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154

Executive Function Tools: Natural Consequences

By | NESCA Notes 2021

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Real-life Skills Program Manager and Coach, NESCA

In my last blog that focused on executive function tools, I delved into the benefits of using and committing to a digital calendar. The calendar is a concrete tool that can be directly taught to students using traditional methods. Less concrete, but in many ways equally useful, is this next executive function tool – the natural consequence.

When most people think of natural consequences, they think of younger children refusing to do things like eat a meal that their caregiver prepared or put on a coat when it is cold outside. If a child refuses their dinner, the natural consequence is hunger. If a child refuses to wear their coat, the natural consequence is feeling cold. These are consequences that will happen without parents or caregivers explicitly providing a consequence. When it comes to executive function mishaps, the natural consequence is often the need to independently deal with the fallout.

Many of the students I serve directly need scaffolded executive function support with direct instruction and specific opportunities for practice. I am not advocating for removing these services or throwing these students to the proverbial wolves. What I am advocating for is using mistakes or lapses in executive function skill as learning opportunities, as opposed to absolving our students from all responsibility and continuously jumping in to save the day. To demonstrate this difference, here are a few examples of ways I have seen parents successfully use natural consequences as a tool to teach executive function.

Case Studies

  1. Amber is a student who has had consistent difficulty organizing her time after school. While she attends many different afterschool activities, such as recycling club and track, she is often late to practice or misses important changes to the schedule. To help Amber, her parents set up a calendar with notifications and reminders that appear on her phone and her computer directly after school. Recently, Amber started driving lessons with the local driving school. A few weeks ago, Amber had a conversation with her mother in the morning about the fact that she would be picked up for a lesson 10 minutes after the end of the school day. Amber’s notification on her phone went off 15 minutes before the lesson, and she received a pop-up on her computer screen 30 minutes before the end of the school day. Despite these reminders, Amber hopped onto the bus at the end of the day. While this was an honest mistake, Amber was not using her tools or the time management strategies that she has been taught and is expected to use. Amber’s parents decided that as a natural consequence, Amber would need to deal with fixing her mistake. They were there to support her as she called the driving school, apologized to the instructor, and rescheduled her appointment. If she was not willing to take these steps, another natural consequence would have been a delay in getting her license. This caused some heightened anxiety for Amber, but with encouragement from her parents, she practiced the phone call out loud and looked through her calendar to see where she had availability for a make-up appointment. Amber’s parents could have easily called the driving school and fixed these problems for her; however, Amber would have missed out on an opportunity to practice problem solving.
  2. Another student who benefited from natural consequences is Albert. Albert’s parents hired a tutor to meet with him over Zoom twice per week to prepare for the SATs. He was expected to meet with his tutor, Barry, two times per week to start building up his skills. Unfortunately, despite frequent reminders and systems being put in place, Albert often missed or was late to these meetings as he was distracted by playing video games. When Albert’s parents started to receive charges for missed appointments from Barry’s company, they thought carefully about how to impress on Albert the importance of using his strategies and making it to his appointments. Eventually, Albert’s parents informed him that if he missed another session, he would be responsible for the late fee, as the charge was an inevitable consequence. When Albert eventually missed another session, his father drove him to the bank and helped him withdraw the money from his own savings account to pay his parents for the missed session. Unsurprisingly, this was hugely frustrating to Albert in the moment; however, his meetings with Barry became a priority and Albert quickly started making it to tutoring on time. After experiencing the natural consequence himself, Albert began to change his actions.

Both of these examples led to increased buy-in from the adolescents who were actively working on building up their executive functioning skills. As they started to participate in problem solving after they made a mistake, they were more aware of the work that their parents had typically been doing for them. Some language that can be productive includes:

  • “I know it was a mistake and now we just need to figure out how to fix it. What do you think we should do?”
  • “What are the next steps you need to take to solve this problem?”
  • “I can tell you what I think we should do, but I would love to hear your ideas first. Where would you start?”

As adolescents forge toward young adulthood, they will inevitably make mistakes, miss appointments, arrive late, and misplace some of their belongings. If we are constantly picking up the pieces, then they are missing out on the opportunity to learn how to solve their own problems and build an understanding of the consequences.

 

About the Author
Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

 

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

 

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

 

151

Executive Function Tools: The Calendar

By | NESCA Notes 2021

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Real-life Skills Program Manager and Coach, NESCA

When working with young adults and adolescents to build up executive function skills, my main goal is to find systems and strategies that are truly helpful, easily accessed and that will eventually be used independently. While there are many fabulous apps that have been developed to target specific organizational skills, such as medication management, creating to-do lists and taking notes, I would argue that the number one, most important tool is an accurate, up-to-date calendar. The format of a digital calendar provides three hugely important supports.

  1. Visual Map of Time – Time management is tricky, and for many of our students, the concept of time itself is quite abstract. A calendar that has chunks of time visually blocked out helps to concretize an abstract concept. Additionally, having a calendar can help students plan their work. If a student has five different assignments to work on in a given week, looking at a calendar to find available segments of time will often help them realize that leaving everything until the last minute will not be possible. Notably, this requires guidance at first. Asking students questions, such as, “how long does an assignment like this generally take you?” or “would that available hour on Tuesday give you enough time for your problem set?” will help them start to internally ask themselves the right questions.
  2. Built-in Notification Systems – Some students use the alarms on their phone as reminders that they need to complete academic or daily living tasks. For example, they may have an alarm at 7:00pm every evening as a prompt to take their medication. Digital calendar apps allow for notifications to be linked to an event or task. Sometimes a simple reminder 10 minutes before a meeting or class is plenty, and our students can arrive on time with that quick prompt. For other appointments, I have students set two separate notifications, one in the morning and one at the time they would need to start getting ready or prepared for an appointment. For example, if a student has a doctor’s appointment two months in the future, a student could benefit from setting a notification eight hours and 1 hour before the appointment. This way, they start their morning with an acute awareness of their responsibility that afternoon and are reminded again when they need to start getting ready to leave.
  3. Constant Access when Synced across Devices – Calendars, such as the Google Calendar, sync seamlessly across digital devices. The same calendar can be accessed from a phone, a tablet, a laptop or a desktop quickly and easily. Students can refer to their phone when they are out and about or their computer if they are focused in class.

Research shows us that building executive function skills requires direct instruction and the opportunity to practice (Semenov & Zelazo, 2019). While using a calendar may seem like a simple skill, many of the systems provided in high schools take away the opportunity for students to practice setting up and maintaining their own calendar. Online portals have calendars that are immediately synced to the teacher’s schedule with assignments and due dates already entered. Additionally, many of our students rely on their parents to keep track of any and all appointments (medical or otherwise), meetings and other scheduled activities. This means that when starting a more independent schedule – whether at a university, vocational program or first job – these students often find themselves overwhelmed by the deadlines and the number of responsibilities that they must track. I urge parents to slowly increase the number of appointment and activities that students are in charge of remembering on their own. Helping a student enter doctor or dentist appointments, vacation details, such as flight or bus times, and deadlines into their personal calendar helps them start to build this habit and provides opportunity for practice. We have the tools to help students make this transition more easily, and with small, intentional changes to expectations of responsibility and independence, we can provide students with tools in their back pockets so they are ready to support (and schedule) themselves!

References

Semenov A, D, Zelazo P, D: Mindful Family Routines and the Cultivation of Executive Function Skills in Childhood. Human Development 2019;63:112-131. doi: 10.1159/000503822

 

About the Author

Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

 

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

 

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

 

150

Digital Literacy, Executive Function and Remote Learning

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L

Occupational Therapist; Real-life Skills Program Manager and Coach, NESCA

The experience of watching a small child who is only two or three years old pick up a smartphone, quickly type in a passcode (as they have memorized the pattern) and open up their favorite game can be jarring for adults who remember the days of dial-up internet and who learned to use technology as it staggeringly evolved. For many of today’s children, handheld electronics have always been a fundamental part of their world. Flipping between apps, using their pointer finger to manipulate games and opening a screen using facial recognition all feel like second nature to many in the current generation of school age children. We assume that children have higher digital literacy than we do and intrinsically understand technology in a way that many of us never will. But what do our children actually know? And, are they missing out on vastly important direct instruction when adults make an assumption that they are already tiny experts in the digital field?

Over the past six months, a time fraught with a monumental shift in education, I have worked one-on-one with a widely diverse group of learners. If I had to pinpoint one theme that comes up over and over, across ages, levels of ability and school systems, it is frustration, confusion and lack of problem-solving strategies as they relate to technology. Statements I have heard during this period of remote learning include:

  • “I don’t turn off my Chromebook. I lose everything, and I’m actually not quite sure that I know how to turn it back on.” – High school honors student
  • “I didn’t know that Google Slide and PowerPoint were different things. I lost so much trying to switch between them.” – High school senior
  • “Hardware or software? I didn’t realize there was a difference.” – Middle school student
  • “I just save my document with whatever my computer suggests as a title. I guess it does make it tricky to find things later.” – High school junior

As an occupational therapist focused on making sure our students can access their curriculum, comments like these teach me a few incredibly important lessons.

  1. Students are lacking information on the basics. The same student who is not sure how to turn off his Chromebook can quickly navigate Google Classroom without any support, both uploading files and opening modules with ease. We need to focus on teaching the fundamentals of technology. What are hardware and software and how to they interact? What options exist within the system preferences of a particular device? How is an iPad different from a Chromebook, a Windows laptop or a MacBook? Why do we need to power down devices sometimes? What are the downsides to never restarting a computer or updating an operating system?
  2. Successful digital organization does not come naturally. Students are typically taught specific systems for organizing physical space and materials, such as color-coded folders, binders and labels. Teaching students to organize their digital space and their digital materials is equally, if not even more, important. Learning to create folders for each class and systematic ways of labeling documents saves students time and energy, and this often decreases frustration in the moment.
  3. Academic and professional tools are not particularly intuitive (a stark contrast to entertainment tools). There are incredible programs designed to help students create presentations, synthesize data and put documents together. These include, but are not limited to, the Microsoft Suite and Google Workspace. These tools can be tricky to manipulate and many middle and high school students would benefit from taking an introductory course, watching online tutorials or working directly with teachers to explore their functionality before layering on assignments requiring competent use of the tools.
  4. Students are often completely unaware of their gaps in knowledge. This is potentially due to the fact that today’s students are so impressive when it comes to using technology for leisure purposes. They seamlessly transition from an iPad, to a Chromebook, to a Samsung phone and can access games or social media without difficulty on each device. Unfortunately, very few schools have programs focused on teaching computing skills or digital literacy in the academic context. Our students piece together enough information to get by for a short while, but often come up against challenges later. Students also may believe they have built competency because they have some exposure to a tool. For instance, I have worked with students who are building resumes and including claims such as, “Proficient in Excel, PowerPoint and Word” but score poorly when tested on these computer abilities.

So, what do can we do?

The first step towards ensuring that a child or adolescent has adequate digital literacy skills is to actually assess how much they already know. Some students do have these skills mastered and others will have unexpected deficits or gaps. This assessment can be done formally or informally. A starting point I often use is to sit down with a student at a computer and ask how they organize, how they navigate, how they save files, etc. I also like using online assessment resources, such as TypingClub.com and Northstar Digital Literacy.

Once the skills that a student needs to grow are identified, there are many opportunities available to teach them. A few options include:

  • Online courses in specific software programs. Sites, such as Coursera, LinkedIn and Udemy, have comprehensive courses focused on specific programs for all different levels of learners.
  • Free online videos. A quick search on YouTube often leads to short, accurate videos and tutorials filmed by teachers or professionals. If your student learns well through video format, these can be a great tool.
  • Ask your school for support. Often, students learn better with direct instruction. If a student’s team is aware of their lack of knowledge regarding technology, there are many professionals at school who may be able to teach these skills during a free period, study hall or meeting.

 

About the Author

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Dr. Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

 

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

 

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

 

2

Simple Executive Functioning Strategies When The World Is Anything But Simple

By | NESCA Notes 2020

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

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

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

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

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

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

 

Resources:

Positive impact of exercise:

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

Executive Functioning tips and sample schedules:

https://www.smartbutscatteredkids.com/

 

About the Author: 

Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.

 

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

 

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

149

YES! COVID-19 May be Making Basic Daily Tasks More Difficult: The Link Between Executive Function Difficulties and Anxiety/Stress

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L

Occupational Therapist; Real-life Skills Program Manager and Coach

As our country continues to adapt to life in the era of COVID-19, it is quite well established that there has been a rise in anxiety and stress among our population. According to the Centers for Disease Control and Prevention (CDC), the mental health effects of the current pandemic have been substantial and include difficulty sleeping, worsening chronic health problems, changes in eating patterns, fear about personal health and the health of loved ones, and increased use of tobacco and alcohol (CDC, 2020). Many of these fears and new challenges are expected and understandable. They are responses that intuitively make sense to us as humans, as many of us experience them on a small scale throughout a typical year. Most people can name a time when they could not fall asleep before a big test or did not take excellent care of their physical health when they were hugely stressed or anxious. However, one effect of this newly heightened stress and anxiety that is less frequently mentioned is the decrease in executive function skills.

The term executive function refers to the brain processes that allow someone to stay organized, initiate tasks, maintain focus and attention, and manipulative information in their mind. As NESCA Pediatric Neuropsychologist Dr. Alissa Talamo describes in her piece, “What is Executive Function?,” this group of skills can be thought of as the conductor of the brain, similar to the conductor of an orchestra. They are keeping time, telling us when to start and stop tasks and helping us to stay regulated through the ups and downs of the day. You may have noticed that through stay at home orders and social distancing regulations, organizing daily tasks has become increasingly difficult. You may find yourself missing calls or meeting times, forgetting to respond to emails or misplacing items that are usually easy to track. You are not alone. Some people have started to describe a brain fog and a perceived inability to stay focused on a task for more than a short period of time.

While maybe not as intuitive as a lack of sleep, this decrease in executive function is to be expected as we collectively move through this stressful experience. Substantial research has described the correlation between depression, anxiety and stress, and executive function deficits. This seems to be particularly strong for adolescents with depressive and anxious symptoms, who have trouble with cognitive flexibility (Han, Helm, Iucha, Zahn-Waxler & Hastings, 2016). Similarly, university students are another population vulnerable to these effects, as described by Ajilchi and Nejati in 2017, who found specific difficulties with sustained attention and decision making. It is no surprise that one diagnostic criteria for generalized anxiety disorder is “difficulty concentrating or mind going blank” (APA, 2013). When reviewing the literature, it is clear that the brain fog and inability to focus through COVID-19 is not only unsurprising, for many people, it was inevitable.

So, what do we do? How do we soldier on through this incredibly unique time, despite the feeling that everything takes just a bit more time and effort?

It is increasingly important to cut ourselves some slack and stop expecting perfection. Focusing on self-care and taking care of each other emotionally will potentially lead to a natural return to successful executive function. By creating habits and routines that promote positive mental health, we are more likely to mitigate the feelings of being overwhelmed and the potential for burnout. Additionally, using technology and digital reminders to help take over the tasks of initiation and organization can give our over-extended brains a bit of a rest.

Finally, it is imperative that we think about the adolescents and students in our communities who are just starting to build these skills. Building executive function skills comes from a combination of direct instruction and opportunity to practice. Currently, students are being provided ample opportunity to practice, with limited direct instruction and guidance. Consider teaching your children and adolescents the tricks that you have learned to stay organized, prepared and productive. If you feel like teaching these skills is outside of your wheelhouse, or at all daunting, look into the prospect of an executive function coach. With all of the uncertainty about what education will look like this fall, helping students feel ready to tackle learning is one way to mitigate the anxiety and stress of this transitional time.

 

References

Ajilchi, B., & Nejati, V. (2017). Executive Functions in Students with Depression, Anxiety, and Stress Symptoms. Basic and clinical neuroscience, 8(3), 223–232. https://doi.org/10.18869/nirp.bcn.8.3.223

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Center for Disease Control and Prevention. (2020) Coronavirus disease 2019: Coping with stress. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html

Han, G., Helm, J., Iucha, C., Zahn-Waxler, C., Hastings, P. D., & Klimes-Dougan, B. (2016). Are Executive Functioning Deficits Concurrently and Predictively Associated with Depressive and Anxiety Symptoms in Adolescents?. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 45(1), 44–58. https://doi.org/10.1080/15374416.2015.1041592

 

 

About the Author

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Dr. Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

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

 

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

 

4

Mindfulness: It’s Not Just for Grown-ups

By | NESCA Notes 2019

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow

There has been increasing interest in intervention strategies that target self-regulation in childhood. Self-regulation is the process through which the systems of emotion, attention and behavior are controlled in response to a situation, stimulus or demand. It develops rapidly in the early years of life. Self-regulation is necessary for social development because it supports and enhances peer acceptance and social success. Furthermore, it increases academic performance, particularly in elementary school. Problems with self-regulation and the accompanying executive functioning have been shown to correlate with a number of behavioral and emotional problems, particularly depression and anxiety. Mindfulness is emerging as an effective intervention for children struggling with self-regulation, especially when implemented at a time when children are acquiring these foundational skills.

Mindfulness is a way of paying attention, on purpose and non-judgmentally, to the experience of the present moment. Being mindful involves reflecting on the current internal experiences such as thoughts or emotions and the current external environment, such as sights and sounds, both clearly and objectively. This act of purposeful reflection enhances and facilitates self-regulation by promoting control, such as sustained attention and cognitive flexibility. Furthermore, it helps to reduce the incidences of such things as snap judgments, emotional reactivity or distressing thoughts.

Mindfulness-based social-emotional training has been shown to be effective in reducing stress, improving coping skills and building resilience when used with children. Mindfulness teaches children the skills needed to improve focus, calm themselves, plan and organize, and behave in a thoughtful manner. Research on adult populations shows that practicing mindfulness may reduce symptoms of anxiety and depression, and limited number of studies show some of the same benefits in children. Mindfulness is well tolerated by children and has been proven to improve psychological well-being. Introducing mindfulness practices to children has the potential to make a positive impact on a child’s ability to self-regulate, and thus facilitate their social, emotional and educational growth.

There are a number of ways to introduce children to mindfulness. One activity that children have responded positively to is being challenged to sit still and silent for as long as they possibly can. I have used this strategy in classrooms of children from pre-k to high school, as well as individually with children of all ages. Sometimes they are able to sit for 15 seconds, but they embraced the challenge of trying to beat their record by trying it again. Another mindful technique that works well with children is called “grounding.” Grounding techniques use the five senses to bring ourselves into the present moment. One grounding technique is finding five things in the room – they can be 5 things of the same color or any five things; four things the child can feel; three things the child can hear; two things the child can smell; and one thing the child can taste. Mindfulness can be playful and fun for children and families while effectively reducing stress, improving coping skills, improving ability to self-regulate and building resilience in children.

 

Helpful resources for families:

Mindful Games Activity Cards: 55 Fun Ways to Share Mindfulness with Kids and Teens. Susan Kaiser Greenland and Annaka Harris

A Still Quiet Place: A Mindfulness Program for Teaching Children and Adolescents to Ease Stress and Difficult Emotions By Amy Salzman, MD

I am Peace: A Book of Mindfulness By Susan Verde and Peter H. Reynolds

Breathe Like a Bear: 30 Mindful Moments for Kids to Feel Calm and Focused Anytime, Anywhere By Kira Willey

 

References:

Britton, W. B., Lepp, N. E., Niles, H. F., Rocha, T., Fisher, N. E., & Gold, J. S. (2014). A randomized controlled pilot trial of classroom-based mindfulness meditation compared to an active control condition in sixth-grade children. Journal of School Psychology, 52(3), 263-278.

Masten, A. S., Best, K. M., & Garmezy, N. (1990). Resilience and development: Contributions from the study of children who overcome adversity. Development and psychopathology, 2(4), 425-444.

Schonert-Reichl, K. A., Oberle, E., Lawlor, M. S., Abbott, D., Thomson, K., Oberlander, T. F., & Diamond, A. (2015). Enhancing cognitive and social–emotional development through a simple-to-administer mindfulness-based school program for elementary school children: A randomized controlled trial. Developmental psychology, 51(1), 52.

Schonert-Reichl, K. A., & Lawlor, M. S. (2010). The effects of a mindfulness-based education program on pre-and early adolescents’ well-being and social and emotional competence. Mindfulness, 1(3), 137-151.

Sibinga, E. M., Webb, L., Ghazarian, S. R., & Ellen, J. M. (2016). School-based mindfulness instruction: an RCT. Pediatrics, 137(1), e20152532.

 

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations. Currently, Dr. Hess is a second-year post-doctoral fellow in pediatric neuropsychological assessment, working with NESCA Londonderry’s Dr. Angela Currie and Dr. Jessica Geragosian.

 

To schedule an appointment with one of NESCA’s expert neuropsychologists, please complete our online intake form. 

 

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

 

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