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Tag

medication

10

Supporting Teens: Helping Them Engage in Treatment

By | NESCA Notes 2024

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

I was fortunate to join my colleague, Kelley Challen, Ed.M., CAS, in a recent presentation about fostering self-advocacy and self-determination for young adults. The focus of our conversation was around encouraging teens to participate in the special education process as active members of their IEP team. It got me thinking: what are other ways that teens should be included in decision making? How do we ensure that teens are included in vital treatment decisions? And what do we do about those teens who are reluctant to engage?

There is a robust body of empirical evidence to suggest that the combination of medications and therapy is most effective at reducing symptom severity for emotional health disorders including anxiety and mood disorders. While adults on a treatment team may be well aware of this evidence, teens may look elsewhere to gather information – turning to the less than reliable sources of anecdotal conversations and social media. If we want teens to participate in the treatment planning process armed with greater information, there are a few steps we can follow to support their treatment engagement.

First, when the question relates to medications, I always encourage teens to have very open discussions with their parents and providers about the risks and side effects of medications. It’s incredibly helpful to open conversations by asking teens what they already know or what they have already heard or read about different types of medications. This helps to eliminate any confusion or misperceptions, either about negative side effects or about their unrealistic expectations that things will be “magically cured” in a very short period of time. It is important for teens to understand how long medications may work in their system, how long they need to take the medication to reach the therapeutic dosing, and the risks of not taking it or experimenting with other substances which may interfere with the mechanisms of action. For anxious kids who may not feel comfortable speaking up within an appointment, I encourage families to make a list of their teen’s questions and a plan for who will read the list of questions in the appointment. There are valuable supports that can help with the executive functioning demands needed to remember medications (e.g., daily pill boxes, setting alarms, or reminders on their phone, etc.).

When it comes to therapy, it is relatively common for me to hear a parent state that a child is reluctant or unwilling to attend therapy. There may be many very valid reasons why a teen may feel this way, and it is a sign that they are engaging in the developmental task of individuation when they push back on this recommendation. We don’t need to fear this struggle, and we can use it as an opportunity to invite a conversation. For teens who struggle to explain why they are reluctant about treatment, I might share a few common explanations to see if they resonate with the teen: “Some teens think it’s boring, or it’s too hard, or it’s a waste of time. Some worry their parents will know each thing they say, or feel like they are not in control of the treatment goals.” It may also be as simple as finding virtual sessions to be frustrating and impersonal, or finding the commute to an office for an in-person session to be time consuming. Many of these logistic concerns can be addressed with scheduling. It is also important for teens to know that therapy is not “one size fits all.” There are different forms of therapeutic treatment, and it is important to find a provider with experience delivering evidence-based treatments for the specific diagnosis that your teen carries.

One of the most important factors in treatment adherence is a trusting therapeutic relationship. Those relationships take time to build. If a teen is not feeling well connected to their therapeutic provider, I encourage them to have a discussion either directly with their provider about this or to explore other treatment providers. The same way someone may not wish to be friends with every person they meet, there are certain connections that just “feel right.” Skilled providers also use techniques, such as Motivational Interviewing, to encourage teens to develop their own goals for treatment. This can help to diffuse the argument that a teen is only engaging in a treatment to appease their parent or caregiver. These powerful tactics include important elements of empathy, highlighting discrepancies in thinking (or in conflicting actions and behaviors), accepting (and even expecting) resistance, and promoting self-efficacy.

In helping teens to find their own voice in the treatment process, a power struggle or a demand for engagement from a parent is unlikely to get us very far. Bringing in the support of other trusted people in a teen’s life (e.g., teacher, school counselor, coach, uncle or aunt, older cousin) may also be a useful way to open the discussion about why therapy feels stressful. While teens may wish for things to get better on their own, ignored or avoided struggles do not just go away magically. Treatment can be hard as it does involve facing anxiety-provoking material. However, teens will be facing this content with a trusted adult and armed with new tools to master these triggers. It is important to acknowledge that therapy can be hard work, and they will not be doing it alone. Engaging in special self-care routines after a therapy session, particularly if parents can acknowledge and create space for these, can be a powerful way to encourage commitment to treatment. When teens feel more control in engaging with their treatment, they are far more likely to persist.

For more information on enhancing motivation for treatment engagement, consider the following resources:

 

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. 

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

5

Mindfulness-based Interventions for Children with ADHD

By | NESCA Notes 2024

By: Lauren Halladay, Ph.D.
Pediatric Neuropsychologist, NESCA

Children with Attention Deficit-Hyperactivity Disorder (ADHD) often struggle to sustain attention, follow directions, and appropriately interact with peers when compared to children with typical development. Executive functioning challenges, including difficulties with self-regulation, are also common in individuals with ADHD. Executive functioning refers to the neuropsychological-based functions involved in the regulation of behavioral states and the organization of goal-directed behavior. This can present as difficulty breaking down goals into steps, planning, monitoring the effectiveness of an approach to a task, modulating one’s emotions, etc.

Currently, evidence-based treatment methods for managing ADHD symptomology include medication, behavioral interventions, or the combination of the two. In addition, one domain that has received increased attention from the scientific community over the past several years is the integration of mindfulness-based interventions (MBI) within treatment (Felver & Jennings, 2016).

Mindfulness is the ability to bring one’s attention to experiences occurring in the present moment, which can allow an individual to consider alternative ways to perceive and react to a situation (Singh et al., 2007). Many MBI curriculums include lessons on focusing one’s attention on the present moment, which can improve individuals’ self-regulation, executive functioning, concentration, and emotional-reactivity, while reducing aggressive behavior, social problems, and anxiety (Keng et al., 2011; Parker et al., 2014).

One such curriculum, originally developed for adults with Intellectual Disabilities and aggressive behaviors, is Soles of the Feet (SoF) (Singh et al., 2003). The purpose of this exercise is to shift the individual’s attention from a typically triggering situation to a neutral stimulus. The SoF intervention involves teaching an individual to recognize situations that trigger an emotional response in real life or through role-play scenarios. Next, the individual is guided through steps in the curriculum that consist of finding a neutral body posture, breathing naturally while thinking about the triggering event, and shifting attention to the soles of the feet. Then the individual is guided to be mindful of their feet on the ground. The goal is for the individual to end this process having appropriately responded to the situation without engaging in behavior that was contrary to expectations. Research suggests that engaging in this intervention significantly improved participants’ ability to regulate their aggressive and disruptive behaviors, and appropriately engage with others (Felver et al., 2013; Singh et al., 2007).

There are several mindfulness-based activities, such as progressive muscle relaxation and focusing on your five senses, that can be modified to support children’s attentional and emotional regulation. For some ideas, please consider visiting the American Psychological Association (APA)’s Magination Press website, where they offer several children’s book titles related to a variety of topics, including mindfulness.

References

Felver, J. C., Doerner, E., Jones, J., Kaye, N., & Merrell, K. M. (2013). Mindfulness in school psychology: Applications for intervention and research. Psychology in the Schools, 50, 531–547

Felver, J. C., Celis-DeHoyos, C., Tezanos, K., & Singh, N. N. (2016) A systematic review of mindfulness-based interventions for youth in school settings. Mindfulness. doi:10.1007/s12671-015-0389-4

Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: a review of empirical studies. Clinical Psychology Review, 31(6), 1041-56.

Parker, A. E., Kupersmidt, J. B., Mathis, E. T., Scull, T. M., & Sims, C. (2014). The impact of Mindfulness education on elementary school students: evaluation of the Master Mind program. Advances in School Mental Health Promotion, 7(3), 184-204. doi:10.1080/1754730x.2014.916497

Singh, N. N., Wahler, R. G., Winton, Adkins, A. D., Myers, R. E., & The Mindfulness Research Group. (2003). Soles of the feet: A mindfulness based self-control intervention for aggression by an individual with mild mental retardation and mental illness. Research in Developmental Disabilities, 24, 158–169.

Singh, N. N., Lancioni, G. E., Winton, A. S. W., Singh, J., Curtis, W. J., Wahler, R. G., & McAleavey, K. M. (2007). Mindful parenting decreases aggression and increases social behavior in children with developmental disabilities. Behavior Modification, 31(6), 749-771. doi:10.1177/0145445507300924

 

About Lauren Halladay, Ph.D.

Dr. Halladay conducts comprehensive evaluations of toddlers, preschoolers, and school-aged children with a wide range of developmental, behavioral, and emotional concerns. She particularly enjoys working with individuals with Autism Spectrum Disorder, Intellectual and Developmental Disabilities, and complex medical conditions. She has experience working in schools, as well as outpatient and inpatient hospital settings. She is passionate about optimizing outcomes for children with neurodevelopmental disabilities by providing evidence-based, family-oriented care.

 

If you are interested in booking an appointment for an evaluation with a Dr. Halladay or another NESCA neuropsychologist/clinician, please fill out and submit our online intake form. 

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

4

The Importance of SMEDMERTS

By | NESCA Notes 2022

By: Ann Helmus, Ph.D.
NESCA Founder/Director; Clinical Neuropsychologist

While supporting a friend who was recently diagnosed with bipolar disorder, I have come to appreciate how challenging it is for people with this disorder to maintain a stable mood state. One of the most helpful resources I discovered in my search for information to help me support my friend was a TEDx talk by Ellen Forney, an author who has successfully managed her bipolar disorder for two decades by following SMEDMERTS, an acronym for: Sleep, Medication, Eat Well, Doctor/therapy, Mindfulness/Meditation, Exercise, Routine, Tools (coping), and Support System. I was struck that only 25% of the solution for managing her mental illness involves the mental health system: medication and doctor. The bulk of her treatment system relates to lifestyle choices.

While attention to SMEDMERTS is important for all of us, especially in these stressful times, consistent focus on these lifestyle choices is particularly critical for the many children and adolescents who we see at NESCA presenting with anxiety, mood disorders, ADHD, and behavioral issues. Most of us struggle to achieve our daily goals for sleep, diet, meditation, exercise, sticking to a routine, practicing adaptive coping strategies, and nurturing our support system, even though we know how much better we feel and how much better our children function when we are focused on SMEDMERTS in our daily life. While the impact of medications and doctors on functioning is largely outside of our control, we can control our lifestyle choices, which are critical to the success of managing any mental health issue.

How can we help the children in our lives to embrace SMEDMERTS?

  • Modeling it for them. As Robert Fulgham said, “Don’t worry that your children never listen to you; worry that they are always watching you.”
  • Praising their efforts. Offer positive feedback, such as, “Great idea to get up early to go for a run,” or, “I like how you called a friend when you were upset to get some advice.”
  • Enlisting the help of a coach. NESCA offers real-life skills coaching, executive functioning coaching, and health coaching to help children, adolescents, and young adults build and maintain habits to support positive lifestyle choices.

Health coaching is available to parents of NESCA clients who are seeking support in developing positive health habits, such as exercise, diet, stress management, and meditation.

If you are interested in coaching services at NESCA to support your quest for SMEDMERTS, please contact Crystal Jean: cjean@nesca-newton.com or fill out our intake form at www.nesca-newton.com.

 

About the Author
NESCA Founder/Director Ann Helmus, Ph.D. is a licensed clinical neuropsychologist who has been practicing for almost 20 years. In 1996, she jointly founded the  Children’s Evaluation Center (CEC) in Newton, Massachusetts, serving as co-director there for almost ten years. During that time, CEC emerged as a leading regional center for the diagnosis and remediation of both learning disabilities and Autism Spectrum Disorders.

In September of 2007, Dr. Helmus established NESCA (Neuropsychology & Education Services for Children & Adolescents), a client and family-centered group of seasoned neuropsychologists and allied staff, many of whom she trained, striving to create and refine innovative clinical protocols and dedicated to setting new standards of care in the field.

Dr. Helmus specializes in the evaluation of children with learning disabilities, attention and executive function deficits and primary neurological disorders. In addition to assessing children, she also provides consultation and training to both public and private school systems. She frequently makes presentations to groups of parents, particularly on the topics of non-verbal learning disability and executive functioning.

To book an evaluation with one of NESCA’s many expert neuropsychologists, complete NESCA’s online intake form. 

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

157

Executive Function Tasks – Medication Management

By | NESCA Notes 2021

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

Medication management is an extremely complex executive function task that many of our students will have to master before they are able to tackle living alone. While there are many executive function tools available to help organize and remind individuals about their medication, there are also some long-term teaching strategies and opportunities for habit building throughout a students’ middle and high school career that parents may want to capitalize on before their children leave the home. Today we will explore some of the commonly used tools to help with medication adherence and touch on a few tips and suggestions to help adolescents develop a base of knowledge around their own health status and need for medication.

Tools

Seven Day Pillbox – The most ubiquitous tool to help individuals keep track of medication is a weekly pillbox. This may seem like a simple tool, but pillboxes are hugely varied and have many different additional features. Make sure to consider how many boxes there are per day (morning, afternoon, evening, etc.), whether there is a need for different colors to help with visual discrimination, and whether an audible or vibrating alarm could be beneficial. All of these are potential options that are built into the different pillbox options provided below:

Automatic Pill Dispenser – Some individuals may benefit from having the added support of a pill dispenser that automatically dispenses the correct prescriptions at the time they should be taken. Here is one example of this tool:

The Calendar – Those who have read my previous blog regarding the wonders of a functional digital calendar are likely unsurprised by this suggestion, but make use of this fabulous tool! Adding in an appointment to refill pillboxes, marking down anticipated dates to refill prescriptions, and setting notifications or alarms to go off when it is time to take medication each day can help students remember each step of the process.

Tips

Involve children in filling their pillboxes as early as possible. Many children will enjoy sitting down with a parent to place the pills in each little box and feel special when they are given some responsibility. When this is normalized as a typical part of a week, it becomes an expected activity of daily living for children. Make sure to point out the things that you notice as you fill the box. For example, stating, “Oh! I only count five pills left, that means I need to call and refill the prescription today,” each month will help your child to associate a nearly empty bottle with the need to problem solve.

Set a specific time or day of the week to refill pillboxes. Many children will continue to stick to routines and habits that they built up through childhood once they venture out of the home. Consider designating a specific time of the week to fill a pillbox together. For example, if Sunday after dinner works consistently, make this part of the family routine.

Pair medication with a daily task. Some individuals enjoy using alarms as reminders; however, others feel much more empowered by simply building medication into their routine. Pairing medication with an activity that happens daily anyways, such as brushing teeth in the morning, makes it easier to remember without direct prompting.

Help your child or adolescent put together a medication chart. Many of our children do not know the reasons for their medication. They are unaware of the intent, potential side effects, exact dosage, or name of the medication itself. The more our children and adolescents understand, the better they are able to advocate for themselves to doctors or other health professionals. Putting together a one-page medication chart that outlines all of this important information – in terms that can be easily understood and communicated to others by the child – can help children feel empowered in their conversation about their health. Consider adding a picture of each pill or capsule if they routinely appear the same. At times, pharmacies may unexpectedly need to fill generic prescriptions from different manufacturers, based on availability or other factors, therefore lending to a different appearance of the same generic prescription. This medication chart can also be a helpful tool to reference when adolescents start to independently fill their pillboxes.

Refill prescriptions together. While refilling prescriptions at the pharmacy is often a task that needs to be led and managed by adults, it’s still possible to include adolescents so that they start to learn the process. A great first step is to call the pharmacy on speaker phone and allow your child to listen in for a few months in a row.

 

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.

 

18

Life Skills for College to Work on Now – Part 2

By | NESCA Notes 2020

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

In Massachusetts, we are more than five weeks into home-based learning and looking toward another two months (or more) of schools and childcare facilities being closed. Unfortunately, this is taking a particularly large social and emotional toll on our teenagers and young adults. One strategy for coping with current conditions is to focus on concrete ways that we can control our daily lives and to set short-term tangible goals. With that in mind, I am writing a second blog focusing on the opportunity teenagers are being given to build daily living and executive functioning skills that will ultimately help them live away from home and self-direct their lives. Last week, I discussed four important skills that are critical for attending residential colleges: getting up on time each morning, doing laundry, having basic kitchen skills, and using basic tools for assembling and fixing things around home. This week, I am offering another four skills. For any young person, I always suggest letting the student pick the skill(s) they want to work on first. When you have a lot to work on, you may as well pick the starting point that feels most important and motivating!

  • Medications: For students who have been on medication during high school, keeping that medication regimen stable is typically a must during the transition to college. Students need to have the knowledge, preparation and organizational skills needed to maintain their own medication regimen. Often a good way to start this process is to purchase a 7-day pill organizer and have teens be responsible for dispensing their own medication for the week. Certainly, a smartphone or smartwatch with several alarms can be useful for remembering medications at needed times. For more information about medication management expectations in college, check out this article by Rae Jacobson. He makes some useful recommendations, such as using a unique alarm tone for medication reminders and putting pills in highly or frequently visible locations (e.g., next to your toothbrush that you routinely use).
  • Money: Students in early stages of high school may be too young for their own bank accounts and credit cards. However, some banks do offer accounts that are specially tailored for minors. Students can open a joint bank account as a minor with a parent or legal guardian. Teens can also practice managing plastic through use of traditional prepaid debit cards, Amazon.com or store gift cards, or a debit card made especially for minors like Greenlight. From home, teens can practice making necessary online purchases, tracking payments and shipping, checking account balances, and using a software like Microsoft Excel or Google Sheets to keep a record of purchases. There are also plenty of great free web-based financial literacy resources that teens can use to learn about banking and consumer skills from home; a few resources that my colleague Becki Lauzon, M.A., CRC, and I like include:
  • Building an Exercise Routine: Believe it or not, basic fundamentals like healthy eating, sleep hygiene and regular vigorous exercise are strong predictors of college success and satisfaction. As we are living in a period of time where team sports are not accessible, this may be exactly the right time for teenagers to build their own individual exercise routine that can be carried out at home and in one’s local neighborhood. A good baseline to strive for is a routine that includes exercise sessions at least three days per week. With decreased time factors in our lives, students can play around with morning, afternoon or evening exercise to see what feels best for their bodies and brains. If brisk dog-walking, jogging/running or biking activities are not appealing, there are plenty of great YouTube exercise videos (e.g., dance, yoga, strength training, cardio training, etc.) that require no equipment and are calibrated for all kinds of bodies and levels of fitness. Setting a schedule for weekly workouts will help to ensure that exercise becomes more routine and tracking progress with that schedule (e.g., journaling, marking a calendar, using an app like Strava or Aaptiv, etc.) helps to build and sustain motivation. Some teens (and adults) also find that they are more able to stick to an exercise routine if they use a smartwatch to help track, celebrate and prompt their progress.
  • Using a Calendar System for Scheduling: The alarm clock mentioned in last week’s blog is certainly an important time management tool that is vital to master prior to attending college. Another critical time management tool for college (and life beyond) is a calendar system for managing one’s schedule. When starting to build time management skills, simply asking your teen to write down their schedule can be a good place to start. What do they know they have to do each day of the week? What appointments or activities are missing? Teens may have a calendar system that they are already accustomed to using for checking the date, but may not be using that tool to manage their entire schedule. Some common calendar app tools include iCal, Google Calendar and Outlook, but some teens may do better with paper-based systems. If a teen benefits from a paper copy of their schedule, I would still recommend that they learn to use something electronic, then just print off their daily, weekly or monthly schedule based on preference and need. Practice inputting activities that are happening right now, such as assignments, remote classes, meals, therapy, etc. Teens can also play around with reminder settings to see what feels best for prompting participation in activities. Sometimes 15 minutes is too much time, but 5 or 10 is just right. Other times, more than one reminder is needed.

To read more about the Life Skills recommendations from last week’s Transition Thursday blog, click here!

 

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

 

About the Author:

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

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

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