Tag

child development

Therapeutic Toy Guide to Promote Skill-building

By | NESCA Notes 2021

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

It’s that time of year when parents and loved ones are looking for the perfect gift. As pediatric occupational therapists, we are often asked about our recommendations for the best toys and activities that encourage learning and the development of specific skills. During an occupational therapy session, toys and games are used with people across the life span for many reasons. The biggest reason is to bring joy and develop confidence while simultaneously working on skill-building in areas that require getting and maintaining attention in an effort to improve and develop independence in functional tasks.

Play and exploration of games and toys are for those of all ages. The right toy and game can be used to develop new skills and strengthen and refine learned skills.

Skills addressed through play and active exploration:

  • Attention and concentration
  • Balance
  • Coordination skills
  • Core strength
  • Executive functioning
  • Emotional regulation
  • Fine motor skills
  • Gross motor skills
  • Handwriting
  • Imaginative play
  • Motor planning
  • Sensory motor needs
  • Visual perceptual skills

How many times have you endlessly scrolled online looking for the best-fit gift, wondering if it will be one more item that ends up collecting dust on a shelf? How often do you wish a toy store existed like when we were kids, instead of walking down the same small toy aisle at the local department store and leaving with nothing? Or having to weed through page after page of online stores and catalogs?

Below is a helpful guide to therapeutic games and toys that focus on a couple of specific skill areas. Most of the games included can fall into more than one skill area, depending on how it’s used.

Coordination Skills – Skills that help develop body control and awareness. Bilateral coordination is the ability to use both sides of your body together in a coordinated way, and hand-eye coordination is when the eyes guide the hands in movement.

3 + years

  • EleFun (Hasbro)
  • Feed the Woozle
  • Kids Magnetic Fishing Games (iPlay, iLearn)
  • Instrument toys
  • Marble Run
  • Target activities
  • The Yoga Garden Game
  • Wooden Balance Board
  • Zoom Ball

6 + years

  • Bob it
  • BucketBall
  • Kan Jam
  • Klask
  • Rev balance board
  • Ring Toss
  • Simon
  • Spike Ball
  • Throw the Burrito
  • Twister

Executive Functioning Skills The ability to sustain attention, organize and plan, initiate and complete, problem solve and regulate emotions.

3 + years

  • Bee Genius (MUKIKIM)
  • Bunny Hop (Educational Insights)
  • Cootie
  • Create-A-Burger (Lakeshore)
  • Dino Escape
  • Don’t Break the Ice
  • Frankie’s Food Truck Fiasco Game
  • iPlay, iLearn Kids Magnetic Fishing Games
  • Hoot Owl Hoot
  • Movement Memory

 6+ years

  • Battleship
  • Checkers
  • Chess
  • DogPile
  • Distraction
  • Gravity Maze
  • Life Junior
  • Monopoly
  • Outfoxed
  • Rush Hour (Think Fun)

Fine Motor Skills – The ability to control the small muscles of the hands and fingers. Fine motor development contains many components. Some of those areas include pincer and pre-writing grasp development, hand strength, wrist stability, motor control, and separation of the sides of the hand.

3 + years

  • Alphabet Learning Locks
  • Bee Genius
  • Duplo Sets
  • Forest Friends Playset (Lakeshore)
  • Light table pegs and pegboard (Lakeshore)
  • Magnet Alphabet Maze
  • Noodle Knockout!
  • Pegcasso Build and Drill
  • Poke-a-Dot: Old MacDonald’s Farm
  • Pop the Pig
  • Woodpecker feeding game (iPlay, iLearn)
  • Snap Dinos (Lakeshore)

6+ years

  • Frankie’s Food Truck Fiasco Game
  • LEGOs
  • Light Brite
  • LiquiPen (Yoya Toys)
  • Mancala
  • Kanoodle
  • Operation
  • Perfection
  • Pictionary
  • Scratch Art
  • Shelby’s Snack Shack Game
  • Trouble

Sensory Play – The opportunity to receive sensory input through play. It can foster listening skills and body awareness, encourage tactile exploration and risk-taking, and promote a calming and alert state of being.

3+ years

  • Bean bags
  • Kinetic Sand
  • Monkey Noodle
  • What’s in Ned’s Head?
  • Playdoh
  • Pop Fidgets
  • Squishmellos
  • Scooter boards
  • Sit and Spin
  • Trampoline

6 + years

  • Aromatherapy
  • Bubble tubes
  • Color mix sensory tubes
  • Doorway Sensory Swing Kit (DreamGym Store)
  • Thinking Putty (scented/glow in the dark)
  • Tent
  • Tunnel
  • Water Beads
  • Weighted blanket
  • LiquiPen (Yoya Toys)

Visual Perception Skills – The ability to make sense of what is being seen. Skills are used to copy information from a board, manipulate items, identify, read, recall info, visually locate things, and write.

3 + years

  • Alphabet Bingo
  • CandyLand
  • Chutes and Ladders
  • Fox in the Box
  • Honeybee Tree
  • Magnatiles
  • Spot-it
  • Pete the Cat- I Love My Buttons Game
  • Puzzles
  • Zingo (Think Fun)

6+ years

  • Connect Four
  • DogPile
  • Guess Who
  • Jenga
  • Kanoodle
  • Klask
  • Let’s Go Code
  • Mancala
  • Perfection
  • Pixy Cubes

This list is just the tip of the iceberg of the many toys and games you will come across. Many toys and games can be therapeutically and easily graded to any individual, no matter the age. The trick is to find the just-right challenge to work on the skill area desired through fun and motivating means. We recommend reaching out to your occupational therapist if you require assistance with either new or older games and toys and how to create the just-right challenge for your child.

 

About the Author

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

 

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

 

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

 

Assessing Social Skills Challenges: A Developmental Perspective

By | NESCA Notes 2021

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

As parents and teachers, we want the world for our children, and one of the biggest worries is around social development and friendships. This worry is particularly acute when our child has a learning, emotional, or behavioral challenge that affects their functioning in school, the community, and at home. Knowing more about the developmental process and developmental expectations can help to identify challenges and develop appropriate interventions to support growth.

Human Development: A Dynamic Interactional Process

Human development is a dynamic and ongoing process between three factors:

  • the “hard-wired” general road map that governs the emergence and refinement of brain and body systems for all humans
  • the environment in which that development occurs, including relational components, such as availability of consistent attachment figures, threats to physical safety—including war, toxins in the water, etc., and access to resources, such as food, housing, education, and supportive family and friends
  • Unique constellation of the individual learning, temperament, and emotional style that provides resources as well as vulnerabilities

The ways in which these three factors interact can be hard to predict—just look at the difference between siblings who grow up in the same home. Some children are more vulnerable than others by virtue of a temperamental that “runs anxious,” in the words of one of my parents, which causes them to perceive unexpected events as threatening. Another’s vulnerability comes from their difficulties with understanding how social interactions actually work. How much difficulty each one encounters is likely to be calibrated by other elements, such as a consistent, predictable learning and social environment that makes developmentally appropriate demands and provides clear, reasonable (for the child) expectations. This can be a little trickier because vulnerable children are often delayed in their social-emotional development. For this reason, it is important to know more about the stages of friendship to know where your child is and how to help them grow.

The Laboratory of Childhood Social Development: Stages of Children’s Friendships (Robert Selman) This is one of many schemas for the meaning of friendship changes as a child grows and develops. Again, remember that there is a wide range of normal development, and that children with other challenges may move more slowly.

Level 0: Momentary Playmates (approximately 3-7 years old) Proximity is key; friends are people who are nearby and with whom you can have fun. The child assumes that “everyone thinks like me” and assumes that if a playmate has a different opinion, “s/he doesn’t want to be my friend anymore.”

Level 1: One Way Assistance (approximately 6-12 years) Friends are people who do nice things for you, like share a snack. Having a friend is very important, more important than someone being nice to you. Friendship can be used as leverage (“I will/won’t be your friend if…”).

Level 2: Two-Way Fair-Weather Cooperation (approximately 6-12 years) The child can take another’s perspective as well as his/her own—but not at the same time. Fairness and reciprocity become really important in a rigid way (“If I do something nice for you, you must do something nice for me”). Children are very judgmental about themselves and assume that others think the same way about them. Fitting in is also really important, and jealousy can become prominent. It is the time for cliques and secret clubs.

Level 3: Intimate, Mutually Shared Relationships (approximately 11-15 years) Friends are people who help you solve problems and will keep your secrets. They do kind things for you and don’t keep track because they care about each other. Best friends become really important and spend all of their time together. They can feel betrayed if their friend spends time with someone else.

Level 4: Mature Friendship (approximately 12 years-adulthood) Friends place a high value on emotional closeness. Trust and support maintain the relationship, not proximity. Friends accept and even appreciate their differences, and for this reason, they are not as threatened by other relationships.

You will notice as you read through these stages that there some key cognitive skills needed for social development. These include:

  • Self-regulation—the ability to inhibit impulses, control emotional reactions and manage behavioral responses . It also includes the ability to respond flexibly to changing demands.
  • Awareness of Others/Theory of Mind—the ability to recognize the difference between self and other; that other people do not share your thoughts and feelings.
  • Understanding of Norms, Rules, and Conventions—these are the agreed upon boundaries of expected behavior.
  • Perspective taking—the ability to not only recognize that other people do not think the way that you do, but to actually try to understand things from their point of view (“stand in their shoes”).
  • Mutuality-shared appreciation of each other and the reciprocal nature of the relationship.

Assessment: Before trying to intervene to help a child be more successful in making friends, it is important to distinguish between social skills and social competence. Social Skills are the discrete techniques for managing specific social interactions. These could range from maintaining eye contact to starting a conversation. Social Competence has to do with the overall ability to manage the variety of social demands in one’s environment. While we teach social skills, we are aiming for social competence. The criteria for social competence changes as children get older and the demands of their environment increase. This means that while a child may do perfectly well in one social environment, their mismatch in another could cause problems. Therefore, getting a general idea of how your child is thinking about friendship in relation to his peers is an important first step.

A second step in helping children become more socially competent is to figure out what the problem is. These problems can be divided into three general categories:

  • Skill Acquisition—Does the child know what to do? For instance, does the child know the steps to take to initiate conversations?
  • Skill Performance—Does the child have the motivation to perform the steps, and do they know when to do so (context)? For instance, does the child want to start a conversation, and do they know when to do so—like on the playground and not when the teacher is talking.
  • Skill Fluency—While they may know what to do to start a conversation and when to do it, how good are they at it? Can they do it in a timely manner without obvious awkwardness? Is there something else, like anxiety, getting in their way?

The final impediment to learning and using social skills to achieve social competency is the interference caused by anxiety. Anxiety is the experience of feeling unsafe and helpless to control a situation. It sparks a cascade of physiological changes that facilitate the process of escape by stimulating the sympathetic nervous system—when the danger is over, a complementary system takes over (parasympathetic nervous system) to calm things down and return to equilibrium. However, when a child is continuously stressed by, say, an unfriendly school environment, their system never calms down. They become stuck in “threat alert” where any unexpected stimuli is given a negative interpretation and the survival reflexes of “fight/flight/freeze” take over. How to “turn off” the threat alert? Make a child feel safe through a supportive relationship and then teach them the skills they will need to gain more mastery over the situation.

 

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.

What’s the Big Deal about a Pencil Grip?

By | NESCA Notes 2021

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

With kids back in school, drawings, coloring pages, and written work will make their way from the classroom to backpacks and eventually to the fridge for everyone to admire.

From infancy to adulthood, we all hit many milestones in life. Some milestones stand out more than others, but the little ones are no less important. The ability to hold a writing tool is a milestone that moves through various stages from infancy through adulthood. If you get the chance to view and capture each stage along a child’s development, it’s genuinely fascinating!

So, what’s the big deal about the stages involved in holding a writing tool, such as a crayon, marker, or pencil? These stages are the foundation for developing the tiny muscles and arches of the human hand, creating strength and endurance during a writing/drawing activity, and developing stability to manipulate the writing tool to use it the intended way. As humans, we all move through these stages at one point. The progression through each stage is not uniform or standard. The ultimate goal is to reach the ability to hold a writing tool with a functional grasp pattern that promotes adequate speed, accuracy, and legibility without it being the cause of pain or fatigue.

For many kids, achieving fine motor precision and the skill for written output is challenging. However, as NESCA Occupational Therapist Sophie Bellenis, OTD, OTR/L, reminds us in her recent post, “Handwriting vs. Typing: Where do we draw the line?,” handwriting is still a valuable life tool.

So, what does the progression of pencil grasp development actually look like?

Primitive Stages – Observed between 12 and 36 months. The art of drawing and coloring is often the first exposure and gateway to children learning how to hold a writing tool. There is all the freedom, no pressure of writing, and no right and wrong to their drawing.

  • Radial Cross Palmer Grasp (Fig a.) – Full arm and shoulder movement is used to move the writing tool. The writing tool is positioned across the palm of the hand, held with a fisted hand, and the forearm is fully pronated with elbow winged high out to the side.
  • Palmer Supinate Grasp (Fig b.) – Full arm and shoulder movement is used to move the writing tool. The writing tool is positioned across the palm of the hand, held with a fisted hand, with slight flexion of the wrist, and the elbow slightly lowered out to the side.
  • Digital Pronate Grasp (Fig c.) – Full arm and shoulder movement used to move the writing tool. Arm and wrist are floating in the air, and only the index finger extends along the writing tool toward the tip.

Schneck, CM, and Henderson (1990)

Children will begin to shift between the various pencil grips as their shoulder and arm muscles become stronger and steadier.

Immature grasp or transitional grip phase – This grip has been observed as young as 2.7 years of age through 6.6 years of age as stated through research (Schneck, CM, and Henderson (1990)).

  • Static Tripod grasp (Fig g.) – The child will use their forearm and wrist movements only keeping fingers stationery and wrists slightly bent. Movement of the hand can be observed as not graceful. The thumb, index and middle finger will work together as the shaft of the pencil is stabilized by the 4th finger.

Ann-Sofie Selin (2003)

Mature grips – There is so much talk about what looks right and what looks wrong. Traditional pencil grips have evolved through time. There have been four pencil grips now classified as a mature grasp pattern. All mature grips use precise finger movement to manipulate a writing tool while keeping the forearm stabilized.

  • Dynamic Tripod Grip (Fig 1) – Previously known as the golden standard of all grips, where the thumb, index, and middle finger function together, while the pencil shaft rests on the middle finger.
  • Dynamic Quadrupod Grip (Fig 2) –The thumb, index, middle, and ring fingers function together while the pencil shaft rests on the ring finger.
  • Lateral Tripod Grip (Fig 3) – The pencil shaft is stabilized by the inner (lateral) side of the thumb and index finger while resting on the middle finger.
  • Lateral Quadrupod Grip (Fig 4) – The pencil shaft is stabilized by the inner (lateral) side of the thumb, index, and middle finger while resting on the ring finger.

Koziatek SM, Powell NJ (2003)

Pencil grips are generally believed to affect handwriting, and awkward pencil grips become the most commonly assumed cause as to why that is (Ann-Sofie Selin, 2003). However, the production of untidy or illegible handwriting does not always correlate to an unusual pencil grip. The most efficient pencil grip for a child is the one that will help them write with speed and legibility, without pain for an extended period of time.

When should a parent, caregiver or educator be concerned?

  • There is pain and excessive pressure on the writing tool by holding on too tight
  • Illegible handwriting
  • Writing speed is compromised
  • Complaint of hand fatigue during writing and coloring activities
  • Holding the pencil with a primitive grasp (e.g., full fist) after 4 years of age
  • White knuckles or hyperextended joints in fingers holding a writing tool
  • Visible flexed wrist and forearm lifted off the writing surface
  • Inability to choose a clear hand preference between ages 4 and 6 years of age
  • Complete avoidance of all drawing or writing activities

If you are concerned about your child’s pencil grip and/or handwriting, an Occupational Therapist can work with you to identify challenging areas and determine next steps. Let us know if we can help support your child.

References

Koziatek SM, Powell NJ. Pencil grips, legibility, and speed of fourth-graders’ writing in cursive. Am J Occup Ther. 2003 May-Jun;57(3):284-8.

Schneck, CM, and Henderson (1990) Descriptive analysis of the developmental progression of grip position for pencil and crayon control in nondysfunctional children. American Journal of Occupational Therapy, 44, (10) 893 – 900

Ann-Sofie Selin (2003). Pencil Grip: A Descriptive Model and Four Empirical Studies. Åbo Akademi University Press.

 

About the Author

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

 

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

 

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

 

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.

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.

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.

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.

“Can I Hug You?” – Why the pandemic has us craving closeness

By | NESCA Notes 2020

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

At the end of a testing session last week, my young client and I stood looking at each other through the large glass window of our contactless, adjoined testing rooms. Our hands were newly washed; the fresh scent of antibacterial wipes emitted from the tables; and our face coverings were in place. And while looking at one another from our respective bubbles, inside this necessarily sterile setting, my client looked me in the eye and asked: “Can I hug you?”

The question hung in the air for a moment. In the 15 years that I have worked with children, I have rarely hesitated when a child asks me this. But there we were, mid-pandemic, in this brief, perhaps imperceptible, moment of uncertainty.

One thing I have become keenly aware of since starting to see family and friends for socially distanced visits is how much I, and my children, have to consciously fight the physical urge to embrace the people we love. The urge is palpable. But where does this come from?

There is a great body of research demonstrating the importance of physical touch, particularly hugging. Hugs are not just a simply a way of demonstrating your love or support for someone, but hugging actually causes physiological changes within the body. Stress hormones, such as cortisol, reduce, and the nervous system slows down. Oxytocin – a hormone integral to bonding – is released, increasing closeness and affection. Over time, close physical contact results in improved brain development, heart health, emotional health, relationship patterns and immune function.

In many ways, physical touch is a basic human need that must be met. Individuals who are deprived of these experiences, particularly early in life, can experience detrimental effects. Fortunately, some of these effects can be mitigated once opportunities for closeness are offered. As such, our bodies and brains never fully give up on the urge for closeness, even after long durations of it being unmet. And this urge has a name – skin hunger.

Most people have felt skin hunger at some point – a driving urge for human contact and connection. This may come after a particularly stressful day at work, an argument with a friend or just a general feeling of loneliness. In times of uncertainty, distress or instability, the human need for closeness increases. And yet, for so many who are enduring the COVID-19 pandemic, closeness is the exact thing that they are being deprived of. Even when we are lucky enough to still have access to our families, or perhaps a small group of close friends, our emotional needs are high. Physiologically, psychologically, we need more hugs.

The good news is, there are things that you can do to meet this need:

  • Consciously make an effort to hug those you can, and do it more often than typical.
  • Snuggle up with your dog, your cat or other pet of choice.
  • For those who live alone and do not have pets, a weighted blanket, warm bath or hugging a pillow can simulate the effects of human touch.
  • Maintain social connection through video chat, phone calls and socially distanced visits. Interpersonal contact without hugging is better than no contact.
  • Be careful to not accidentally over-associate hugs or touch with danger. Coronavirus will eventually be managed, but training our children to fear closeness could have enduring, negative effects. Choose words wisely, teaching pragmatic, unemotional caution, not fear.

 

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.

Why “Find something to do” Doesn’t Work – Teaching Independent Play Skills during Quarantine

By | NESCA Notes 2020

 

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

Nowadays, children’s schedules tend to be highly regimented. For many, free play has been replaced by extracurricular activities, sports and planned playdates. Recess hours have also been reduced in favor of structured learning activities. The reduction in free play throughout the day can delay or interfere with the development of independent play and time management skills. Unfortunately, with schools and childcare centers now closed, our children may not know how to use all of the extra time they now have.

I have two young children – a preschooler who is generally an expert at independent play, and a first grader who needs a lot of structure, support and attention to fill his time. Unfortunately, with much of our attention turning toward working from home and remote learning, even my formerly-skilled independent player is now overwhelmed with the amount of unstructured time he has, resulting in some new and not-so-fun attention-seeking behaviors.

Sound familiar? I am guessing this is the experience many families are facing. Both parents and children are trying to navigate life without any clear time boundaries (What day is it, anyway??), and this is stressful. When kids are stressed, they look to their caregiver to help them regulate – “attention seeking” behavior is their way of saying “I’m stressed out and don’t know what to do with myself – help!” The question is, how do we help them play independently (buying us time to get things done) while still supporting their emotional needs?

The experience of navigating the stress of unstructured time and teaching independent play is addressed in Kate Rope’s recent New York Times article titled “Now’s a Good Time to Teach Your Kids to Play on Their Own.” In the article, Rope discusses ways to embrace this new opportunity to teach independent play – a skill that encourages time management, executive function and self-regulation skills. Some of the strategies she outlines are similar to those that we have attempted at my house in the past few weeks. Here are some that have worked for us:

  • Get outside: My kids’ capacity to play on their own is markedly better when outdoors. Allow them to dig in the dirt, explore the woods (with supervision), build a fort and roll down the hill. This will not only keep them occupied, but the physical activity and fresh air will make them better-focused once inside.
  • Make an activities menu: Kids often have so many toys that they do not know what to pick. Slightly structure “free choice” by making a single-page picture “menu” of activities, reducing the amount of time they aimlessly roam around looking for something to do.
  • Start in their play: Children often do not know how to get started. After they pick an activity, say “I have 15 minutes to play,” set a timer, and give them your undivided attention. Comment on what they do and encourage their imagination, rather than making up the play for them. When the timer beeps, say you had fun playing but need to go do something. Hopefully, your child will continue their play without you.
  • Show your interest: Saying “find something to do” is way too vague and not particularly helpful (I’m very guilty of this). Instead, give a “challenge” and convey your interest in it. For example, say “Why don’t you go get the blocks and build the tallest tower you can. Come get me when you’re ready for me to see it. I can’t wait!”
  • Set up new ways to use toys: The same old toys can get boring, so mix things up a bit. Find a spare storage bin, bucket or large container. Each day create a new, multisensory “set-up” for some toys. For example, construction trucks can dig in dried beans; baby dolls can take a bath in soapy water; dinosaurs can play in water beads; or kids can build fine motor skills by just cutting up a bin of scrap paper.
  • Be patient and loosen up: Let your kids guide the play, take some risks and make mistakes. The more you guide them, the more they will need you later. Also, messy kids are happy kids. Use messy activities as a way to teach daily living and self-care skills (e.g. how to use the broom to sweep up beans; how to get mud out of your finger nails; etc.).
  • Make remote learning fun: The more fun your child has with you during instruction, the less attention they will seek from you later. Find way to use your child’s interests to aid teaching. For example, we used my son’s love of hockey to reinforce long A spelling skills – hit the puck into one net if the word was spelled with /ai/ and another for those with /ay/. Because he viewed this as special one-on-one time, he was able to continue playing hockey by himself afterward.

Finding the balance between providing support and teaching independence is not an easy one, but these are some ways to start. If you need guidance on how to create structure and manage your child’s needs at home, NESCA has providers available for remote consultations. Email info@nesca-newton.com for more information.

 

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.