Tag

MENTAL HEALTH

Rating Scales/Questionnaires – Why Do We Give Them and Why Do They Matter?

By | NESCA Notes 2021

By Yvonne M. Asher, Ph.D. 
Pediatric Neuropsychologist

When you request a neuropsychological evaluation, you are undoubtably inundated with paperwork. Consent forms, confidentiality forms, COVID forms, and credit card forms. Then, to your surprise, you bring your child to their first appointment, and the neuropsychologist hands you…more forms! Why? What are these forms for, and what will you do with the information? These are great questions, and always feel free to ask your neuropsychologist. Here are some answers I give when I am asked:

Why do you need so many forms?

Our goal in completing a neuropsychological evaluation is to have as comprehensive picture of a child as possible. This means gathering information from many sources, including what you and/or others are noticing that is raising concerns (what we discuss in the intake appointment), prior evaluations and documentation (e.g., their IEP, testing done at school), your child’s performance on our assessment measures (what they do when they come to the office), and important people’s perceptions of your child’s functioning in daily settings – this is what we assess through the rating scales (also called questionnaires). The parent/teacher rating scales are an important source of information because they not only capture your concerns, but also show us how your concerns may be similar to or different from parents (or teachers) of same-age children. For example, concerns with “attention and focus” are common for us to hear. Attentional skills develop gradually over time, and having a standardized rating scale that evaluates your concerns (or your child’s teacher’s concerns) with attention helps us understand how far off your child’s skills are from what is expected for their age.

What do the forms ask about?

This depends on why your child is being referred for a neuropsychological evaluation. For example, if your child is referred for a question around autism, you will likely be given forms that ask about their social functioning, such as how they do at playdates, birthday parties, the playground, or other community spaces with peers. Your child’s teacher would also likely be given forms to evaluate how your child interacts with peers at school, such as how they do during lunch, snack, and recess; how well they work in groups; and if they have been successful in forming strong friendships. If the concerns are more related to mental health, you may be given forms that ask about their symptoms of anxiety, depression, etc.

What will you do with the forms?

We will take your ratings (or your child’s teacher’s ratings) and compare them to normative data. This is a fancy way of saying “we will see how your child compares to kids their age.” Then, we will take that information to help us form a more comprehensive picture of your child’s profile and our recommendations for how to best help and support them. For example, something I see often is a concern with kids following directions, remembering what they are told to do, and finishing all the steps necessary for a task or project (e.g., getting ready for school or bed). This can be (though certainly isn’t always) a difficulty with working memory or, holding information in mind. We assess working memory in many ways during testing. However, we can’t always see the deficits that parents and teachers see, because testing is inherently different from “real life.” So, rating scales serve as an important source of information in understanding what is going on day-to-day, which helps us to make more comprehensive recommendations.

How do I fill these out?

Please, please, please – read the directions carefully! Each form is meant to evaluate something different. For example, some ask you about your child’s emotional state “in general,” others ask about how they have been behaving over the last two weeks, and others ask about how well they can complete tasks independently (i.e., without any help or guidance). Do your best to complete each question – skipping questions that seem “irrelevant” or “inappropriate” may impact how well we can use the information later on. We realize that not every question will apply to every child – we are using the best tools we have, and some are designed to assess a wide range of children. If you have questions about the wording or phrasing, please ask your neuropsychologist – we really don’t mind!

I have a teenager. Why don’t you just ask them about how they are feeling?

If your child is old enough, we will absolutely talk to them about their perceptions of what is going on, what their concerns are, and what has been helpful for them. Many rating scales have a “child” or “self-report” version, and we may have them complete those, in addition to talking more conversationally about how they are doing.

 

About the Author

Dr. Yvonne M. Asher enjoys working with a wide range of children and teens, including those with autism spectrum disorder, developmental delays, learning disabilities, attention difficulties and executive functioning challenges. She often works with children whose complex profiles are not easily captured by a single label or diagnosis. She particularly enjoys working with young children and helping parents through their “first touch” with mental health care or developmental concerns.

Dr. Asher’s approach to assessment is gentle and supportive, and recognizes the importance of building rapport and trust. When working with young children, Dr. Asher incorporates play and “games” that allow children to complete standardized assessments in a fun and engaging environment.

Dr. Asher has extensive experience working in public, charter and religious schools, both as a classroom teacher and psychologist. She holds a master’s degree in education and continues to love working with educators. As a psychologist working in public schools, she gained invaluable experience with the IEP process from start to finish. She incorporates both her educational and psychological training when formulating recommendations to school teams.

Dr. Asher attended Swarthmore College and the Jewish Theological Seminary. She completed her doctoral degree at Suffolk University, where her dissertation looked at the impact of starting middle school on children’s social and emotional wellbeing. After graduating, she completed an intensive fellowship at the MGH Lurie Center for Autism, where she worked with a wide range of children, adolescents and young adults with autism and related disorders.

 

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.

 

To book an appointment with Dr. Yvonne Asher, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

Cyberbullying and Autism Spectrum Disorders

By | NESCA Notes 2021

By Yvonne M. Asher, Ph.D. 
Pediatric Neuropsychologist

I recently had the opportunity to attend a webinar by Justin Patchin, Ph.D., one of the foremost cyberbullying researchers. I have used his work myself in designing both my master’s thesis and doctoral dissertation research, so it was wonderful to hear him speak. He began with a story about his childhood and some of the rules he was taught – don’t meet up with strangers that you meet online, don’t get into anyone’s car if you don’t know them well – lessons I was also taught as a child. These are the kind of rules that individuals with Autism Spectrum Disorders (ASD) often crave – black and white, clear, no middle ground. The online world, he argued, does not allow for such stark and rigid rules. Rather, he says, it calls for “guidelines.” Working with children with ASD, when I hear “guidelines,” I think, “grey,” “fuzzy,” and “it depends.” These can be some of the toughest situations for an individual who is not neurotypical.

I think he’s right. The online world is fast, fluid, ever-changing, and highly dependent on specific circumstances. It calls for the kind of flexible thinking and evaluation of context that kids with ASD are so often challenged by. Yet, as the adults parenting, educating, and supporting these young people, these are exactly the skills that they need. The online world is not going anywhere anytime soon, and it is not likely to slow down either.

Cyberbullying is one of the difficult online phenomena to manage, as youth who are bullied online are most frequently also bullied in “real life,” usually at school. The bullies are often peers they know and must see on a regular basis. For children with social challenges, navigating bullying that is occurring across settings is an especially difficult task. And the solution is not to take away technology. Now more than ever, children need access to technology for homework, classwork, enjoyable peer activities, and hobbies. Where does that leave us?

Unfortunately, Dr. Patchin did not give any practical advice for how to support individuals with autism around cyberbullying. I think that one important starting point is to help these individuals learn to check in with themselves. Time and time again, I hear from students, “I’m not really sure what was going on, but I think they were being mean.” (In fact, I hear this from children who are decidedly not on the autism spectrum, especially when bullying is occurring by older peers.) Bullying is hurtful (intentionally so), and recognizing that hurt is an important first step. Once children and adolescents identify that something is hurtful, adults can help and support them in navigating through the situation.

Whether bullying, cyberbullying, or a misunderstanding, it is important for adults to listen carefully when children come to us with social concerns. In addition, we must have a solid understanding of the online world in which students are living, learning, and engaging. Social media shifts rapidly, with new platforms becoming wildly popular in a matter of weeks. Working with youth requires us to keep as current as we can, making certain that we understand the “ins and outs” of each platform. It is also incumbent upon us to ensure that all children and adolescents (not just those with an autism diagnosis) learn guidelines that will allow them to safely make their way through a constantly evolving world of platforms, apps, and services. Safety online is as critical as safety in person.

 

About the Author

Dr. Yvonne M. Asher enjoys working with a wide range of children and teens, including those with autism spectrum disorder, developmental delays, learning disabilities, attention difficulties and executive functioning challenges. She often works with children whose complex profiles are not easily captured by a single label or diagnosis. She particularly enjoys working with young children and helping parents through their “first touch” with mental health care or developmental concerns.

Dr. Asher’s approach to assessment is gentle and supportive, and recognizes the importance of building rapport and trust. When working with young children, Dr. Asher incorporates play and “games” that allow children to complete standardized assessments in a fun and engaging environment.

Dr. Asher has extensive experience working in public, charter and religious schools, both as a classroom teacher and psychologist. She holds a master’s degree in education and continues to love working with educators. As a psychologist working in public schools, she gained invaluable experience with the IEP process from start to finish. She incorporates both her educational and psychological training when formulating recommendations to school teams.

Dr. Asher attended Swarthmore College and the Jewish Theological Seminary. She completed her doctoral degree at Suffolk University, where her dissertation looked at the impact of starting middle school on children’s social and emotional wellbeing. After graduating, she completed an intensive fellowship at the MGH Lurie Center for Autism, where she worked with a wide range of children, adolescents and young adults with autism and related disorders.

 

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.

 

To book an appointment with Dr. Yvonne Asher, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

Daily Journaling While Social Distancing

By | NESCA Notes 2020

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

*This post was originally published almost a year ago. While we slowly start to emerge from our quarantine and begin to safely re-engage in some of the activities and duties from our pre-pandemic lives, it is important to remember to participate in activities to better ourselves and others on a daily basis.

This is such a unique time that we are living in, but one day it will be a distant memory. Get a special journal book, make it from scratch or create one online. It will give you something to look back on and remember how you achieved something every day, smiled and made it through a very surreal time in history. Keep your journal to share with future generations. While we are practicing social distancing or being asked to stay home, challenge yourself to do something out of every category below on a daily basis. Do something for your brain, your mental health, your body, your home, your community, your creativity, your family, the environment and your friends/neighbors. Adults and kids can do this.

 

While Physically Distancing, Do Something For:

Your Brain

❏     Do a puzzle

❏     Listen to a podcast

❏     Tour a Virtual Museum

❏     READ

❏     Challenge yourself with a game, crossword puzzle, Sudoku, etc.

Your Mental Health

❏     Try a meditation app, like “stop, breathe, think” or www.calm.com

❏     Find an example of someone giving back or helping others

❏     Laugh out loud at least twice a day, tell a joke, watch a funny movie

❏     Turn off the news

❏     Record how you are feeling using the Yale Mood Meter

Your Body

❏     Take a walk, go for a run, ride a bike

❏     Create a dance play list and dance, dance, dance – We Are Family!

❏     GoNoodle Indoor Recess

❏     YouTube: workouts, yoga or dance

Your Home

❏     Do a chore – vacuum, dishes, laundry

❏     Clean your room

❏     Put your things away

Your Creativity

❏     Learn something new

❏     Draw/paint

❏     Build with LEGO

❏     Learn Calligraphy or Hand Lettering

❏     Play an instrument

❏     Search Pinterest for “DIY” or “upcycle”

Your Community

❏     Follow CDC Guidelines – stay home and wash your hands

❏     Go through clothing and toys to donate

❏     Check out your community website for what is needed

❏     Make cards to send to a local nursing home, nurses, doctors

The Earth

❏     Go for walks and enjoy nature

❏     Plant something

❏     Pick up litter – wear gloves

❏     Find another use for something before you recycle it

Family, Friends, Neighbors

❏     Stay in touch with each other

❏     Connect on FaceTime calls

❏     Have dinners together over FaceTime, Skype, Zoom

❏     Call people instead of text, write a letter, draw a picture

❏     Make a photo book of memories with a service like shutterfly

❏     Cook something for your family, neighbors

❏     Ask if someone needs help

 

About the Author

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

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

 

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

 

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

 

Looking for Answers? Ask the Right Questions.

By | NESCA Notes 2021

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

Many parents have met with me concerned that, “We had a full evaluation and got a lot of scores and a diagnosis but we still don’t understand why our child has this problem and what we can do about it.” This outcome can be avoided if parents and the evaluator are both clear on why the child is being evaluated, have laid out specific questions to be answered and what kinds of recommendations are being sought. Determining the referral question(s) should be a key goal of the intake session.

During the intake meeting, the evaluator can help the parent to shape their concerns into a specific referral question that can be addressed effectively through the process of neuropsychological evaluation. The evaluator can manage parental expectations in this process so there is not disappointment with evaluation results that don’t answer the parents’ questions. For example, I’ve had parents request an evaluation because they want to know if their fifth grader will get into Harvard or their child with high-functioning ASD (autism spectrum disorder) will get married. These questions can’t be addressed through a neuropsychological evaluation, but they can be re-worked into answerable questions. A neuropsychological evaluation can tell us if a child’s cognitive and academic skills are in the range of students who attend the most competitive colleges. However, there are many other factors that influence the college acceptance process. In this case, the referral question might be revised into “assess the child’s potential for academic success in a rigorous academic setting.” Similarly, it is beyond the scope of a neuropsychologist to determine if anyone will get married, but through the evaluation process we can assess the child’s current social and emotional functioning and offer some predictions about their likely developmental trajectory in the social domain.

While the previous examples of referral questions are too broad or abstract, I am also often confronted with referral questions that are too narrow, such as, “Does this child have ADHD?”.  In this case, I would work with the parents to reframe the referral question to, “Why does this child appear to have difficulty paying attention in school?” This referral question recognizes the fact that there are many reasons that a child may have difficulty concentrating or appear distractible – ADHD being only one of the possibilities.

When I train neuropsychologists, I emphasize the importance of understanding “Why now?”. What is it that motivated the parent or school team to seek evaluation at this point in time as they work to frame the referral question with parents? Common reasons include: concern about how the child will manage an upcoming transition (e.g., to middle school), sudden appearance of a problem, obvious widening of the gap between a child and peers, inability to meet increased developmental demands, lack of response to interventions, change in emotional status, or deterioration in academic performance.

It is extremely helpful when parents and/or school teams prepare for the intake meeting by brainstorming what they are seeking from the evaluation, questions they hope will be answered, issues to be assessed, and specific guidance that is being requested. The evaluator can then work with the parents or school team to fashion these into a referral question that is specific and relevant to the child so that all parties are “on the same page” as they undertake the evaluation process.

 

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 Dr. Helmus, NESCA Founder and Director, or one of our many other expert neuropsychologists or therapists, 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.

Appreciating and Responding to The New York Times article, For Some Teens, It’s Been a Year of Anxiety and Trips to the E.R. by Benedict Carey

By | NESCA Notes 2021

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

As an occupational therapist working almost exclusively with teenagers and young adults over the past year, the title of Benedict Carey’s article jumped out at me like a tired and worn flag, waving frantically for acknowledgement. Our teens are anxious, tired, and dealing with living through the proverbial “unprecedented times” without the developmental capabilities needed to quickly adapt in this era of remote learning, remote social interaction, and remote extracurriculars. Remote everything!

It is important for me to note that I really enjoy working with teenagers. I find myself in constant awe of their resiliency, their willingness to confront hard truths that many of us shy away from, and their ability to push forward despite having huge questions about who they truly are. All of these things are tough and require immense emotional fortitude, but this year many of these challenges feel impossible.

Carey has taken the time to gather perspectives from multiple stakeholders. He provides a platform for parents, educators, professors, therapists, pediatricians, and directors of hospital programs to explain the struggles of supporting these kids without adequate resources. Parents describe the fear of supporting their children as they struggle with mental health. Doctors discuss the frustration of having inadequate resources and support in emergency rooms around the country. Carey highlights that, according to the Centers for Disease Control and Prevention (CDC), the proportion of adolescent emergency admissions for mental problems, like panic and anxiety, is up 31 percent. Some of my clients add to this statistic and are navigating their own path through chaotic hospitalizations and overwhelmed support systems. Carey’s article is absolutely worth taking the time to read, if only to see the ubiquity of these issues and how they are happening all around our country. Simply put, we have a clear problem. Less clear, is the solution.

When meeting with adolescents and young adults themselves, I hear three main fears popping up week after week. Here are a few thoughts and suggestions on how to support these specific fears or feelings.

  1. “I can’t get this done, (and therefore) I am going to completely ruin my future.”

When looking at future success through a transition lens, we consider the areas of independent living, community participation, post-secondary education, and employment. In the school setting, most students’ curricula are focused solely on academic success. Sometimes, we do a poor job of teaching students about multiple intelligences or emphasizing the importance of hard work. While grades are important, they are not everything, and while standardized testing is returning to students’ schedules, they should not serve as students’ measure of self-worth. We know this, but do they? We have to teach our children that if they are hardworking, kind, and truly doing their best, the threat of “ruining their future” is much less likely than they fear. Let’s highlight the undeniably true narrative that everyone’s path can look different and still lead to success.

  1. “I’m so tired. All of the time.”

Many of my clients tell me they are not sleeping. If they are sleeping, they fall asleep late with a phone in their hand, constantly refreshing apps or trying to maintain communication with their peers. In our current remote world, the phone can feel like a lifeline. Sleep is a foundational need for mental and physical health. Students who are 15 or 16 years old often have a limited understanding of how holistic the effects of decreased sleep can be. Sleep is not their priority. Recently, I have seen parents disable the internet or have their teenagers put their phones into a lockbox from midnight until 6:00am. This new boundary is often met with anger or frustration at the beginning, but then these students start to sleep. They are better able to manage their emotions. They have more energy. They start to see the benefits despite their skepticism. If a tech break doesn’t feel quite right for your family, it is still worth opening up a conversation about the need for strong sleep hygiene and modeling a routine that promotes calming down by limiting screens before bed, which can have hugely positive effects.

  1. “This is never going to end.”

In many ways, a year feels much longer to a 17 year-old than it does to an older adult. Working at a job for four years never feels as long or as formative as the four years of high school. And objectively, a year to a 17 year-old is over five percent of their life, while it’s only two percent of 50 year old’s life. Let’s acknowledge that. Let’s verbalize the fact that teenage years are also full of milestones that have been constantly cancelled or changed to fit social distancing recommendations and safety precautions. There is a sense of loss and grief surrounding many events that these students have been looking forward to since elementary school. Encourage students to do their own research into what the next six months may look like as we start to open back up. Help them to understand the vaccine rollout and the pitfalls and successes that we have had as a nation tackling a novel disease.

Adolescent mental health is going to be an on-going challenge that we tackle as a community. As we slowly forge out of isolation, let’s center our conversations around the mental health of our teens and honestly acknowledge the unique position that they have found themselves in.

References

Carey, B. (2021, February 23). For some teens, it’s been a year of anxiety and trips to the e.r. The New York Times. https://www.nytimes.com/2021/02/23/health/coronavirus-mental-health-teens.html

Leeb, R.T., Radhakrishnan, L., Martinez, P., Njaj, R., Holland, K.M. (2020, October 27). Mental health-related emergency department visits among children aged <18 during the covid-19 pandemic. MMWR Morbidity and Mortality Weekly Report 2020:1675-1680. DOI: http://dx.doi.org/10.15585/mmwr.mm6945a3

 

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.

 

Helping Your Anxious Child through COVID-19

By | NESCA Notes 2020

 

Almost a year into Covid-19, many of us can use this blog as a reminder when our children exhibit signs of anxiety from learning of new developments with the pandemic; friends, family or others testing positive for Covid-19; or returning to school. The guidance shared in this blog still holds true, nearly one year since many of us went into lockdown and schools shuttered. 

 

By Yvonne M. Asher, Ph.D. 
Pediatric Neuropsychologist

A recent New York Times article by Jessica Grose discusses ways to support your child, specifically helping them to feel less anxious, during the COVID-19 situation. Their “top 4” suggestions are great ones – validate their feelings, manage your own anxiety, aim for some kind of predictable routine and try mindfulness or progressive muscle relaxation activities.

The larger consideration in this case is this: anxiety, particularly in the current situation, is normal. We can label it with clinical words, give you our best clinical tools and recommend that you seek help (and please do!). At the same time, if we take a large step back, being anxious right now is exactly how we are meant to feel. We are social beings, designed to live in the community and support one another through face-to-face social interactions. When something threatens our safety, or the safety of our families, it is normal to respond with fear, worry and hypervigilance. Everyday interactions that would typically result in no response, like hearing someone nearby cough or sneeze, all of a sudden have become indicators of a threat. Even having others in close proximity to us is now a threat, meaning that the social communities in which we are supposed to thrive have now become potentially dangerous places. In this new environment, our bodies, well-attuned and primed to handle threats, are doing what they should do – they are putting us on “hyper-alert mode,” keeping us exceedingly sensitive to these threats so that we can avoid them and preserve our safety.

Children are in this mode, too, albeit with far fewer resources to help mitigate their fear and worry. As adults, we have far more lived experience with threats, anxiety, fear and worry, and we can use this experience to manage our responses to this novel situation. For children, this may be the first time they are struggling with persistent worry and fear. Or, they may have struggled to cope with other fears and worries for a long time, and this new stressor has overwhelmed their system. In either case, it is important to normalize fear and anxiety, in addition to the myriad of other emotions that children may be experiencing.

The key is balance. We have to balance validating and normalizing feelings with reinforcing unhealthy habits. What does that look like? One dimension to consider is time – validating and normalizing feelings is a short acknowledgement that the child is heard, understood and believed. On the other hand, repeatedly discussing the same questions or topics, engaging in persistent conversations about the threats and explaining “adult” information to children (especially dire predictions, long-term impacts, etc.) is not healthy. These behaviors may appear to decrease anxiety in the short-term, but over time, can be detrimental.

Another important consideration is space – focusing on what is happening in the present is important to help children process and understand the radical changes that are impacting their day-to-day lives. However, if you find that your conversations linger on the past or the future, try to shift back to the present. Your mind may be filled with regrets from the past (e.g., “I knew we should have stocked up on their favorite snack last time we were at the store”) or fears for the future (e.g., “My parents are elderly and at high risk”), and these thoughts are entirely normal. At the same time, when talking with children, it is important to try as much as possible to focus on the here and now. Of course, it is important to give children the space to express their fears for the future, and we can and should acknowledge and validate these fears. We can also, simultaneously, bring children’s focus back to the present and back to tangible, concrete things that they can do (e.g., “I know you are really worried about grandma, and it’s sad that we can’t see her right now. Everyone is working hard to keep her safe, and we are going to call and talk to her later today”).

For some children, advanced intellectual abilities may allow them to understand (at least, in some sense) a great deal of the information that is portrayed on the television and news media. However, it is important to remember that, while their cognitive abilities are years ahead of their peers, their emotional development is not. It may be necessary to closely monitor their online activity, as they may be seeking out information (which is a normal response to fears, especially fear of the unknown) without having the critical thinking abilities to understand the source or potential biases in the way the information is presented. On the other hand, some children may struggle to understand the situation, either because of their young age, learning disability or other developmental delays. If this describes your child, consider putting together a story, with pictures and words, to help them understand some basic information (e.g., why we can’t go to school right now, why we can’t go play with friends). This is often referred to as a “social story,” and clinicians at NESCA can help you create one specifically for your child.

Last, and most certainly not least, seek help and support for yourself, your child or anyone in your family who is struggling. While experiencing anxiety during these times is normal, when these thoughts and feelings are taking over your child’s daily life (or your own), it may be time to look for assistance. Many clinicians, including here at NESCA, are available via phone or videoconferencing, and we can assist with a range of concerns. Whether you want a brief consultation to help you respond to persistent questions from your child or whether your child has a pre-existing anxiety disorder that is exacerbated by these challenging times, we are here to help.

 

About Pediatric Neuropsychologist Dr. Yvonne Asher:

Dr. Yvonne M. Asher enjoys working with a wide range of children and teens, including those with autism spectrum disorder, developmental delays, learning disabilities, attention difficulties and executive functioning challenges. She often works with children whose complex profiles are not easily captured by a single label or diagnosis. She particularly enjoys working with young children and helping parents through their “first touch” with mental health care or developmental concerns.

Dr. Asher’s approach to assessment is gentle and supportive, and recognizes the importance of building rapport and trust. When working with young children, Dr. Asher incorporates play and “games” that allow children to complete standardized assessments in a fun and engaging environment.

Dr. Asher has extensive experience working in public, charter and religious schools, both as a classroom teacher and psychologist. She holds a master’s degree in education and continues to love working with educators. As a psychologist working in public schools, she gained invaluable experience with the IEP process from start to finish. She incorporates both her educational and psychological training when formulating recommendations to school teams.

Dr. Asher attended Swarthmore College and the Jewish Theological Seminary. She completed her doctoral degree at Suffolk University, where her dissertation looked at the impact of starting middle school on children’s social and emotional wellbeing. After graduating, she completed an intensive fellowship at the MGH Lurie Center for Autism, where she worked with a wide range of children, adolescents and young adults with autism and related disorders.

 

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.

 

To book an appointment with Dr. Yvonne Asher, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

Teens Online: Participation vs. Observation

By | NESCA Notes 2021

By Yvonne M. Asher, Ph.D. 
Pediatric Neuropsychologist

As we enter the beginning of 2021, the COVID-19 pandemic continues to shape our world. More and more, events, activities and interactions are pushed online – onto videoconferencing apps, social media and academic learning  platforms. Online social interactions are not new, and they won’t disappear anytime soon. With this, how do we, as adults, understand and navigate these oddly draining electronically-mediated gatherings, and how do we help our teens do the same?

One unique characteristic of online interaction is the ability to be present without being visible. In traditional social settings, to be present with the group is to be seen and, often times, noticed. Joining a Zoom or Google Meet offers one the ability to listen, watch and take the information presented without offering anything of yourself – no one has to see you, hear you, know where you are or know what you are doing. As many adults have noticed, this gives incredible freedom to the multi-taskers – listen to your meetings while getting the dishes done or the laundry folded.

For some adolescents, though, this is an opportunity to bypass many of the core tasks of social development, while still engaging with the material needed to accomplish one’s academic goals. A high schooler, acutely aware of how they are perceived and what others think of them, can sit silently, invisibly in social studies class. They can hone in on the economic impacts of World War I without the crushing anxiety of worrying about being teased or ostracized. However, that same high schooler may never have to confront the developmentally-expected challenges of venturing out of their “comfort zone” socially. They may not learn to ask someone out on a date, explore a new friendship or show up to the first meeting of a club.

How can we help our teens learn to take the best from online interactions while also pushing them to fully engage with others? There is no one, clear-cut answer – no “10 things…” or similar checklist. In any situation, we must look holistically at the teen, the context and the goals, and, from there, determine the best path forward. Sometimes, the anonymity of the online world is a welcome respite for teens looking to explore a new facet of their identity. Other times, it undercuts the core tasks of adolescence – building deep bonds with peers, taking responsibility for one’s social relationships and developing independence. Having direct, open conversations with our teens helps them understand and begin to own the challenges of the online world. If cameras are always off and microphones are always on mute, maybe it is time for a chat about participation versus observation.

 

About the Author

Dr. Yvonne M. Asher enjoys working with a wide range of children and teens, including those with autism spectrum disorder, developmental delays, learning disabilities, attention difficulties and executive functioning challenges. She often works with children whose complex profiles are not easily captured by a single label or diagnosis. She particularly enjoys working with young children and helping parents through their “first touch” with mental health care or developmental concerns.

Dr. Asher’s approach to assessment is gentle and supportive, and recognizes the importance of building rapport and trust. When working with young children, Dr. Asher incorporates play and “games” that allow children to complete standardized assessments in a fun and engaging environment.

Dr. Asher has extensive experience working in public, charter and religious schools, both as a classroom teacher and psychologist. She holds a master’s degree in education and continues to love working with educators. As a psychologist working in public schools, she gained invaluable experience with the IEP process from start to finish. She incorporates both her educational and psychological training when formulating recommendations to school teams.

Dr. Asher attended Swarthmore College and the Jewish Theological Seminary. She completed her doctoral degree at Suffolk University, where her dissertation looked at the impact of starting middle school on children’s social and emotional wellbeing. After graduating, she completed an intensive fellowship at the MGH Lurie Center for Autism, where she worked with a wide range of children, adolescents and young adults with autism and related disorders.

 

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.

 

To book an appointment with Dr. Yvonne Asher, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

The Intention to Thrive

By | NESCA Notes 2021

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

As I reflect on the year that we have all come through, my overwhelming emotion (aside from exhaustion) is pride in the NESCA team for working together in an extraordinary manner under incredibly challenging circumstances. Just before closing the doors at NESCA in mid-March, I wrote to all staff:

NESCA is going to not only survive through this pandemic but we are going to thrive as an organization and show leadership in the special education community. The needs of our clients have not gone away; in fact, they are likely increasing.  School systems are scrambling to meet their obligations for students with special needs. We will continue to do the work we have always done, albeit in a somewhat modified fashion. 

Each of the NESCA staff—clinical and administrative—immediately rose to the occasion to help me realize this vision for navigating the pandemic. We increased the frequency our blog posts and introduced regular webinars, gearing them towards the needs of parents facing the challenges of the pandemic and increased our social media following from 4,000 to more than 40,000 by offering supportive and helpful content. NESCA clinicians offered multiple, free online support groups for parents and professionals related to topics they were now experiencing due to COVID-19. We acknowledged and addressed the unprecedented COVID-19-related concerns and challenges professionals and educators who support those with autism were experiencing through our free Autism Educator Hangouts.

After a great deal of research and discussion about how to conduct evaluations in a manner that ensured the safety of staff and clients while producing valid results, we settled on our “two office model,” renovating our space with plexiglass panes so that clients and clinicians would be able to work together in separate but adjoining offices. We collaborated with Massachusetts Advocates for Children (MAC), Massachusetts Department of Elementary and Secondary Education (DESE), The Federation for Children with Special Needs (FCSN) and the Massachusetts Urban Project, Inc., providing information about assessments and other services during the pandemic.

NESCA grew by adding new staff and service offerings this past year. We welcomed Dr. Moira Creedon to our pediatric neuropsychology staff. Tabitha Monahan, M.A., CRC, and Becki Lauzon, M.A., CRC, both joined NESCA’s Transition Services team. Julie Robinson, OT, joined NESCA in September with three occupational therapists to offer insurance-based, sensory-motor therapy. Abigael Gray, MS, CCC-SLP, also joined at that time to offer insurance-based speech/language and feeding therapy at NESCA. These staff have been incredibly innovative in their use of teletherapy to continue providing services to clients remotely.  And, they and their clients have experienced some surprising benefits stemming from the delivery of services via telehealth. 2020 also saw the introduction of NESCA’s ASD Diagnostic Clinic, helping families to diagnose children with Autism Spectrum Disorder as early as possible so they may gain access to critically important interventions.

Over the last decade, NESCA has had a strong commitment to international work, seeing clients for evaluation and consultation in the NESCA offices as well as abroad. With travel severely limited by the pandemic, we have instituted teletherapy for international work and are pleased to continue to assist  families abroad. NESCA was honored to be a Gold Sponsor for the annual SENIA conference (Special Education Network & Inclusion Association) that was held virtually. I was pleased to present about the differences between testing and assessment with professionals from schools all over Asia.

In the midst of the global pandemic, we continued to do the work that we have always done. We continued to support each other and became even more closely bonded as a team. We contributed to the community. No matter how challenging it has been, we are motivated by the knowledge that children with special needs and their parents need our support now more than ever.

 

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 Dr. Helmus, NESCA Founder and Director, or one of our many other expert neuropsychologists or therapists, 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.

The Next Pandemic: Mental Health Issues

By | NESCA Notes 2020

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

The return to school, whether remotely or in person, will be a transition that is bound to be stressful for many children and adolescents as well as their parents and teachers. Coming on the heels of five stressful months of lockdown, remote learning, loss of social contact and so many other changes,  children will be meeting this challenge with depleted resources for coping with stress and may show new signs of anxiety or mood issues. This will be particularly true for children and adolescents who have underlying issues with mental health, attention or learning. Prioritizing the mental health of students and focusing on providing emotional support will be key to helping children manage the transition back to school. “When children feel connected, they’re going to learn better, do better, stay on track,” commented Dr. Nadine Kaslow, professor of psychiatry at Emory School of Medicine and past president of the American Psychological Association, in this article. She emphasized that “loving warm interactions need to take precedence” over struggling with them about behavior or about schoolwork.”   Remembering that undesirable behaviors are often driven by emotional distress and are a form of communication can be helpful for parents in responding in a positive and supportive manner. As we continue through this period of unprecedented levels of stress and change, children need to feel connected to and supported by their parents even more than is usual; maintaining this connection is far more important than any academic goals, no matter how far behind parents fear their child is as a result of the interruption to regular schooling.

If you have concerns about your child’s mental health, clinicians at NESCA are available for expert consultation or evaluation of your child’s emotional functioning so that the appropriate supports can be put in place. This work can be done either through teletherapy or in-person through contactless evaluations in all three of our locations (Newton and Plainville, MA and Londonderry, NH). NESCA has several suites in which there is a large plexiglass panel in the shared wall between two offices so that the child/parent and evaluator/therapist are in separate offices but have the benefit of full visibility and communication through headphones. For more information, please view, “Testing in the Age of COVID-19” on our Video Resources page.

If you have questions about your child’s mental health and would like professional help, please reach out to Dot Lucci, M.Ed., CAGS: dlucci@nesca-newton.com for an intake and screening.

 

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 Dr. Helmus, NESCA Founder and Director, or one of our many other expert neuropsychologists or therapists, 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.