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Aug 09
1

Growing in a Fog: The Impact of Sleep Loss on Children’s Development

By | NESCA Notes 2020

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

A recent study conducted at the University of Warwick, in the United Kingdom, supported the long-held belief that reduced sleep in children has a significant negative effect on their cognitive and emotional functioning. Findings were recently published in the journal Molecular Psychiatry, in an article, titled “Sleep duration, brain structure, and psychiatric and cognitive problems in children.”

When examining children ages nine to 11, reduced sleep was associated with higher levels of depression, anxiety and impulsive behavior, as well as poorer cognitive performance. Findings showed that, on average, behavior problems were 53% higher in children who got less than seven hours of sleep, compared to those who got nine to 11 hours. Additionally, on average, total cognitive scores were 7.8% lower in the children with reduced sleep.

Negative effects of sleep loss were not only observed through children’s behavior and task performance, but there were table differences within brain structure as well. Shorter sleep duration was related to lower volume in brain structures that are responsible for decision making, learning, emotion regulation, memory, executive function, sensory regulation, language function and spatial perception, among other skills. Because sleep is a highly active process, during which children’s brain circuitry reorganizes, it is thought that sleep loss can interfere with actual physical brain maturation, not just emotional, behavioral and cognitive functioning.

This study conducted by the University of Warwick is not the first to demonstrate how a lack of sleep negatively impacts children’s and adolescent’s functioning. In addition to better emotional and cognitive health, adequate sleep is also related to better physical health, including reduced injuries, heart disease and obesity (www.aap.org).

The American Academy of Pediatrics recommends that preschoolers get 10 to 13 hours of sleep per day; grade school children get 9 to 12 hours of sleep; and teenagers get eight to 10 hours of sleep. While this is so, children are often chronically sleep deprived due to excessive school, social and extracurricular demands. Increasing screen time and access to social media is also problematic, not only because these distract children and teens from sleeping, but technology use interferes with the release of melatonin, reduces REM sleep and activates the wake center of the brain. It is thus not surprising that a 2015 analysis of data from the Youth Risk Behavior Surveys found that approximately 57.8% of middle schoolers and 72.7% percent of high schoolers are not getting enough sleep. In spite of this, school start times remain early, expectations for extracurricular involvement remain high, and blue-light-filled technology is increasingly necessary for the completion of late-night homework assignments. This occurs alongside a steady rise of stress and anxiety within pediatric populations, pointing to the importance of re-evaluating the demands and conditions under which our children are expected to grow and learn.

Sleep is a foundational necessity on which cognition, emotion regulation, attention and learning build. The negative effects of sleep loss can be felt at any age, but they are particularly concerning in childhood, a time when the brain is rapidly developing. The American Academy of Pediatrics has provided some tips on how to support healthy sleep in a child of any age. These can be accessed at www.healthychildren.org, at the below link.

References

University of Warwick. (2020, February 4). Children’s mental health is affected by sleep duration. Retrieved on February 24, 2020 from www.sciencedaily.com/releases/2020/02/200204094726.htm

Wheaton AG, Jones SE, Cooper AC, Croft JB 2018, ‘Short Sleep Duration Among Middle School and High School Students — United States, 2015’, MMWR Morb Mortal Wkly Rep., vol. 67, pp. 85–90.

American Academy of Pediatrics (2016). American Academy of Pediatrics Supports Childhood Sleep Guidelines, June 13, 2016. Retrieved on February 24, 2020 from https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/American-Academy-of-Pediatrics-Supports-Childhood-Sleep-Guidelines.aspx

American Academy of Pediatrics (2018). Healthy Sleep Habits: How Many Hours Does Your Child Need? Retrieved on February 24, 2020 from https://www.healthychildren.org/English/healthy-living/sleep/Pages/Healthy-Sleep-Habits-How-Many-Hours-Does-Your-Child-Need.aspx

 

About the Author:

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

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

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

Jun 14
5

Dealing with End of the School Year Uncertainty

By | NESCA Notes 2021

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

The end of the school year can bring a lot of emotions, such as excitement for summer activities, sadness about closing relationships, and anxiety related to change. Often, children are experiencing these mixed emotions without truly understanding them. The end of this particular school year may bring some unique emotions, as it is the second consecutive ending that “looks different,” be it because students were remote for all or some of the year, class parties and field days are not happening, or children cannot give their teacher an end of the year hug. The loss of such traditions may cause kids to feel a lack of closure. Further, this transition is happening at a time when the world is starting to change again. While the loosening of restrictions and return to a semblance of “normal” may be positive for most, children may not know how to cope with all of this simultaneous change.

Here are some tips for things that adults can do to help children cope with what may be a difficult or uncertain end to the current school year:

  • Watch for signs that your child may be struggling with this transition. This may include new sleep difficulties, low frustration tolerance, heightened emotions, meltdowns, reduced appetite, loss of interest, etc.
  • Talk about their feelings related to the end of the year in an open and responsive manner, validating their emotions (e.g., “I can see why that would make you feel sad,” rather than accidentally dismissing them (e.g., “Don’t worry.”).
  • Help provide some closure with their teacher, such as writing a card or letter about what they enjoyed, learned, or overcame together this year.
  • Using artwork or journaling, help your child reflect on their development, accomplishments, and experiences this past year.
  • Create a plan for how they can stay in touch with friends over the summer and schedule some specific playdates or events to reduce worry about losing touch.
  • Maintain your basic schedule, such as morning and bedtime routines.
  • To reduce worry related to uncertainty, provide some age-appropriate opportunities to feel a sense of control, such as allowing your child to design a new daily schedule for “home days,” choose individual or family activities, etc.

The end of any school year provides a great opportunity to teach children about transition and change. We can teach them that it is okay to celebrate their accomplishment while also simultaneously feeling discomfort about what is to come and sadness about saying goodbye. Particularly during a year that has been marked by adversity, learning how to recognize, “sit with,” and manage these mixed emotions will help to build resiliency for the future.

 

About the Author

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

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

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

May 24
5

Why Kids Need to Outdoor Free Play

By | NESCA Notes 2020

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

One of the best ways to make the most of your summer is to get outside and engage in lots of outdoor play. We live in a society where we tend to over-schedule ourselves and our children. Particularly during the school year, this makes it very difficult for children to get the amount of free play that they require. With this, I’m going to tell you five great reasons why you should throw away your schedule, put down the tablet, and get outside.

The first reason is probably the most obvious. Outdoor play provides great benefits to physical development. It improves motor coordination, strength, and balance, and it puts kids in an overall healthier position.

The next reason to play outside is that there are benefits for internal regulation. Not only does it make kids sleep better at night, but there is research to show that it aids attentional control and stress reduction. Being outdoors also provides kids with different sensory experiences – such as feeling the texture of sand and mud, or feeling the wind blow on your face – which will help to build children’s sensory tolerance.

The next reason to get outside is to improve cognitive development. Being outdoors provides a lot of opportunities to make observations, draw conclusions about things, see cause and effect, and be imaginative.

Next, playing outside aids emotional development. When we are over-scheduled, children do not have the opportunity to feel confident in their ability to step outside of their comfort zone or take risks. Experimenting and taking risks during outdoor play can help children understand that they have some control over what they can do within their environment, as well as begin to recognize boundaries.

Finally, the last reason to get outside is that it really bolsters social development. When there is no structure or there are no rules to follow, kids have to learn how to initiate their interactions, engage in conversation with each other, communicate, problem solve, and find ways to along, even when others have different ideas.

With all of the above benefits, outdoor free play is one of the best things you can give to your child. So as the weather is getting nicer and summer is fast approaching, if you are looking for something to do, sometimes it is best to just put down your schedule, get outside, and get dirty.

 

About the Author

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

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

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

May 10
15

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.

 

Feb 22
2

School Stressors in a Pandemic

By | NESCA Notes 2021

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

A recent article published by NBC News highlights the multiple stressors facing school-aged children and their families during this pandemic, with a more specific focus on the differing stress levels between remote and in-person learners. It is becoming clearer that during this time, learners and their families are facing higher rates of depression and anxiety, and there are concerns that students who are attending school remotely are learning less, particularly children with disabilities and those from low-income families.

A recent study from NBC News and Challenge Success, a nonprofit affiliated with Stanford Graduate School of Education, compared the differences between students who have been learning exclusively online and those who have been able to attend at least partially in-person. The study involved more than 10,000 students in 12 U.S. high schools who completed a self-questionnaire provided by the research study. The high schools were reported to come from multiple locations around the country (Arizona, Texas, New York and Midwest) and were descried as “demographically similar to the nation in terms of student family income,” though this was not true of being matched for race and likely other factors not discussed in the article. This also does not appear to be a peer-reviewed study, which suggests limitations to predictive power of the outcomes. Nevertheless, findings suggested that students who spent time in the classroom self-reported lower rates of stress and worry than students who were fully remote. An alarming finding was that half of all students, regardless of how they were attending school at the time of the study, reported they were more stressed by school than they had been during the previous year. Students reported exhaustion, headaches, insomnia or other stress-related ailments at high levels – regardless of whether they were in-person or not – with the highest rates being for remote learners: 84 percent fully remote learners; 82 percent hybrid students; and 78 percent fully in-person.

The article suggested that additional stressors found for remote students included on average more homework and that these remote students were also less likely to feel they had an adult they could go to with a personal problem. Anecdotally, one teacher commented, “In the room, you get more eye contact.” The teacher added, “On the screen, oftentimes the kid could be sitting in front of a window. You can’t see them, so it’s hard to make sure they’re attentive.”

While there are limitations to this study, it is clear that students and their families are currently experiencing a high level of stress. Many schools have been aware of this problem and have taken steps to embed extra programming into their students’ weeks. We need to continue to prioritize community connection and wellness for students attending school in-person and online. It is important to ensure that students know who they can reach out to and how, particularly those learners who are not stepping foot into a school building this year. It is also important to build in opportunities for stress management, as well as instruction in healthy habits, such as exercise, sleep hygiene and healthy eating. Clearly both children and their caregivers could benefit from this type of support right now. If you or a loved one is experiencing heightened emotional stress, it is important to reach out for help. This can include alerting your child’s school to their increasing stress, as well as bringing concerns to your child’s doctor. A referral to a psychologist or licensed mental health professional may be in order to help you and your child through this difficult time.

Source: Remote Students Are More Stressed Than Their Peers In The Classroom, Study Shows by Erin Einhorn, 2/15/2021 published by NBC News.

 

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

 

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

 

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

 

 

Dec 07
5

The Holiday Blues Coupled with Covid

By | NESCA Notes 2020

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

The holidays can be a time of great joy, but they can also be a time of great stress. Celebrations and merriment can be contrasted with pressure to amaze, long to-do lists, financial constraints or reminders of those we have lost. For many, it is a time of mixed emotions or strong internal conflict about why they cannot feel happy during a season that practically dictates it.

Holiday blues have been felt my many people for a long time, but now during a global pandemic, those feelings may be amplified and more prevalent than previous years. Families are trying to provide children with a positive holiday experience during a time of high stress and significant restriction. Family gatherings and holiday traditions are being cancelled, and many families are mourning the loss of loved ones. Adults are not the only ones feeling increased stress as we enter the holiday season. Children likely feel excited about the holiday but sad about not seeing family, not having holiday parties in school, and not being able to attend their traditional holiday events. This holiday season is simply different in ways that can bring great strain.

So, what can we do as adults to emotionally support children this holiday season? Do we allow them to observe our stress or do we keep it to ourselves in an effort to provide them with the happy holiday season that they deserve?

In June 2018, I wrote a blog post titled: “The Struggle is Not only Real, It is Necessary,” which discusses the importance of embracing uncomfortable, unwanted emotions as being necessary for personal growth and resiliency. By acknowledging, accepting and using unwanted feelings in a functional manner, we teach children to be competent and confident in their ability to navigate a stressful world. Of course, when I wrote the article, I could not have imagined the extent or duration of stress or discomfort that we would be facing in 2020. But does that change anything?

To put it simply, no, not really. Entering into the holidays with the expectation that we can protect our children from life’s stress is unrealistic. Attempting to do so will only add pressure while ignoring the mixed emotions that children are likely feeling as well. During this emotionally high-stakes time, acceptance of the struggles we face is even more critical. Adults and children both need “permission” to feel sad, frustrated, lonely or scared while also still allowing themselves to feel excited, thankful, and, yes, even joyful.

Here are some suggestions for how to help your family navigate the holiday blues this unique holiday season:

  • Talk about your feelings – wanted and unwanted ones – throughout the day, modeling and encouraging regular emotional discourse (e.g. “I love giving gifts, but getting all the shopping done is kind of stressful.”).
  • Help children label and interpret the emotions they may be having, as they may not have the right words or language for expressing them (e.g. “It sounds like you’re really disappointed we can’t go to Grandma’s house.”).
  • Be careful to not accidentally dismiss children’s feelings (e.g. “No need to be sad; we will find another fun way to celebrate.”), instead reflecting their emotion (e.g. “I know you’re sad that we can’t have a holiday party; I am, too.”).
  • Normalize the experience of mixed emotions (e.g. It’s okay to be excited for children while also feeling sad that we won’t see our family.).
  • Find new, safe holiday activities or events (e.g. holiday light drive, virtual gift exchange, etc.) and adapt previous traditions when able (e.g. virtual family gatherings).
  • Don’t romanticize the traditions that were lost this year (e.g. avoid such things as, “Our parties were always the most magical part of the holiday.”).
  • Help children understand new holiday plans as an opportunity to “celebrate” or “experience” the holiday, but be careful to not impose emotional expectations (e.g. “Enjoy the holidays!”) that can add pressure.
  • Reassure children that these changes are temporary, and traditions and visits will continue when it is safe to do so.

 

About the Author

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

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

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

Dec 03
9

Transition Planning for Adulthood—It Starts at Birth

By | NESCA Notes 2019

 

By: Kelley Challen, Ed.M., CAS
Director of Transition Services; Transition Specialist

There are many transitions throughout a person’s life, but as a transition specialist working at a pediatric neuropsychology practice, my focus is most often on helping students who have struggled with learning, social and/or emotional difficulties to plan for and successfully navigate the transition from secondary school to whatever comes next in life (e.g., employment, transition program, community college, apprenticeship, etc.). I focus on helping young people envision their future selves and set short- and long-term goals for themselves—putting them into the driver’s seat for their own lives and helping them manage the risks and responsibilities that come with making choices for themselves.

When a family walks into my office for the first time, it is common for one parent or caretaker to worry aloud that they are starting transition planning for their child “too late.” I consistently respond that it is never too late to start planning and to begin transferring responsibility from one generation to the next. But today, I also want to emphasize that “it’s never too early” to start to plan for your child to be a more independent and competent adult—the best transition planning starts at birth.

Some common examples of transitions that start at a very early age that many parents and caregivers can relate to are: a child sleeping through the night for the first time unsupported, holding a cup and drinking without spilling, feeding oneself with a spoon, and/or riding a bicycle. Each of these activities is an example of a child building competence and independence while their parents simultaneously relinquish some amount of control. Often times, mistakes, messes and even pain are a natural part of the process.

From a young age, there are many skills that children can learn that will make a big difference for them later in life. Some examples include:

  • Picking out clothes for the next morning
  • Putting dirty clothes in a hamper
  • Loading the washing machine
  • Putting clean clothes away in drawers
  • Washing hands before eating, after using the bathroom and after playing outside
  • Setting the table (maybe not plates or glasses, but perhaps napkins, forks and spoons)
  • Carrying dishes to the counter and placing them next to the sink after dinner—or even in the dishwasher
  • Putting their own garbage in the trash
  • Collecting small trash bins to dump into a larger bin/bag on trash day
  • Helping to pack their own lunch
  • Helping to prep a meal (e.g., washing veggies, pouring ingredients, etc.)
  • Getting condiments from the refrigerator and putting them away after dinner
  • Getting a snack for self or a sibling from the refrigerator or pantry
  • Wiping down the table after a meal
  • Feeding/providing water for pets
  • Weeding
  • Raking leaves
  • Shoveling snow
  • Helping to get the mail
  • Brainstorming for/making a shopping list
  • Finding assigned items at the grocery store
  • Carrying light grocery bags
  • Helping to pack belongings for a family trip
  • Making gifts/cards for a celebration
  • Budgeting a few dollars to buy inexpensive but thoughtful gifts for family members

Some of these will apply to your child and some of them will not. And some of these may require adding time to your schedule, allowing a child to complete tasks at their own pace, or doing some household reorganization, allowing a child to access items necessary to complete tasks. Finally, a lot of deep breathing and patience—for both you and your child—will be required!

At any point in time, you can identify a task  you regularly do for your child and consider where there are pieces they can do for themselves. If your only role in the task is to prompt your child, consider whether there might be a low-technology tool (post-it, photograph) or high-technology tool (alarm, phone reminder) that could take the place of your prompt. If you are not sure how to make a change, it may be a good time to get help from a teacher, pediatrician, behavioral therapist, special educator, etc.

The important thing is that you are starting to think about where there is a potential for increasing competence, independence, confidence and self-esteem for your child. You are starting to plan for your own obsolescence in your child’s life, or at least in their carrying out every day self-care activities and chores. While that is a scary thing, it is also a beautiful and empowering thing!

*This blog was originally published in August, 2019.

 

If you are interested in working with a transition specialist at NESCA for consultation, planning or evaluation, please complete our online intake form: https://nesca-newton.com/intake-form/.

 

About the Author:

Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

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.

 

Oct 12
7

Developing Self-Motivation So It Sticks

By | NESCA Notes 2020

By Dot Lucci, M.Ed., CAGS

Director of Consultation and Psychoeducational Services, NESCA

Motivation can be elusive for many of our students especially for activities they don’t like, they don’t find interesting or they find challenging. In other blogs, I’ve written about the 3 S’s: self-awareness, stress management and social competency, as keys to thriving in life. For this blog, self-awareness and stress-management are relevant. Being able to handle failures, set-backs and challenges are a part of life whether you are a child or an adult. Developing internal-motivation and self-efficacy are two powerful ingredients to thriving in life. So, how do we help children tolerate distress, rebound from setbacks and stretch beyond their comfort zones?

Russian psychologist Leo Vygotsky proposed a concept called the Zone of Proximal Development (ZPD). He defined ZPD as the area just beyond a student’s independent functioning level where he/she may need some assistance but isn’t too far out of reach. To hit the ZPD accurately, one has to assess the student’s knowledge and experiences accurately.

If we haven’t helped children recognize that new learning is challenging and takes effort, we have done them a disservice. When they struggle and haven’t learned that it is a part of learning, we see students push back with comments such as, “It’s too hard,” “I don’t know how to do it,” or “I can’t do it.”

Tasks in the student’s comfort zone don’t take much effort; they just “breeze through them” with little exertion or motivation. If adults raise the bar just beyond the student’s reach, but the student can reach it with minimal support, this develops efficacy, stamina and internal-motivation. Once they’ve reached the bar, there is often a sense of accomplishment and pride with the feeling of, “I did it!”

How do we encourage, support and guide students to “push themselves beyond their comfort zone”? The answers to this question are important, as they can backfire on us and discourage a student or encourage a student to move into their ZPD. In general, there are four approaches/steps:

  • Adults model what it means to be in the ZPD
  • Students imitate the adults
  • Adults fade the support/instruction
  • Adults offer feedback on the student’s effort and performance.

Adults model, guide, encourage and praise authentically. Think out loud about how you persevere. Provide support and guidance, such as, “I know this is hard for you, but let’s start with what you do know.” Or, “I like how you stuck with it even when you wanted to give up.” Finally, “You’re building tolerance and stamina for new learning.” As students become more comfortable in their ZPD, they become more self-motivated and develop greater self-efficacy.

Helping children get there can be a journey, but if the adults in their lives take the time and effort, the pay-off is worth it! When you give children guides to know when they are in each zone, it helps them know what to expect, how to think and what to do. For instance, when students are in their comfort zone you may hear, “I get it (and it is quick), “this is a breeze,” “this won’t take me any time,” or “I’m bored.” Little to no effort is required in this zone. In the ZPD, students may be saying, “I have to think,” “I have to work at this,” “I’ll get some wrong,” “I may get stuck,” or “It’s ok, I know some of it, so maybe I can do more.” It takes effort, thinking and the student feels challenged. And finally, in the OMG Zone, you may hear, “I don’t know where to begin,” “I can’t figure this out,” “I’m spinning my wheels; this makes no sense,” “I don’t care,” and “I’m frustrated and angry.” Adults are doing most of the work at this stage, and the student’s effort doesn’t pay off. He or she is not ready for this learning yet – it’s too far of a stretch. Helping students develop their comfort in their ZPD is paramount to developing self-motivation and self-efficacy.

 

Resources

Vygotskian Principles on the ZPD and Scaffolding

https://www.open.edu/openlearncreate/pluginfile.php/5904/mod_resource/content/1/Vygotskian_principles_on_the_ZPD_and_scaffolding.pdf

What is the Zone of Proximal Development

https://www.healthline.com/health/zone-of-proximal-development

 

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.

 

Sep 21
4

Adapting Academic Accommodations for Return to Learning

By | NESCA Notes 2020

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, Director of Training and New Hampshire Operations, NESCA

As students with disabilities return to learning, the accommodations provided through their 504 Plan or Individualized Education Program (IEP) may no longer meet their needs within the structure and limitations of remote learning and/or return to school protocols. For example, when remote learning, teachers are not as readily available to provide “in the moment” redirection, check-ins for understanding or modifications to the presentation or length of assignments. When at school, many students are at the same desk all day, for academics, “specials,” snack and lunch, meaning teachers have to identify new ways to provide movement and sensory breaks while maintaining social distancing. For hybrid learners, teachers have to consider how to provide structure and predictability in the face of frequent transition and increased demands on independent work.

Within all return to learning plans, parents and school teams are having to be more creative than ever before, working to quickly and flexibly identify and implement new accommodations to address a range of new challenges. While this is new territory for all, there is fortunately an increasing number of online resources to aid this process, some of which are listed below. Foundational to the success of any COVID-era accommodations plan will be the team’s ability to regularly assess its feasibility and effectiveness, engage in open communication between home and school, and steadfastly and flexibly adapt the accommodation plan as individual needs and/or school instructional plans change.

See the following websites for information about how to implement accommodations during COVID-19:

In IEP Accommodations During Distance Learning, Amanda Morin of www.understood.org presents a list of many standard accommodations for presentation of information, assignment completion and daily management/organization, with ways to adapt each for remote instruction, giving specific consideration of available tools within Microsoft and Google suites.

Socially Distant Sensory and Movement Break Ideas by Katie McKenna, M.S., ORT/L, of The Autism Helper provides a range of creative solutions for meeting regulation needs for a wide range of students.

The State Educational Technology Directors Association (SETDA) eLearning Coalition website provides webinars and a host of information regarding the development and implementation of accessible educational materials during remote learning.

 

About the Author:

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

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

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

Aug 03
7

Coronavirus & Social Injustice: A Crisis or an Opportunity? – Part 2

By | NESCA Notes 2020

By Dot Lucci, M.Ed., CAGS

Director of Consultation and Psychoeducational Services, NESCA

Last week in my blog post, I wrote about one’s perspective about the coronavirus as an opportunity or as a crisis. Initially, most everyone thought it was a crisis and we needed to mobilize to fight it. Massachusetts Governor Charlie Baker recognized it as a crisis early on and has handled it with steadfastness and clarity; whether or not you agree with his decisions. Recently, he mobilized a commission to discuss the re-opening of schools in the fall. This commission has stakeholders from across the Commonwealth, including parents, business leaders, community leaders, educators and administrators. As part of guidance on the reopening of schools, Governor Baker and the Massachusetts Department of Elementary and Secondary Education (DESE) told school district administrators to plan for three scenarios of returning to school in the fall: in-person, a hybrid of remote and in-person, and all remote learning. The districts were given deadlines to submit their plans – a daunting task for all involved. But this pandemic has created many daunting tasks for all of us, and we must come together thinking flexibly, creatively and collaboratively to handle this crisis and move towards thinking about it as an opportunity. Our world as we know it and much of the workings of our world have changed and probably will remain changed for the foreseeable future (i.e., open floor offices are a thing of the past; working from home is proving for some to be more productive).

We are all in this together and when parents, students, teachers and administrators think about the return to in-person instruction in the fall, it brings about many different emotions as well as concerns. Administrators have to plan for all three scenarios, because there are so many unknown variables to consider. For instance, we could start in-person learning then need to switch to remote if there is an uptick in positive cases of the coronavirus. School re-entry in the fall is an unknown, but our leaders are trying to plan as best they can for all possibilities. Ultimately, returning to in-person learning will be a personal decision for every parent based on many variables for each of their children. What’s good for one child may not be good for another in the same family, let alone one family to another.

I wonder about viewing the coronavirus and the havoc it’s wreaked on our educational systems as a genuine opportunity to truly rethink how we educate students. Maybe it is seriously time to consider dramatic school reform. Our education system is antiquated and has not changed much over the years even with the advent of STEAM. We still have achievement gaps with many students not succeeding even with reforms and many dollars spent. Maybe the coronavirus and the social injustice movement are just the crises that are the opportunity that will really change how we think about education, bringing about dynamic and dramatic school reform.

In last week’s blog, I quoted John F. Kennedy as saying, “The Chinese use two brush strokes to write the word ‘crisis.’ One brush stroke stands for danger; the other for opportunity. In a crisis be aware of the danger – but recognize the opportunity.” The coronavirus and social injustice are certainly crises of today, yet I do see them as an opportunity to heal the divisions in our country, increase dialogue and create change.

Last week Massachusetts DESE Commissioner Riley’s Weekly Update included “Protocols for Responding to COVID-19 Scenarios.” This guidance provides more information and protocols to answer the following questions:

  • What should a district do if there is a symptomatic individual – at home, on the bus or at school?
  • What should a district do if someone in the school community tests positive for COVID-19 – be it a student, teacher, staff, bus driver, or one of their household members or close contacts?
  • Who should get tested for COVID-19 and when?
  • In what circumstances would someone need to quarantine (when they have been exposed but are not sick) or isolate (when they are sick)?
  • What should school districts do to monitor COVID-19 spread in their communities?”

These guidelines may change as the situation changes, but as they stand now. I have heard a variety of responses to these guidelines, such as:

  • “This makes my head hurt and eyes blur.”
  • “They have got to be joking.”
  • “It’s an attempt. They’re trying.”
  • “Kids have to go back some day.”
  • “Deep breaths and an open mind are needed.”
  • “We’re all in this together. We have to try.”

As these comments demonstrate, there are many different feelings and thoughts about going back to in-person instruction in the fall. Our administrators and leaders are juggling so many different variables in making decisions. It “requires” us to trust them and show concern, compassion and gratitude in their attempts at re-opening schools. I recognize the three options presented are just that – three options. No matter what the decisions are about how we return to school, it will be what it will be in each community.

It is my hope that our leaders can view this pandemic, this crisis, as an opportunity to seriously contemplate and delve deeply into discussions about school reform within our country. This pandemic has dramatically shown the inequities that exist across our state and country and in our cities and towns. We knew they were there before, but now they are in our faces. We have an opportunity to think about education as not related to one’s zip code, socio-economic status, color of one’s skin/ethnicity or other factors; instead we can think about it as a basic human right that should be equal for all.

Education is about preparing children to become a competent member of our society and community. We have an opportunity to think about how and where we educate students. Education is about learning and preparing students for tomorrow. Many districts that were socially-emotionally-focused and had good technology capabilities were able to be nimble and pivoted smoothly to remote learning during the pandemic. These districts also had good leadership, solid communication with families and students, and staff felt cared for. There were many other districts that struggled to pivot to remote learning for a myriad of reasons, and this points out that equity in our educational system is necessary. So, while you think about the fall and schools reopening, do what you think is right for your child and family. Also, remember that this “new normal” of remote learning can be okay if done well.

In the special education vernacular, you often hear that special education isn’t a place or a program. That is also true for all education – education isn’t a place. It is so much more. The Center for Education Reform states that the future of schools is students, not systems. This might be a good time to devote some energy to reforming our educational system for the future.

 

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.