear angry, oppositional and defiant to adults. However, these behaviors oftentimes reflect secondary responses to an underlying cause: anxiety. Responses to anxiety can be categorized as “fight, flight or freeze.” As a classic example, if you run into a grizzly bear on a hike, your body’s natural physiological response is to fight, flee or freeze. Your anxiety about the demands of a situation send your body and brain into a state of “threat alert.” Similarly, when a child is worrying about something, is socially anxious, or is feeling nervous about their ability to handle a task, this “threat alert” system is activated and the child’s ability to make well-thought out decisions is impaired. The child may be labeled a “behavior problem” because of the impulsivity, defiance, disruptiveness or aggression (fight mode). Or the child may appear distractible, silly and immature, or avoidant of challenging tasks (flight mode). An anxious child may also show difficulties shifting gears/transitioning, problems letting go of events, or seem unmotivated or apathetic (freeze mode). It is also not uncommon for children with anxiety to have challenges demonstrating appropriate social skills, such as problems with insight into how their behaviors may affect others. They may also experience challenges reading the nonverbal and verbal cues in their environment because their brain is “soaked” with high arousal, immobilizing their capacity to apply logic to everyday situations. How do we help children manage their anxiety and the resulting behavioral challenges from that anxiety?

A neuropsychological evaluation can provide insights into your child’s behavioral challenges to determine if there may be an “underlying cause,” such as anxiety, (or other causes such as learning disabilities, depression or poor information processing) which are driving weak emotional and behavior control. Once identified, a neuropsychologist can provide guidance on the most effective interventions for a child at school and at home.

In my experience, one of the most important interventions for a child who experiences anxiety and secondary behavioral challenges is the development of a Positive Behavior Plan at school, which can then be included in a child’s IEP. However, many children with anxiety do not respond well to traditional behavioral reward systems that solely focus on increasing or decreasing behaviors (e.g. follow directions, sit calmly, keep your body safe, etc.), as these systems do not teach the child the self-regulation skills necessary for controlling emotional and behavioral responses. Instead, an effective Positive Behavior Plan for a child with anxiety includes behavioral targets or “goals” that focus on the attempt at coping strategy application. Importantly, a child with anxiety should be rewarded for trying to use a coping strategy, as it will take time, practice and reinforcement before a child develops the capacity to apply coping strategies consistently and successfully.

Sample coping strategies that a child should be taught by a special educator, counselor or other specialist include “taking deep breaths, jumping jacks, taking a break, using words to say how I feel,” or other self-regulation tools. When the goals of a Positive Behavior Plan focus on using a coping strategy before or during moments of distress rather than a plan that is tied to increasing or decreasing specific behaviors after they occur, a child builds independent capacity to appraise and react appropriately to physical and emotional responses in the classroom and the community. Children learn the signs (e.g. in their body, mind and in their environment) that the WorryBug is approaching, and feel better equipped, confident and more in control of their emotions and behaviors. For more information on how to appropriately develop Positive Behavior Plans for children with anxiety, “The Behavior Code” by Jessica Minahan and Nancy Rappaport is an excellent resource for parents and educators.

When the “WorryBug” or anxiety makes kids mad, mean and aggressive, a comprehensive and thorough neuropsychological evaluation can determine how to best tackle the anxiety “beneath the surface” through therapeutic and educational interventions. A neuropsychological evaluation can also direct the development of strategic Positive Behavior Plans that are individualized and appropriate for the child’s home and school environment.

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.

 

Mind the Gap: Why You Should Consider Summer OT and Speech Services at NESCA

By | NESCA Notes 2021

By: Julie Robinson, OT
Director of Clinical Services; Occupational Therapist, NESCA

It has been a challenging school year, with ever-changing schedules, routines, and unfortunately with a good deal of inconsistency in the provision of therapeutic services through the schools, due to the many impacts of COVID. Parents, caregivers and students have all experienced differing levels of anxiety about what progress has been and is being made, with many children experiencing some level of regression with regard to behavior, self-regulation, motor skills or language development. In anticipation of many of our children returning to school in-person in April, parents have expressed concerns that their children may be lagging behind or that they have not had ample support throughout the earlier parts of their school year to ensure they can keep up with the other children in their class. Over the months of April, May and June, we will all get to see firsthand where the gaps might arise. And then when school is over, many of us might be concerned that the gains of just a few short months will be lost again over summer. This is why those of us at NESCA perceive that the benefits of summer services will be an important part of ensuring progress and the ability to jump right back into learning – as we hope all school will be in-person again in the fall.

NESCA is available to provide summer services, as we do consistently for our weekly patients. In addition, we are offering short-term services to those children who may not qualify for them through their school systems, or for those families who would simply like to supplement what their children are receiving in-district to give them a boost before school begins again in the fall.

Our occupational therapists (OTs) can work on the following areas of focus with your child:

  • self-regulation and coping skills
  • how best to transition from the quiet of home to the multiple stimuli of a classroom full of children
  • how to cope with longer hours of wearing a mask
  • how to follow social distancing requirements, when they long for a closer physical connection with their peers

We can also help to ease the anxiety some children may have about becoming sick or how NOT to feel fearful of getting back into the classroom when sensory processing issues push them to feel uneasy. Our OTs can continue work on handwriting and motor development work started throughout the school year to ensure there is no regression or to improve the speed and automaticity of written expression and legibility. We can teach organizational and executive functioning skills to encourage kids to be independent, prioritize assignments and manage their time. OTs can address self-care skills of dressing, shoe tying, feeding and hygiene, which are likely to require more independence with social distancing requirements. While it’s summer, we help build outdoor skills, such as bike riding and greater self-confidence on the playground to elicit more social connections with peers. Our OTs are providing services in-person in our Newton and Plainville, Massachusetts clinics, by teletherapy or outdoors in the community as appropriate.

Our speech therapists at NESCA can also help to continue and supplement the hard work children have been putting in throughout the school year. They can work on social pragmatics and help with the skills needed to transition from so much time alone, to being in groups with their peers once again. NESCA’s speech therapists can support children on how to:

  • initiate play
  • find shared interests
  • be flexible thinkers
  • communicate with kindness and an appropriate level of voice
  • read gestures and non-verbal communication (especially while wearing masks, which can impede the ability to properly read another person’s mood, reactions or emotions)

We can continue to work on the established goals from school, regarding both expressive and receptive communication, language articulation and language as it pertains to written communication. Our speech therapists are currently providing all services via teletherapy while we work on a transition back to in-person therapy.

If you are interested in seeking out summer services at NESCA, or any of our assessments and services, please contact NESCA’s Director of Clinical Services Julie A. Robinson. She can be reached at jrobinson@nesca-newton.org and will conduct a phone intake with you to help you best determine your needs.

 

About the Author

Julie Robinson is an occupational therapist with over 25 years of experience as a clinician. The work Julie does is integral to human development, wellness and a solid family unit. She particularly enjoys supporting families through the process of adoption and in working with children who are victims of trauma. Julie has extensive experience working with children diagnosed with an Autism Spectrum Disorder (ASD), or who have learning or emotional disabilities. She provides services that address Sensory Processing Disorder (SPD) and self-regulation challenges, as well as development of motor and executive functioning skills.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services or other clinical therapies, 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.

 

Behavior Happens! But Does It Have To?

By | NESCA Notes 2020

By Dot Lucci, M.Ed., CAGS

Director of Consultation and Psychoeducational Services, NESCA

Recently, I’ve written a few blogs about behavior management and meltdowns and being a behavior detective. I thought I’d end the behavior series with a blog on how to prevent meltdowns from occurring, or at least try to prevent them! Obviously, preventing meltdowns is the best option if at all possible. No one likes to be around a meltdown, and the child doesn’t like it either.

There are many different experts with their own methods and strategies, but most start with common principles. Know yourself, know your child, meet him/her where they are, know what makes them tick and what works for them, as every child is different. It’s the behavior that is unacceptable, not the child. The child is still valued and loved; the behavior isn’t.

Kids will be kids, and they will lose control. Hopefully, over time, they learn self-control and emotional regulation. But the brain’s frontal lobes which control executive function, which includes behavioral control, don’t fully develop until the child I in his or her late 20’s…so buckle up as it’s going to be a long ride! Remember a meltdown is a child’s best attempt in the moment. It is the fight, flight and fright/freeze response. Trying to prevent these from happening are good for the child and the whole family. Life isn’t perfect and meltdowns will occur, but let’s try to lessen their frequency by employing some of the following:

  • Pick your battles—What’s negotiable and what’s non-negotiable? Make sure your kids know the list of “have-to’s” or non-negotiables. Simplify rules and make them realistic to the age of your child. Don’t make a rule/consequence that you cannot be consistent with or follow through with.
  • Keep calm in the eye of the storm.
  • Catch ‘em being good and let them know you saw them behaving well.
  • Tell your child what you want him or her to do, not what you don’t want them to do. Kids do the best they can in the moment.
  • Whenever possible, limit the amount of times you say the word “No.” Leave “No” for safety concerns. Instead, give information, and acknowledge and accept your child’s feelings/opinions. Substitute a “yes” for a “no” and use fantasy talk. “Yes, I wish you could stay up late, too, but we have to get up early tomorrow.”
  • Don’t phrase things so kids can say ‘no’ if the answer “no” isn’t an option. Wording and phrasing matters. Sometimes indirect requests get better results than directives. Explain your reason for non-negotiables (even if they don’t agree or like them). Do some tasks together that are problematic for your child. Shared ownership is better than no ownership.
  • Allow choice and control whenever possible. Don’t get into power struggles you will lose.
  • Having agency and mastery helps all kids grow and learn.
  • Consistency, Structure and Predictability are providers of Stability and Simplicity that enable your child to Anticipate, which is a means to enhance independence.
  • Clear rules, expectations and consequences provide organization, safety, structure and limits while enhancing mastery, self-control and improved self-efficacy.
  • Children don’t have the same sense of time or urgency as adults do, so allow for extra time to complete tasks when possible and use timers to help them organize their time.
  • Use humor and distraction to achieve desired results.
  • Compromise, Flexibility and Negotiation done proactively can go a long way. Work with your child to solve problems before they occur. Be flexible when necessary and make a compromise. Provide your reasoning for the compromise. This is not bribing; rather this approach teaches valuable lessons in win-win solution making, negotiation, compromise, flexibility, fairness and trust. Use this approach next time, and your child will hopefully, over time, learn these valuable lessons/skills.
  • Know your child’s triggers and be prepared. Try to eliminate/lessen them if possible. If they can’t be lessened, teach your child  the necessary tools to cope with them during more calm moments.
  • Know your child’s limits regarding experiences (i.e. downtime, waiting, loosing at games, etc., sensory needs (i.e. hunger, tiredness, sensitivities, etc.) and take these and other areas into consideration. Be prepared and think ahead.

 

Resources to consider:

 

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

 

To book a consultation with Ms. Lucci or one of our many expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician/consultant in the referral line.

 

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.

 

Becoming a Behavior Detective

By | NESCA Notes 2020

By Dot Lucci, M.Ed., CAGS

Director of Consultation and Psychoeducational Services, NESCA

Behavior = Communication

Behavior is everywhere you look. All behavior is adaptive and purposeful whether “appropriate or inappropriate,” “expected or unexpected,” or “regulated or not.” Have you ever heard of the phrase, “Behavior = Communication?” It is often used to help us think about behavior as a meaningful and purposeful means of communication, even when it is maladaptive.

Behavior is multifaceted and can be internally- and externally-driven. Every behavior that any one of us does can be interpreted as communicative and as having meaning. When a mom says to load the dishwasher and a child doesn’t respond, the child may not have heard her or may have actually heard the direction and chosen to ignore her. Ignoring her and not responding is actually responding – the is escaping a demand or that direction. If a child asks for a toy at the store and the parent says, “No,” and the child cries and stomps their feet in displeasure, the child is definitely expressing feelings. If the parent gives in to the tantrum and agrees to buy the toy to quiet the child down, the parent is reinforcing the inappropriate behavior/tantrum. This pattern often repeats itself, leaving parents and kids in a vicious cycle. The child learns that crying and stomping gets what he/she wants.

Becoming a Behavior Detective

In the current COVID-19/stay at home landscape, being a behavior detective could serve parents and caregivers well! Parents and children are feeling stressed and anxious, even if they don’t appear so. This is a communal feeling given the current situation, and parents may need to pick and choose their battles wisely. Otherwise, they may spend hours of each day dealing with many unpleasant moments. Being “cooped up” with each other may present an opportunity for parents to become behavior detectives to figure out what their kids are trying to communicate. If the children are older, parents may want share this with them so both parent and child become detectives together; maybe even of each other!

Conjunction, Junction, What’s the Function?

Maladaptive behavior is communicating something, and if we want to change that we need to know what the communicative function of the behavior is. By knowing the function behind the behavior (what they are trying to accomplish by the behavior), we can then think about prevention, intervention and post-intervention—thus being able to intervene at three different times before a behavior actually occurs, during the behavior or after the behavior occurs.

Communicative functions of behavior include:

  • Escape/Avoidance of a task
  • Access to something/someone desirable
  • To make a request or a comment
  • Negations/refusal
  • Self-non-interactive—communicating with ourselves or self-talk/actions
  • Attention-seeking
  • Expression of feelings
  • Expression of sensory needs

Given our current environment, it may be important to think about the communicative function of a child’s “maladaptive behaviors.” This provides a way to intervene with a hypothesis of function and consistency of prevention, intervention or response. Given parents’ own mental, emotional or psychological state, they have the option to escalate or deescalate any situation. Be honest with your kids if you are tired, stressed or overloaded; let them know that you may have less patience when appropriate. Remind them that they have a role in helping to make the house and family a kind, happy and compassionate place. Honest communication, kindness and gentleness with one another (even when we lose control) goes a long way to help during these trying times.

If you need help in being a behavior detective, NESCA is providing virtual parent coaching and consultation. Complete our online Intake Form for more information.

 

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

 

To book a consultation with Ms. Lucci or one of our many expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician/consultant in the referral line.

 

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.

 

Meltdown Analysis — Part 2

By | NESCA Notes 2020

By Dot Lucci, M.Ed., CAGS

Director of Consultation and Psychoeducational Services, NESCA

As discussed in last week’s blog, Meltdowns Happen, all children meltdown. Adults meltdown, too. Losing control can take many forms. It is a part of human nature unless we deliberately work on “controlling the beast” that’s lurking inside of us when our system gets taxed. When children are very young, we expect them to lose control because they are learning how to identify and express their emotions. A three-year-old who tantrums is not that uncommon; however, by the time that child is six and then 10, we want them to have developed more and more control as they mature.  But, many children don’t always develop the control that we’d like, and those diagnosed with learning differences sometimes have even more difficulty controlling their emotions.

Teaching children about their emotions, their triggers and how to manage their feelings is the backbone of improving self-awareness, stress management and social competency (3 Ss). If children can label and recognize feelings, notice how their body feels with different emotions and know how to calm themselves when stressed, the better off they will be in life. In a previous role as the program director of Aspire/MGH, we focused on these 3 Ss and utilized a volcano image with our autism spectrum disorder (ASD) participants to teach them about their stress cycle. The volcano image represented a meltdown (see below).

In using this with your child, pick a quiet, calm moment to introduce it to him/her. You might want to start the conversation by reading a book about stress or big emotions. There are many to choose from depending upon the age of your child. You could also just begin a discussion with volcano image to help them understand what they look like and sound like when they are melting down. Discuss with your child what you think s/he looks like as s/he begins to meltdown starting at the bottom of the volcano and working all the way to the top (5) and then what s/he looks like when s/he begins to calm down and recover (moving down the right side of the volcano). If your child has not learned stress management strategies, this is a good time to practice. If your child has learned some techniques, you can also create a list of strategies that s/he can do at each step to help gain control so s/he doesn’t continue to escalate to the next stage. For instance, at a 3, you may be able to use humor to help redirect, but when s/he is at a 4 or 5, using humor may increase distress. I hope this image helps with understanding and reducing the meltdowns that are occurring every day in everyone’s home.

If you’d like assistance in creating your child’s personal meltdown plan, self-awareness plan or behavior plan, NESCA’s parent coaching services can assist you in the journey.

 

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

 

To book a consultation with Ms. Lucci or one of our many expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician/consultant in the referral line.

 

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.